Much of the confusion comes from the fact that different groups provide different recommendations on mammography and other screening options. For example, the U.S. Preventative Services Task Force (USPSTF), American Academy of Family Physicians, and American College of Physicians all recommend waiting until age 50 until routine mammogram screening begins. However, the American Cancer
Society, American College of Obstetricians and Gynecologists (ACOG), American Medical Association, National Cancer Institute, and American College of Radiology all recommend that routine screening begin at age 40. These groups also have varying recommendations as to whether this should be done annually or every one to two years once screening begins.
Guidelines are based upon statistical analysis comparing overall healthcare costs involved in screening, the differences in stage of disease and subsequent overall survival at time of diagnosis, and the risks of harm to patients from unnecessary imaging, procedures, or treatments because of false positive findings. The potential risks of later detection of disease are therefore weighed against the potential harm that can occur from earlier or more frequent screening.
While most breast cancers in the U.S. are first diagnosed as a result of an abnormal screening study, there are still a significant number that are diagnosed by physician exams or patient self-exams. Despite this point there is also great debate about the utility of self-breast exams. Although some of the aforementioned groups still recommend that patients continue to perform regular self-exams, many have begun to recommend against this practice due to the high rate of false positive findings.
Most gynecologists follow the guidelines recommended by ACOG, which include clinical breast exams by a physician beginning by age 20, yearly mammography beginning at age 40, and breast self-awareness, which may include self-exams. While I agree that unnecessary testing comes about in patients due to this regimen of screening,
I also often see earlier detection because of each the various screening modalities that we utilize.
Another important point to remember is that while the overall lifetime risk of breast cancer in a woman is 1 in 8, these risks may be very different for an individual patient because of family history, genetic syndromes such as the BRCA mutation, or other factors. In patients with a higher risk, changes to our routine screening processes could include more frequent imaging, utilization of breast MRI, or even consultation with a breast specialist or genetic counselor. The take-home message is that you should discuss your risks with your physician and then together make a plan for screening.
Dr. Todd Chappell is an OB/GYN with Adams Patterson Gynecology & Obstetrics. For more information call (901) 767-3810 or visit AdamsPatterson.com.