May 14, 2003 -- New guidelines announced today by the American Cancer Society should help clear up confusion about breast cancer screening. The recommendations call for yearly screening mammograms for all healthy women starting at age 40, but put less emphasis on monthly breast self-examinations than in the past.
The guidelines no longer call for women to perform monthly breast self-exams, because there is no evidence the practice saves lives. A better approach for most women is to become familiar with their breasts so they will be aware of changes as soon as they occur, an ACS spokeswoman tells WebMD.
"If a woman feels more comfortable doing a monthly exam, that is fine," says Debbie Saslow, PhD, director of breast and gynecologic cancers for the ACS. "We are saying this is an option for women who feel it helps them be more aware of their breasts. But it is no longer something we are asking them to do because the evidence (of its usefulness) just isn't there."
There has been tremendous debate over the benefits of mammograms in preventing breast cancer deaths particularly among women younger than 50 and over 70, and the new breast cancer screening recommendations were written with this in mind. The ACS has recommended annual mammograms for women 40 and over for many years, and Saslow says long-term follow-up studies now offer unequivocal evidence of the value of yearly mammography screening.
She says annual breast cancer screening makes sense for younger women, whose tumors tend to be fast growing. Annual screening also makes sense for older women. Though their cancers often spread more slowly, they occur far more frequently. Roughly 75% of all breast cancers are diagnosed in women over 50.
"We are more confident than ever that mammograms are useful in women 40 to 49, and in older women," Saslow says. "The reason for screening is to be able to detect a tumor in time to do something about it. If you wait two years between mammograms you increase the chances that screening won't make a difference."
Specifically, the ACS's breast cancer screening recommendations call for:
- Annual mammograms starting at age 40 and continuing as long as a woman is in good health.
- Annual mammograms may be needed earlier for women at increased risk due to family history, genetic predisposition, or history of breast cancer. The ACS recommends high-risk women have frequent exams and discuss with their doctor whether to have early mammograms or other tests, such as breast ultrasound and MRI.
- Clinical breast exams performed by a healthcare provider should be done annually in women 40 and over, and every three years in low-risk women in their 20s and 30s.
The ACS panel that came up with the new guidelines also reviewed the current evidence on new and emerging breast cancer screening technologies, such as MRI or ultrasound breast imaging. It concluded that none of the new technologies has been proven as effective for primary screening as either film or digital mammography, Saslow says.
"Other technologies may offer benefits as adjuncts to mammography," she says. "For women at increased risk these can be used as screening tools in addition to, but not instead of, mammography."
Amy Langer, who is a breast cancer survivor and the executive director of the National Alliance of Breast Cancer Organizations, tells WebMD there is no longer any reason for women to put off breast cancer screening. Annual screenings are now covered by Medicare and most private insurers, and the National Breast and Cervical Cancer Early Detection Program provides mammograms for eligible women who are uninsured.
"The questions about mammography have been answered," she says. "There is nothing left to resolve. We are absolutely certain that mammography saves lives, and that annual screening is a good idea for women who are 40 and older."