In a surprising shift, the American Cancer Society released new guidelines on Tuesday, Oct. 20 extending the age to begin recommended mammograms from 40 to 45 for women of “average breast cancer risk”. The ACS suggests annual screenings until the age of 54 and then biennial screenings. This contradicts what other expert groups like the National Comprehensive Cancer Network and the American College of Obstetricians and Gynecologists recommend.
A Breast Surgeon’s Advice
We turned to new fellowship-trained breast surgeon, Allison DiPasquale, MD, who will be seeing patients at Methodist Charlton and Methodist Dallas. She specializes in removing cancerous tissue in a way for optimal breast reconstruction. Understandably, there was a lot of criticism from the public and many healthcare professionals about these seemingly-drastic changes.
“It does make me a bit nervous, but these guidelines are just that: guidelines, they are not hard and fast rules. Each patient is unique and thus practitioners should strive to have conversations with their patients about the recommended changes and take each patient on a case by case basis and allow clinical judgement and patient input to dictate when they start screening,” Dr. DiPasquale says in reaction to the changes.
What is “average risk” of breast cancer?
She says “average risk” is a woman without a personal or family history of breast cancer, nor one who carries the genetic mutation associated with breast cancer, the BRCA gene. If a woman does carry the BRCA gene, Dr. DiPasquale recommends getting screened before turning 40. In fact, the American Society of Breast Surgeons supports annual mammograms starting at age 30 and alternating with yearly MRI.
The American Cancer Society says one main reason for its suggested changes was because younger women were having anxiety and unnecessary biopsies after getting a mammogram, something Dr. DiPasquale has seen first-hand.
“I have found that anxiety around yearly mammograms is a real issue, especially if the woman has dense breasts and gets called back for additional imaging. However, I have found that anxiety over a large breast cancer is worse. Mammography is not a perfect test, and I believe there is no perfect test in medicine that exists, but mammography has made advances including digital images and tomosynthesis that helps reduce the rate of false positive results and call-backs. In younger women with dense breasts I will order an ultrasound with the mammogram (or an MRI if they are high risk) to help reduce the false positive rates.”
Risk factors for breast cancer
She agrees with the American Cancer Society in the research: high risk women are most at risk of getting early age breast cancers, not the average risk woman. Thus, recommendations for screening for high risk women start earlier. However, that is not to say that an average risk women does not develop breast cancer at an early age, it is just that they are more unlikely which is why women between age 40 and 45 can still choose whether they want mammogram or not.
“Each patient is unique and I would have the conversation with them about the new ACS guidelines and that THEY have the power to choose if they want to start screening at 40 or wait until 45,” Dr. DiPasquale says. “I think that all these conflicting guidelines are confusing and the best way to navigate your patients through the confusion is to talk with them and allow them to participate in their own care.”
Calvert Collins-Bratton is the Public Relations Manager at Methodist Health System. She spent ten years as a news reporter working in Omaha, Las Vegas and Dallas-Fort Worth at FOX 4. When not working, she and her husband Vince love taking Vivienne to neighborhood parks, the Dallas Arboretum, White Rock Lake, and to visit her family nearby.