The American Cancer Society has come out with new recommendations regarding screening mammography for breast cancer. They recommend starting regular screening at age 45, yearly screening from 45 to 54, and screening every 2 years after that. They also discourage self and in-office breast exams. I have to strongly disagree. I understand their concerns about the stress and distress of false positives. However, as a clinician who has cared for women for the last 30 years, I don’t get it. I also don’t understand their recommendations when it comes to eliminating the in-office breast exam.
Starting mammography at the age of 45 years means that we will be missing the aggressive cancers found in younger women. I have diagnosed many in this group. They were not the kind that would lay dormant either. These were inflammatory cancers that had a high likelihood of metastasizing. I am happy with screening yearly between the ages of 45 and 54. But, why would we screen every two years in older women. The chance of breast cancer goes up, not down as we age. As far as the exam, I have picked up many cancers that were quite large that patients did not notice.
Unfortunately, insurance companies will seize on the recommendations and stop paying for mammograms that are recommended for good reason by conscientious primary care providers everywhere. Patients will not want to go to any extra trouble to have an exam that they are afraid of having in the first place, even if they have symptoms or feel a lump.
We have done such a great job with screening. The survival of those with breast cancer continues to improve, in part from early detection. Mammography also continues to get better. We now have the 3D mammogram machine, which promises to improve detection rates of invasive cancer by 40% and decrease false positives by at least 15%.
The American College of Obstetrics and Gynecology (ACOG) have a similar opinion to mine. I believe they feel the same way as I do, because those who belong to the organization have most likely saved many lives as a result of examination and screening.
“ACOG maintains its current advice that women starting at age 40 continue mammography screening every year and recommends a clinical breast exam. ACOG recommendations differ from the American Cancer Society’s because of different interpretation of data and the weight assigned to the harms versus the benefits.”
I am hoping that medical providers can prevail when it comes to common sense and concern for the women we care for and about. I am going to continue doing what I have always done, because I have seen the positive results of prevention and screening. I treat my patients as individuals.
Current global recommendations are just that. They do not take into account each person. They look at averages and base them on the whole not the parts. The recommendations will work for you if you are in the middle of the pack. If you are on the outskirts you will suffer. How do you know if you are on the outskirts? You don’t until it is too late.