ACS establishes new mammogram guidelines
A radiologist compares an image from an earlier, 2-D technology mammogram to the new 3-D Digital Breast Tomosynthesis mammography in Wichita Falls, Texas. The technology can detect much smaller cancers earlier. In guidelines published Oct. 20, the American Cancer Society revised its advice on who should get mammograms and when, recommending annual screenings for women at age 45 instead of 40 and switching to every other year at age 55.
Miller
The American Cancer Society recently released new guidelines for mammogram screening and breast cancer detection.
According to Dr. Carmen Guerra, current president of the American Cancer Society East Central Division (comprised of Pennsylvania and Ohio), associate professor or medicine, division of general internal medicine at the Perelman School of Medicine at the University of Pennsylvania, there are two reasons for the update to the 2003 guidelines.
“There were two main motivators: the wealth of scientific information that had been accumulated over the last 12 years and the institute of medicine report,” she said.
In 2011, the Institute of Medicine released a report that established a standard on how to develop guidelines, which stressed the importance of preventing conflicts of interest.
According to Guerra, the report changed things for many groups that issue guidelines.
“In that document there were eight standards they felt were extremely important and critical to follow,” said Guerra. “For example, one of the things established was there has to be very careful monitoring of individuals participating in these guidelines (no conflict of interest).”
In order to establish the new guidelines, the committee looked at the statistics that showed what ages were having the most cases of breast cancer. Instead of looking at 10-year age groups, the committee decided to break things down to a smaller group of cohorts and looked at five-year age groups.
“When they did that, what they saw was a bell-shaped curve,” said Guerra. “The bell shape stays about 12 to 15 percent until women start to reach the age around their 60s and then it starts to go down. Because of that, the new guidelines say those are the women we want screened.”
That is why the new guidelines are encouraging women, who are at average risk of developing breast cancer, to start screening at age 45 every year through age 54. Once they reach age 55, the screenings can drop to once every other year. However, if the individual feels more comfortable they can continue to screen annually.
Dr. Tim Miller of the Department of Diagnostic Imaging at Uniontown Hospital, explains that breast cancer changes as a woman ages.
“It all comes down to that older people who get breast cancer have a less aggressive form. If you do it every other year, it is still early detection,” he said.
Another significant change to the guidelines was that ACS no longer recommends clinical breast examination for breast cancer for women of average risk.
According to Guerra, this guideline is in line with the recommendation from the U.S. Preventative Services Task Force.
Guerra explains that many years ago, possibly in the 1970s, ACS stopped recommending self-breast exams as a way to detect breast cancer. A study was done that took two groups of women. One group was taught the proper way of doing a self-breast exam and the other group was left on their own to figure out how to do the exam. Through the study, it was shown the women who received proper training went to doctors more often because they thought they detected something. This lead to more harm that good because of all the procedures that they underwent to determine that there was no cancer.
When it came time to do the most recent guidelines, the ACS gathered statistics about clinical breast exams.
“They found zero evidence that clinical breast exams reduce mortality,” said Guerra. “There is inconsistency in the training of the doctor, but more importantly the guideline is not based on that. The guideline is based on there is zero evidence that the clinical breast exam is leading to (early detection) of cancer.”
Although these guidelines have been established to help women detect breast cancer early, Guerra cautions that they are not a one-size-fits-all approach.
“I keep emphasizing that these guidelines are for women who are at average risk. There are women who say they don’t believe these guidelines because they found their breast cancer themselves. Well, you get to talk to these women and find out they had a family history,” she said.
Miller said a family history of breast cancer is the number one reason for mammograms earlier than what the guideline recommends.
“There are also genetic markers that we test for. They are called BRCA genes. Any of those are indicators for early testing,” said Miller.
Guerra said the ACS is looking into establishing guidelines for people who have dense breasts or other high-risk situations.