Did you know that there have been new updates to the breast cancer screening recommendations?
We want to share those with you during Breast Cancer Awareness Month to be sure you’re doing everything possible to stay safe and healthy.
According to the American Cancer Society (ACS), breast cancer is the most common cancer in women in the United States, except for skin cancers. It accounts for about 30 percent (or 1 in 3) of all new female cancers each year. The median age at the time of breast cancer diagnosis is 62, but half of the women who develop the disease are 62 years of age or younger when they are diagnosed.
Overall, the average risk of a woman in the United States getting breast cancer is about 13 percent or a 1 in 8 chance.
Considering these statistics, understanding the latest screening recommendations can empower women to take charge of their health.
Breast Cancer Screening Choice: New Updates
Recently, the U.S. Preventive Services Task Force (USPSTF) made headlines by updating its guidelines on breast cancer screenings.
The new recommendation advises women to undergo routine screening mammograms every other year starting at the age of 40. This is a notable shift from what the task force recommended before when they suggested that women start annual screening at the age of 50, with those between the ages of 40 and 49 following individualized recommendations from their doctors.
The update is based on a growing body of research that indicates earlier and more frequent screening can lead to earlier detection of breast cancer, which is often associated with better outcomes.
The task force also wanted to “tackle disparities in breast cancer mortality, particularly among Black women, who are more likely to have aggressive cancer subtypes diagnosed at later stages and face disproportionately higher mortality rates: 40 percent higher compared to white women in the United States.”
The recommendations also include digital breast tomosynthesis—also known as 3D mammography—as a primary screening modality. This type of screening has shown promise in improving the benefit-to-risk ratio compared to traditional digital mammography, mainly by reducing false-positive results.
Unfortunately, 3D mammograms often cost more than 2D mammograms, and insurance policies may not cover this added cost. Check with your provider.
Breast Cancer Screening Choice: More Work Needs to be Done
The task force noted that though these updates should help, there remain challenges in making sure all women are properly screened, diagnosed, and treated. Studies have shown inequalities, for example, in accessing 3D mammography facilities—meaning that many women don’t have access to this advanced technology.
We also need more research on supplemental types of screening—such as ultrasound or MRI—for women with dense breasts.
“Nearly half of all women in the United States have dense breasts,” the task force noted, “and this is a normal variation associated with a small increase in breast cancer risk similar to having an aunt with breast cancer, yet there is currently inadequate evidence to recommend for or against additional screening for this population.”
This is an urgent issue now. The U.S. Food and Drug Administration (FDA) will start mandating that all U.S. screening facilities will need to inform women about their breast density with their mammography results starting in September 2024.
Finally, there are questions surrounding artificial intelligence (AI) and its use in image interpretation in mammography. AI algorithms “show promise,” the task force states, in enhancing cancer detection, but how that will impact patient outcomes is still uncertain.
AI tools have been tested mainly on white women, as well, which could exacerbate existing disparities in diverse populations.
Breast Cancer Screening Choice: What Else You Need to Know
In addition to the above updates, women also need to know about additional guidelines from various health organizations.
American Cancer Society (ACS)
The ACS recommends that women with average risk begin annual screenings at 45 years of age, with the option to start at 40. Women aged 55 and older can switch to biennial screenings or continue annually.
National Comprehensive Cancer Network (NCCN)
The NCCN suggests that women of average risk start annual screenings at age 40. If a family member has been diagnosed with breast cancer, women should start screening when 7 to 10 years younger than when the family member was diagnosed. They emphasize that women should have a discussion with their healthcare providers to personalize their screening plans based on their risk factors.
American College of Radiology (ACR)
The ACR supports annual screening starting at age 40.
Breast Cancer Screening Choice: What If I’m at High Risk?
Women who are at a high risk of breast cancer based on the factors below should get a breast MRI and a mammogram every year, starting at the age of 30, according to the ACS.
Women at high risk include women who:
- Have a lifetime risk of breast cancer of about 20 to 25 percent greater, according to risk assessment tools that are based mainly on family history.
- Have a known BRCA1 or BRCA2 gene mutation.
- Have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves.
- Had radiation therapy to the chest before they were 30 years old.
- Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes.
What About Self-Exams?
In the past, women were advised to perform annual self-exams and/or to undergo physical breast exams with a health care professional. The ACS now notes, however, that research “has not shown a clear benefit” of these exams:
“There is very little evidence that these tests help find breast cancer early when women also get screening mammograms.”
They do note, however, that when breast cancer is detected by symptoms (rather than screening), it is usually because a woman discovers the symptom—such as a lump in the breast—when bathing or dressing.
“Women should be familiar with how their breasts normally look and feel,” the ACS advises, “and should report any changes to a health care provider right away.”
The ACS no longer recommends regular clinical breast exams or breast self-exams as part of a routine breast cancer screening schedule.
Were you aware of the updated breast cancer screening recommendations?
Featured image by Anna Tarazevich via Pexels.
