Newly released guidelines from the American College of Physicians recommend that women who are not at an elevated risk for developing breast cancer have mammogram screenings every other year starting at age 50, and talk with their doctor about the risks and benefits of screening by age 40.
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However, recommendations are not one-size-fits-all, says diagnostic radiologist Nidhi Sharma, MD. She emphasizes that it’s important for women to talk to their doctors about all of the available guidelines to make a personalized and shared decision on when to start screening.
The new recommendations from the ACP, which is a national organization of internal medicine specialists, are in line with those set forth by the U.S. Preventive Services Task Force. But, they differ slightly from other guidelines.
The American Cancer Society, for example, recommends that women at average risk begin yearly mammogram screenings at age 45, switching to every other year after age 54. The American College of Radiology and Society of Breast Imaging recommends that women at average risk start screening at age 40 and undergo a risk assessment by age 30 to see if earlier screening is right for them.
“When there are so many different guidelines, they can be confusing sometimes,” Dr. Sharma says.
“Making an informed decision is one of the most important things the patient can do for themselves so that they are screened appropriately and the cancers are caught in a timely fashion.”
Benefits of mammography
Scientific evidence shows that starting early and regular screening can help detect breast cancer at an early stage and prevent extensive surgery and additional treatment regimens, Dr. Sharma says. It can also reduce anxiety for women and detect high-risk breast lesions that also require treatment.
However, there is a lot of discussion about its potential to lead to overdiagnosis, which can only be estimated, she adds. The new ACP guidelines mention that less frequent mammograms may reduce the potential for false-positive test results, overdiagnosis, overtreatment and radiation exposure.
It’s important to note that these guidelines do not apply to patients who have had prior abnormal screening results or who have a higher risk of breast cancer due to personal history or genetic factors.
A personal decision
Because the level of risk versus the level of benefit is different for every woman, Dr. Sharma believes each woman should have a conversation with her doctor to develop a plan that’s right for her.
“Women should be paying attention to self-breast exams and going in for their annual primary care exams, and then making a shared decision with their physician on what’s right for them,” she says.
And that decision should be based on value judgment rather than scientific calculations and numbers, she adds: “The weighing of the risks and benefits to make the best decision for themselves must be done by the women and not for the women.”
