Screening should be focused on the women who will benefit the most. That's the fundamental message in the guidelines from the American Cancer Society (ACS) on breast-cancer screening.
In particular, the guidelines downplay the importance of screening in those for whom the benefit is small — for example, women under age 40 and women who have a short life expectancy due to other medical problems. They also emphasize more aggressive screening for those women who are at high risk.
Highlights
- While there has been considerable controversy about breast-cancer screening for women between the ages of 40 and 50, several important panels and advocacy groups have stood by the recommendation to begin screening at age 40, including yearly mammograms and breast exams performed by health professionals.
- On the other hand, the ACS says that a breast exam every three years is adequate for women under age 40. Breast cancer is very uncommon in this age group, and neither breast exams nor mammograms are good at detecting cancers in younger women.
- The ACS is no longer recommending that women perform breast self-exams. In part, this is based on recent studies that failed to show that regular breast self-exams saved lives. At the same time, the ACS recommends that women become familiar with the normal feel of their breasts and report any changes to a health care professional.
- Women with a very high risk of breast cancer (greater than 20% lifetime risk of breast cancer) should get an MRI and a mammogram every year. For some women, this may mean starting even before the age of 40.
- The ACS is recommending that women at moderately high risk — for example, women who have already had breast cancer or who have a strong family history of breast cancer — speak with their doctors about the preferred method of screening for them and how often it should be performed.
- The ACS suggests that cancer screening can be stopped in some women, particularly those who have a limited life expectancy due to advanced age or serious underlying medical problems.
What This Means For You
If you are between 40 and 75, you should see your doctor every 1 to 2 years for a breast exam and mammogram. Some experts think that screening every two years is reasonable, too.
If you are under 40, take comfort in knowing that your risk of developing breast cancer is less than one in 250. Unless you have a very strong family history of breast cancer, screening should be low on your list of priorities. It's also important to remember that in young women, an abnormal lump on a breast exam or mammogram is much less likely to be cancerous. However, if you do feel a new breast lump, don't ignore it. Call your doctor's office and arrange an appointment.
If you are over 75, or have serious health problems such as heart disease or a different type of cancer, speak with your doctor about whether it makes sense to discontinue regular breast exams and mammograms. Since these screening tests are intended to detect the earliest stages of breast cancer — and the fact that it takes years or even decades for breast cancer to grow and spread — screening may have little to offer in terms of protecting your health or extending your life.
How about breast self-exams? Most experts now feel that these offer little benefit in detecting the earliest stages of breast cancer. Since finding a lump on a self-exam can dramatically increase a woman's anxiety level, some experts actually think the exam does more harm than good. If you don't perform breast self-exams, you don't need to start. If you do examine your breasts regularly, you can choose to continue or stop. That said, all women who discover a lump — either by accident or as part of a self-exam — should see their doctor promptly.
The ACS states that "it is acceptable for women to choose not to do BSE or to do it occasionally." Talk with your doctor about whether breast self exams make sense for you.
