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Breast Cancer Screening Guidelines: Making Sense of Mayhem

In October 2015, the American Cancer Society (ACS) released their breast cancer screening guidelines.

Departing from their previous recommendation of annual mammography screening starting at age 40, the ACS introduced a tiered set of recommendations for average-risk women based on new age criteria. The new recommendations call for less frequent screening, and screening starting at an older age (45).

These latest ACS guidelines add to a growing list of disparate and conflicting breast cancer screening recommendations that continue to confuse and frustrate women and health care providers alike.

Along with the National Comprehensive Cancer Network, American Congress of Obstetricians and Gynecologists and American College of Radiology, Hoag continues to recommend annual mammography screening starting at age 40.

The reasoning behind the disparate recommendations is complex and multifaceted. However, the following simple facts are fundamental and paramount to the debate over breast cancer screening:

  1. Breast cancer remains the second leading cause of cancer death in women.
  2. One in eight women will develop breast cancer in her lifetime (1 in 68 in her 40’s).
  3. 75-90 percent of women who develop breast cancer are at “average risk.”
  4. Screening mammography unequivocally reduces a woman’s risk of dying from breast cancer.

We know screenings reduce a woman’s chance of dying from breast cancer, but there is more to consider beyond whether a breast cancer would be fatal.

Early detection can mean less-invasive treatment options such as breast conserving surgery, and it sometimes obviates the need for chemotherapy or radiation. We also should not discount the psychological impact of screening, or lack thereof. When faced with a cancer diagnosis, women invariably experience a barrage of emotional and psychological insults. Compound that with feelings of guilt and regret expressed by many women who have chosen not to undergo screening and the results can be devastating.

Like all screening tests, mammography has its limitations, but technology continues to improve. At Hoag, patients have access to the latest screening technologies and receive the best health care has to offer. Digital breast tomosynthesis, or 3D mammography, is a great leap in this direction and has been shown to increase the detection of invasive cancer by 40 percent, while simultaneously reducing the rate of false positive results.

Employing specialized experts to interpret the results is just as important as advancements in the tools we use. Hoag’s highly skilled fellowship-trained breast radiologists give patients peace of mind that their screenings are adeptly handled and read.

Hoag performs more than 40,000 mammograms every year and consistently exceeds national mammography benchmarks. Our 2D mammography recall rate of 8.2 percent is well below the benchmark established by the Breast Cancer Surveillance Consortium (BCSC) of 9.9 percent.

With breast tomosynthesis, or 3D mammography, the numbers are even more impressive. Recall rates with 3D tomosynthesis are 6.5 percent — a 21 percent reduction compared to the 2D exam.

As with any health care decision, the determination to undergo screening mammography is an individual one, based on the context and values of each woman. If the priority is to minimize the risk of dying from breast cancer, then yearly screening mammography is the answer.

For more information, visit www.endtheconfusion.org.