Editorial published in Everyday Health by Electra Paskett, PhD, cancer control researcher at the OSUCCC – James
The recommendations for when and how often women should start getting mammograms to screen for breast cancer had been relatively consistent since 2002 — until recently. Then, in a span of just 90 days in early 2016, several medical groups revised their guidelines, leaving millions of women confused.
As a cancer control researcher at The Ohio State University Comprehensive Cancer Center in Columbus, I understand the various reasons behind the updated guidelines — many of which suggest that women wait longer to start getting regular mammograms, and that they get them less often. But as a breast cancer survivor, I certainly appreciate the invaluable impact the screenings can have: My breast cancer was detected by a mammogram at age 40. My professional research and my personal experiences give me a unique perspective in this ongoing debate. Though there is a lot to consider, there are some very crucial points that all women should remember.
What’s Different About the New Mammogram Guidelines
In an October 2015 issue of The Journal of the American Medical Association, the American Cancer Society (ACS) published new guidelines for women with an average risk for breast cancer, pushing back the age at which mammograms should start from 40 to 45. The ACS also suggested that many women ages 55 and older should consider getting mammograms only every other year, and called for an end to clinical breast exams in doctors’ offices for all women.
Less than three months later, three more groups — including the U.S. Congress — weighed in with their opinions. In January 2016, the American Congress of Obstetricians and Gynecologists released a statement saying they were standing by their previous recommendations that women get a mammogram every year starting at age 40.
A day later, the U.S. Preventive Services Task Force (USPSTF), a panel of independent experts appointed by the federal government, released recommendations suggesting that women with an average risk of breast cancer could put off getting mammograms until age 50, and that most women could get them every other year. The USPSTF also suggested putting an end to teaching women to do breast self-exams.
Finally, Congress chimed in, ordering insurers to ignore the new guidelines from the USPSTF — the very group the government appointed to make recommendations on preventive health screenings — and instead abide by the original guidelines released more than a decade earlier, which called for annual screenings beginning at age 40.
This disagreement among highly esteemed bodies that are supposed to provide guidance to healthcare consumers understandably left a lot of women confused.
Pros and Cons of Mammograms
Before getting into the reasoning behind all of the various guidelines, let me remind all women of two vital points: First, these are all just recommendations based on large population data and are intended only for women who are at average risk of breast cancer. Remember that every woman is different. Instead of relying on broad-based recommendations, you should base your decisions regarding the timing and frequency of mammograms on your family history, your personal risk factors, and conversations with your doctor.
Mammograms have proven to be extremely useful in detecting breast cancer, often in the early stages, giving women and their doctors more time and options for treatment. So why would anyone suggest doing fewer of them? The truth is that mammograms aren’t perfect, and they can lead to unnecessary treatments and unintended consequences. The National Cancer Institute estimates that half of all women who get annual mammograms over a 10-year period will experience a false positive — meaning they will be called back for additional imaging or a biopsy for what ends up being a noncancerous lesion. About one out of every six of those women will undergo biopsies, but only 5 percent of women recalled for further testing are found to have cancer.
In other cases, breast cancers that are asymptomatic and pose no threat to a woman’s life are detected and treated. These cases are commonly overtreated, subjecting women to the pain, cost, and lasting effects of surgery, radiation, hormone therapy, or chemotherapy. In some cases, treatments can cause women to develop lymphedema (irreversible swelling in the arms and legs), heart problems, or other types of cancer due to exposure to radiation — all because tumors were treated aggressively and unnecessarily.
As for the idea of getting mammograms every other year, it’s important to remember that, for the most part, breast cancers are slow growing. Even if a woman develops a tumor in the 24 months between mammograms, there is often still time to treat it effectively.
How to Make Your Own Mammogram Decision
The guidelines also suggest doing away with clinical breast exams and recommend that we stop teaching women how to do breast self-exams. That may seem extreme, but the truth is there is no proof that exams of any kind have ever consistently prevented deaths. That’s not to say that you shouldn’t be aware of your body, of course. If you notice any changes in your breasts, such as dimpling, redness, soreness, puckering, or changes in size, by all means see your doctor.
The bottom line is that every woman is unique. Before ever scheduling your first mammogram, you should get to know your family history and understand your risks. I wasn’t surprised to learn I had breast cancer, but it was a surprise to hear it at age 40, after a routine mammogram. My mother was a breast cancer survivor, and so was my grandmother. In that regard, I was not an “average” woman for whom these guidelines are written. I knew my risks, took my health into my own hands, and worked closely with my doctor every step of the way. And regardless of your take on the latest changes to the mammogram guidelines, you should do the same.
To schedule your James mammogram, call 800-240-4477 or make an appointment online via your MyChart account at mychart.osu.edu/osumc.