As a practicing radiation oncologist and breast cancer survivor, I was shocked at the changes the American Cancer Society made to its breast cancer screening guidelines for women. In case you haven’t seen them yet, here are the new guidelines.
These guidelines are for women at average risk for breast cancer. Women with a personal history of breast cancer, a family history of breast cancer, a genetic mutation known to increase risk of breast cancer (such as BRCA), and women who had radiation therapy to the chest before the age of 30 are at higher risk for breast cancer, not average-risk.
- Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms if they wish to do so. The risks of screening as well as the potential benefits should be considered.
- Women age 45 to 54 should get mammograms every year.
- Women age 55 and older should switch to mammograms every 2 years, or have the choice to continue yearly screening.
- Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.
- All women should be familiar with the known benefits, limitations, and potential harms associated with breast cancer screening. They should also be familiar with how their breasts normally look and feel and report any changes to a health care provider right away.
I believe that adopting these new guidelines could be dangerous and even lethal for many women, especially African American women. Here are 4 reasons why.
The previous guidelines staring screening average risk women at age 40.
- There are many high-risk women walking around who do not know that they are at high risk for having breast cancer. They may not know their family history because of adoption. They may come from families who don’t share their medical history. They may have benign high risk breast lesions that have not been diagnosed yet, or they may not understand what makes them high risk. In addition, they may have primary care physician’s who do not realize that they are high-risk because of an incomplete medical history. With these new guideline, you could potentially have high risk women waiting until age 45 to get their first mammogram, which could be too late to diagnose early stage disease.
I did not know I was at high risk of developing breast cancer until my mother was diagnosed with breast cancer at the age of 76. I was 44 at the time. Even then, I didn’t consider myself high risk because of my mother’s age at the time she was diagnosed. When I was diagnosed with breast cancer 3 years later at the age of 47, I was shocked to find out that I had a genetic mutation. Me and my sisters were following the screening guidelines for average risk women. I was lucky that my cancer didn’t occur at a younger age.
- Twenty-five percent (roughly 77,440 cases) of breast cancers diagnosed in 2013 occurred in women under age 50. With five percent ( 12,880 cases) of them occurring in women under 40. In women under the age of 45, breast cancer is more common in African American women. The chance of dying from breast cancer is greater in an African American woman under the age of 45 as well. Women diagnosed with breast cancer in that 40 to 44 year old window who waited until they were symptomatic to get a mammogram, could potentially be at increased risk of death from breast cancer because of advanced disease at diagnosis, due to the of lack of early detection. There are more African American women in this group. In addition, the opportunity to pick up high risk benign breast disease is missed in these women.
- Allowing women over age 55 to get a mammogram every other year , puts women who are at the greatest risk of getting breast cancer in danger. The most significant risk factor of getting breast cancer is increasing age. The older you get, the higher your risk of developing breast cancer. Even though we know that cancer in older women tends to be slow growing and less aggressive, there are exceptions to every rule. Older women do get aggressive cancers and allowing biannual screening mammograms gives older women a false sense of security.
- There is a group of women who are already less likely to get a mammogram. This could be due to distrust in the medical system, decreased access to screening facilities , and fear of pain from the exam. These new guidelines give them a reason to put off getting a mammogram for another 5 years.
Although the guidelines, give women a choice to start screening at age 40 and to continue yearly screening until such time their poor health precludes it, I fear that insurance companies could adopt these new guidelines and stop covering mammograms at 100% for women aged 40-44 and reduced coverage to every 2 years for women over age 55. Most primary care physicians will adopt these guidelines and delay breast cancer screening until age 45 for their patients and discourage women from continuing yearly mammograms after they turn 55.
During my cancer journey and in my practice, I have met women in their twenties and thirties with breast cancer. They had no family history of cancer and did not have genetic mutations. The option to get a free screening mammogram when they felt their lump did not exist because of their young age. Their diagnosis of breast cancer was delayed because a diagnostic mammogram required an up front payment that they didn’t have and their primary care physicians didn’t think breast cancer could occur in someone their age . All of them had locally advanced disease. I personally think that the guidelines should allow women the option to start screening as early as age 25 if they so choose.
Although mammograms do no pick up every cancer, mammography is the single most effective method of early detection. It can often identify cancer several years before physical symptoms can develop.
Early detection saves lives. It saved mine.
