When it comes to breast cancer screening, confusion abounds these days for when women should get mammograms.
Conflicting messages from leading medical groups have made healthcare decision-making a lot more daunting for women who want to ensure they are getting the best care for their breast health. National headlines in the past few months have shined a spotlight on the perplexing issue of personal choice when medical experts disagree.
So what is a woman to do? Dr. Julie Barone, breast surgeon and Medical Director of Breast Services for SCL Health, says it comes down to incorporating multiple tactics and taking ownership of your personal health. Know your family history, do your research, take care of yourself, and most importantly, consult your physician.
The recommended age for screenings spans as much as 10 years among reputable medical organizations. The American College of Radiology, the Society of Breast Imaging, the American Society of Breast Surgeons and the American College of Obstetricians and Gynecologists maintain that women get annual mammograms starting at age 40.
By contrast, the U.S. Preventive Services Task Force recommends that most healthy women without increased breast cancer risk can start mammograms at the age of 50 and then screen every other year.
The American Cancer Society just changed its recommendations on October 20th, saying most women should start getting yearly mammograms at the age of 45 (rather than the previous recommendation of age 40), and then every other year beginning at age 55 for as long as they are in good health. Women ages 40 to 44 should discuss mammography with their doctor and have the option of starting annual screening if they want it or their risk factors warrant it, according to the ACS. The ACS attributed the changes to new research published on the benefits and drawbacks of screening with mammography.
The take home message is that when recommendations are based on judgments about the balance of risks and benefits, experts can look at the same data and reach different conclusions. Although mammography is less sensitive in younger women and may lead to additional imaging and biopsy for lesions that are ultimately benign, numerous studies have demonstrated that screening mammography leads to improved survival for women aged 40-49.
The guidelines are confusing and ultimately every woman has different needs, according to Dr. Barone.
“Women should begin breast self-exam starting in their 20s. Women should report any breast changes to their health professional right away,” Dr. Barone said. “Annual mammogram should start at age 40 and earlier for women at increased risk. Women who are at high risk for breast cancer based on certain factors should get an MRI and a mammogram every year.”
According to Dr. Barone, women who should get annual breast MRI in addition to their annual mammogram include those women who:
- Have a lifetime risk of breast cancer 20% or greater, according to risk assessment tools that are based mainly on family history
- Have a known BRCA1, BRCA2 or other gene mutation with increased risk for breast cancer
- Have a first-degree relative (parent, brother, sister, or child) who has a gene mutation with increased risk for breast cancer, and have not had genetic testing themselves
- Had radiation therapy to the chest when they were between the ages of 10 and 30 years
- Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes
“Mammograms, MRIs in women at high risk, annual clinical breast exams with your healthcare provider, and reporting breast changes early provide the best chance to reduce the risk of dying from breast cancer,” Dr. Barone said. “This multimodality approach is better than using a single test or exam alone.”
Here are some ways you can advocate for your own health and reduce your risk of breast cancer:
Know your family history.
Women with close relatives who have been diagnosed with breast cancer have a higher risk of developing the disease. Breast specialists, nurse navigators and genetic counselors can help determine who is at a higher risk for developing different types of breast cancers.
Do your research.
Getting screening tests and vaccinations is an important part of preventative care. Find out which tests and immunizations are recommended by age group and gender in our Health Library to help live longer, live better and live happier.
Consult your physician.
Early detection of breast cancer gives a woman more choices – and also increases her chances of having the best possible outcome. Women should speak with their doctor about recommendations for mammograms and other imaging studies as well as available treatment options depending on the results of their studies.
Make healthy lifestyle choices
Women can make conscious decisions to have healthier lifestyles, which also can reduce the risks of developing breast cancer. These include maintaining a healthy weight, exercising regularly, limiting alcohol, eating a nutritious diet, and not smoking.
October is Breast Cancer Awareness Month – as good a time as any to schedule an appointment. Visit www.sclhealth.org to find a location near you. Click here to hear directly from Dr. Barone on breast health and high risk management.