New mammogram guidelines not ‘one size fits all’

Updated guidelines recommend switching to every other year screenings

A radiologist compares an image from earlier, 2-D technology mammogram to the new 3-D Digital Breast Tomosynthesis mammography in Wichita Falls, Texas, July 31, 2012 (Torin Halsey/Times Record News via AP)
A radiologist compares an image from earlier, 2-D technology mammogram to the new 3-D Digital Breast Tomosynthesis mammography in Wichita Falls, Texas, July 31, 2012 (Torin Halsey/Times Record News via AP)

PORTLAND, Ore. (KOIN) — Though the American Cancer Society is revising its advice on when women should start getting mammograms and how often, health experts maintain women and their doctors should have a conversation about what is best for them.

The updated guidelines recommend annual breast cancer screenings at age 45 instead of 40 and switching to every other year at age 55. The update moves the society closer to guidelines from an influential task force that recommends starting routine screening at age 50.

A doctor’s take

Dr. Alison Conlin, an oncologist specializing in breast health at Providence Cancer Center, told KOIN 6 News there are many things for women to think about in making their decision.

“There’s been a lot of evidence that says there are harms to women in mammography (which) can lead to false positives, more biopsies,” Dr. Conlin said.

Mammograms aren’t a perfect test and in younger women or women with dense breast tissue, mammograms are harder to use, she said.

“45 might be a more appropriate starting point, but again I think it’s going to be different for every woman.”

The new guidelines suggest “45 might be a more appropriate starting point, but again I think it’s going to be different for every woman,” the doctor said.

Cancer care, screening and prevention are becoming more individualized, she said. “It’s not one-size-fits-all.”

The American Cancer Society advice is for women at average risk of breast cancer. Doctors generally recommend more intensive screening for higher-risk women. The update also drops a recommendation for routine physical breast exams by doctors. The guidelines were published Tuesday in the Journal of the American Medical Association.

Women need to be aware of their own health history. “A woman who may have a strong family history or a private biopsy of something atypical or other risk factor for breast cancer may not fall into these (new) guidelines.”

Every woman is different, she said. That’s why women should ask their doctor about their risk factors and how family history plays into a decision.

‘Early detection is paramount’

Andrew Asato, the CEO for Susan G. Komen of Oregon and SW Washington, said the new American Cancer Society guidelines gave his organization “pause.”

“We firmly believe that early detection and all the tools that are necessary for early detection is paramount for women, particularly in their age between 40 and 50,” Asato told KOIN 6 News. “We know 20% of women are diagnosed during that period, and 5% are also diagnosed under the age of 40.”

Early detection gives patients a “99% relative survival rate,” he said.

Asato said there has been “a lot of confusion” about when to start screening. He agreed with Dr. Conlin and said “it’s really a personal conversaton between a patient and their health care provider, their doctor, their nurse practioner, to see what is best for them.”

Komen maintains the recommendation to begin screening at age 40

As an organization, Komen stands “by the notion that 40 is an age where that conversation should begin.” They also maintain their recommendation to begin screening at age 40.

“We really just strongly encourage women and men to continue to have this conversation with their physicians and really determine what’s best for them,” he said. “We have to continue to be advocates for ourselves.”

Women in rural communities may not have access to mammography, but clinical breast exams done by a health care provider during a regular check-up is “an important tool that’s not invasive, very quick to do and we feel necessary,” Asato told KOIN 6 News.

He said Komen respects the American Cancer Society but underscored any decision should come from “a conversation that a patient should have with their primary care provider.”

“Early detection saves lives,” he said, “and is our best defense.”

The Associated Press contributed to this report

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