Health & Wellness

Breast Health

by Amanda Jean Harris

New screening recommendations could hamper early detection efforts, one local doc says.

In October, as many celebrated Breast Cancer Awareness Month, the American Cancer Society issued new standards for mammograms to screen for breast cancer pushing the age to 45 years rather than 40.

Local breast surgeon Dr. Tyshaun James-Hart with Women’s and Children’s Hospital weighs in with the facts on how women can best protect themselves and what these suggestions from ACS can mean for you.

IND: What are the benefits to waiting until age 45 for screening mammogram?

Hart: I see no benefit to waiting until age 45 for screening mammograms. According to the SEER report (Surveillance, Epidemiology and End Results Program from the National Cancer Institute), a woman’s 10-year risk of breast cancer at age 30 is 1 in 227. The 10-year risk at age 40 (not 45) is 1 in 68. The 10-year risk at age 50 is 1 in 42. Something changes by the time women reach the age of 40 (not 45). I do see a risk of missing breast cancers in women younger than 45. I believe our goal should be to find more normal breasts at screenings not more cancers. This may very well impede our efforts to get the message out that “early detection is the key.”

IND: Is there any concern that these guidelines could encourage women who need these screenings to wait?

Hart: There is great concern for this. It is through education gained from annual screenings that women find out what their real risks for breast cancer and other diseases are. It is never a good idea to forego an opportunity to be educated and proactive about one’s health.

IND: How would you recommend women consider this new recommendation?

Hart: We all should be reminded that they are simply guidelines. Each of us has to take into consideration what makes sense to us and our future wellbeing. I recommend that women and men still do self-examinations and remain aware of any changes that occur in their bodies. I recommend that women request clinical breast exams and education about what changes to look for and be aware of when they go to their doctors. I am still a proponent of annual screening exams to maintain good health (breast and otherwise) as long as it is feasible. I will still be recommending yearly mammograms for women age 40 and older.

IND: Is there any concern that such recommendation from the ACS could impact insurance coverage for women who would prefer or need screenings beginning at age 40?

Hart: Absolutely! I am afraid that this may lead to some insurance companies dropping coverage for annual mammogram screening. I am afraid that this may be a setup for those of financial means to be able to get the screenings they deserve and those of lesser financial means to be left behind on the trail to good breast health. — AJH

The Reason

Why did ACS change its guideline to say routine screening should start at 45 instead of 40?

The evidence shows that the risk of cancer is lower for women ages 40-44 and the risk of harm from screenings (biopsies for false-positive findings, overdiagnosis) is somewhat higher. Because of this, a direct recommendation to begin screening at age 40 was no longer warranted. However, because the evidence shows some benefit from screening with mammography for women between 40 and 44, the guideline committee concluded that women in this age group should have the opportunity to begin screening based on their preferences and their consideration of the tradeoffs. That balance of benefits to risks becomes more favorable at age 45, so annual screening is recommended starting at this age.

SOURCE: American Cancer Society