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Baystate doctors offer a guide through the new recommendations for breast cancer screening

January 14, 2016

The headlines on Tuesday all used the word new – “New mammogram screening guidelines,” “New mammogram recommendations.” But, they are not new. And, once again, controversy over when a woman should get a mammogram is almost certain to ensue, not to mention confusion for many women over what to do and whom to listen to.

Late on Jan. 11, 2016, the US Preventive Services Task Force (USPSTF) released its final breast cancer screening recommendations:

Women ages 50-74

The USPSTF recommends screening mammography every 2 years for women ages 50 to 74 years.

Women ages 40-49

The decision to start screening mammography in women before age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harm, may choose to begin screening every 2 years between the ages of 40 and 49 years.

Women 75 and older

The current evidence is insufficient to access the balance of benefits and harms of screening mammography in women age 75 years and older.

Changing Recommendations

It all began in 2009 when the USPSTF initially suggested that women undergo breast cancer screening not beginning at age 40, as had long been suggested, but at 50. Once again, in April 2015, the USPSTF issued its updated draft guidelines, reiterating its earlier recommendations that those deriving the greatest benefit of screening mammography are women ages 50-74.

Further complicating matters, the American Cancer Society continued with their recommendation that women get their first screening at age 40, updating its own recommendations late last year that a woman should have her first screening mammogram no later than age 45 (still falling short of the USPSTF), and should begin biennial screening at age 55.

“What is important for a woman to remember as they listen to various sides of the debate is that we are talking about women of average risk for breast cancer. We’re not talking about someone who has a family history of breast cancer or who carries the BRCA1 and BRCA2 genetic mutations placing them at high risk for developing breast cancer,” said Dr. Wilson Mertens, vice president and medical director of Cancer Services for the Baystate Regional Cancer Program

“Just as we have learned that PSA of men for possible prostate cancer is associated with over-diagnosis and the potential for overtreatment, we have come to realize that there are also harms associated with early and frequent routine screening of women that can also result in over-diagnosis and overtreatment,” added Dr. Mertens.

The risk of false positives can lead to additional testing and anxiety for women along with unnecessary biopsies, while the concept of over-diagnosis implies finding a tumor that may never cause harm to a woman.

“Mammography is still the best screening tool for breast cancer and screening saves lives,” said Dr. Nikolaus Kashey, medical director of Population Health at Baystate Health, who helped to establish Baystate Health’s Clinical Practice Guidelines for Screening Mammography.

Shared Decision Between A Patient and Her Doctor

"Baystate Health recognizes that the different national guidelines vary in their recommendations, and we feel that the decision of when to start screening should be made between a woman and her provider after a discussion of the risks and benefits involved," said Dr. Kashey.

Baystate’s minimum standard for mammography is to assess risk and engage in a discussion about screening options with women starting at 40, and at a minimum recommend screening every 2 years for women ages 50-74. Starting mammography earlier or being screened each year and continuing screening beyond age 74, is “at the discretion of the doctor and patient.”

“Basically, what we are saying is that women need to have a discussion with their doctors early on about when to begin screening mammography,” said Dr. Kashey.

“This is shared decision making between a woman and her doctor,” he added.

Interestingly, the USPSTF in its review of numerous research studies on screening mammography stated that there is not enough evidence to determine the effectiveness of screening with 3D mammography.

Insurance Coverage

As a result of congressional action, insurance companies will continue to pay for mammograms for women who want to start them at age 40.

Facts about Breast Cancer from the US Preventive Services Task Force

  • Breast cancer is one of the most common cancers in women. In 2015, about 232,000 women were newly diagnosed with breast cancer, and 40,000 women died from it.
  • The risk of developing breast cancer increases with age. Women between the ages of 55 and 64 are most frequently diagnosed with breast cancer. The most common age of death from breast cancer is 68.
  • Breast cancer is often detected by screening mammography and earlier detection of invasive breast cancer (cancer that spreads beyond the breast) may make it easier to treat.
  • Treatments for breast cancer include surgery, radiation, chemotherapy, or hormonal treatment.