Are New Mammogram Guidelines a Step Backwards in Early Detection?

Technician adjusting mammograph machine
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In October 2015, the American Cancer Society (ACS) came out with new mammogram screening guidelines which:

  • rolled back the start date for annual mammograms from 40 years of age to 45 years of age
  • recommended that women 55+ can get screened every other year
  • suggested that women can stop having comprehensive/clinical breast exams by their physicians

The guidelines caution that this new schedule is for women who have an average risk of getting breast cancer. While women of average risk can continue to start mammograms at 40, it is not recommended. The most important word being average risk. Who determines what average risk is? How many women know their risk for getting breast cancer average or otherwise?

The American Cancer Society is a nationally recognized cancer organization. ACS is known as an authority in all things cancer.

No woman looks forward to having her first mammogram or any thereafter. Many young women will be all too happy to wait until they are 45 before having their first mammogram, and those over 55 will be pleased to skip a year. They will feel safe in their choice since they are following ACS guidelines.

For decades, the American Cancer Society (ACS) has led early detection campaigns, stressing the need to find breast cancers when they are small, easier to treat and have a better chance for survival. They have been adamant about a mammogram being the best screening tool for detecting a breast cancer years before it can be felt in a comprehensive/clinical breast exam.

While mammograms are not recommended earlier than 40 years, as young women tend to have dense breasts, which can prove difficult in getting an accurate screening, ACS has long supported women beginning mammograms at 40 years. Current statistics show that about 11% of all breast cancers are diagnosed in women less than 45 years of age. Using the American Cancer Society estimate for new diagnosed cancers in 2015, which is 231,840, over 25,500 women, less than 45 years old, will be diagnosed with breast cancer this year.

In their second recommendation, ACS suggests having mammograms every two years after 55 years of age. Yet, the highest numbers of newly diagnosed breast cancers, annually, are in women 55-64 years of age with 57,960+ women being diagnosed each year! If I had gone by this recommendation, my breast cancer would have been larger, and more than likely would have required chemotherapy and more extensive surgery.

Their third recommendation, to skip comprehensive/clinical breast exams, pretty much strips away the last of our early detection tools leaving women under 45 and over 55 vulnerable.

What accounts for the ACS recommendations? ACS cited a high incidence of false positives in young women’s mammograms, which leads to stress and costly additional testing and treatment as one of the reasons for the change in guidelines.

Members of the medical community continue to take ACS to task on the new guidelines, faulting the studies that led to the guidelines as most were based on film mammography and not digital mammography, which produces a clearer image than film images of scanned breasts and has a considerably lower rate of false positives. In the U.S. today, film has almost been entirely replaced by digital mammography.

Other medical professionals take exception to ACS focusing on linking screenings to lives saved and ignoring the function of screening in detecting cancers at an early stage, so women could be spared harsh treatments such as chemotherapy.

Women had precious few early detection tools prior to the new guidelines. Before the guidelines, we believed that comprehensive breast exams did find breast lumps suspicious for cancers, and annual mammograms, beginning at 40, did catch early-stage breast cancers.

Unless and until there are other early detection tools taking the place of comprehensive/clinical breast exams and mammograms, young women have to be their own decision-makers about when they start and how often they will continue to have mammograms. Given the numbers of women, less than 45 years diagnosed each year, hopefully, young women will choose to be screened at 40 years.

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