New Mammogram Screening Guidelines FAQ
The new guidelines recommend against breast self-exams and question the benefits of clinical breast exams performed by health care providers. Why?
Two major studies, one from China and another from Russia, found no evidence
that breast self-examinations reduced deaths from breast cancer, but that the
practice leads to additional screening and biopsies.
"The self-exam data were pretty definitive," Pettiti says. "There is high
certainty that there is no benefit, and there are harms which include
unnecessary anxiety from finding something that isn't cancer."
But that doesn't mean a woman should ever ignore a suspicious lump.
"That definitely is not the message," Petitti says. "Anything unusual should
be checked out."
The USPSTF panel concluded the current evidence is insufficient to assess
the risks and benefits of clinical breast exams performed by health care
Evers says she will continue to recommend breast self-exams.
"I don't think the practice is useless," she says. "For many women it is
important because it helps them feel somewhat empowered and in control of their
own breast health."
What should average-risk women in their 40s be doing if mammography and self-exams are no longer recommended?
Although the experts interviewed for this story had different opinions about
whether routine screening is advisable, they all agree that any woman concerned
about breast cancer should discuss her own situation with her doctor or other
health care provider.
The new guidelines don't apply to women at high risk for breast cancer. How often should these women get screened?
The new guidelines aren't about women at high risk of breast cancer.
The American Cancer Society defines high-risk as women with a greater than
20% lifetime risk of breast cancer. This includes women with BRCA1 and BRCA2
gene mutations and women who have not been tested but have a parent, sibling,
or child with a BRCA mutation, as well as certain other groups of women.
The ACS recommends that high-risk women have annual mammograms along with an
MRI beginning at age 30 and
continuing for as long as they are in good health.
Women with a 15% to 20% lifetime risk for breast cancer are considered to
have a moderately increased risk for the disease.
ACS recommends that these women talk to their doctors about the benefits and
risks of adding MRI to annual mammogram screening.
If a woman's breast cancer risk increases with age, why stop screening at 74?
Very few breast cancer screening studies include women in their mid-70s and
older. The task force noted that "breast cancer is a leading cause of death in
older women, which might suggest that the benefits of screening could be
important at this age."
However, the USPSTF also concluded that the benefits of screening are
probably not as great for older women because they tend to have breast cancers
that respond well to treatment and have a higher risk of dying from other
The panel noted that the risk of overdiagnosis and unnecessary treatment is
greater in elderly women than in younger ones because of their increased risk
for death from other causes.