American Cancer Society updates its guidelines on breast-cancer screening



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Breast cancer is the second most common form of the disease in the U.S. after skin cancer. According to the American Cancer Society (ACS), around 1 in 8 American women will develop invasive breast cancer during their lifetime — that's about 12 percent. This week, the American Cancer Society updated its advice to women on screening for the disease.


New advice 

As with all cancers, early detection is the key. Treatment is far more likely to be successful when the disease is caught in its early stages and before it can spread. Previously, the ACS had recommended that annual mammograms and clinical breast exams — where doctors or nurses feel for lumps and other abnormalities — begin at the age of 40. They now say all women should begin having mammograms once a year by 45 and that by 55 these can be reduced to one every other year.

The new guidelines — published October 20 in the Journal of the American Medical Association — are, the organization says, a response to updated research and studies and relate chiefly to women at average risk for breast cancer. Indeed, instead of applying a one-size-fits-all rule, the updated advice seeks to reflect women's wide range of health and treatment preference. In short, the guidance runs as follows: 

  • Women with an average risk of breast cancer — most women — should begin yearly mammograms at age 45.
  • Women should be able to start the screening as early as age 40, if they want to. It’s a good idea to start talking to your health care provider at age 40 about when you should begin screening.
  • At age 55, women should have mammograms every other year — though women who want to keep having yearly mammograms should be able to do so.
  • Regular mammograms should continue for as long as a woman is in good health.
  • Breast exams, either from a medical provider or self-exams, are no longer recommended.


Saving lives

"Since we last wrote a breast cancer screening guideline," says Dr. Richard C. Wender, Chief Cancer Control Officer for ACS, "there has been the publication of quite a number of new studies that inform us about the benefits and drawbacks of screening with mammography, so the American Cancer Society commissioned a detailed evidence review by an external expert group to review all of this new data, which was then presented to our guideline committee,” says Wender. “That committee…did the very difficult job of balancing the benefits and harms, and that’s what led to the change in the guidelines that we’re publishing now.”

Although many lives have undoubtedly been saved through screening, mammography has its risks and human error can occur, producing false-positive results. If something suspicious is discovered or even suspected, the patient may still have to go through all the anxiety, discomfort and indignity that further examination and biopsy may mean — even if it turns out to be harmless. It is because they "do not show they provide a clear benefit" that clinical breast exams are no longer recommended by the ACS — though all women should be familiar with how their breasts normally look and feel and immediately report any changes to their doctor.


Risks and benefits

The ACS say they are aware of the continuing controversy surrounding the issue of screening. A report in the Journal of the American Medical Association (JAMA) suggests that "screening may lead to overdiagnosis of cancers that may not have become life-threatening," leading to unnecessary treatments. “We know that debates will continue about the age to start mammography,” said Wender. “This guideline makes it so clear that all women by age 45 should begin screening — that’s when the benefits substantially outweigh the harms.”

"Simply being a woman is the main risk factor for developing breast cancer," says the ACS. "Men can develop breast cancer, but this disease is about 100 times more common among women than men." Knowing the risks factors can help you make an informed decision on when it's the best time for you to see a health professional. He or she can help you choose the best time for starting a screening program. The ACS suggest that you approach your doctor about breast cancer screening by the age of 40 and be prepared to share your family history as well as your personal medical history to determine your risk and your best course of action for staying healthy. You can find out more about breast cancer screening at the American Cancer Society website.