Breast Cancer Screening Guidelines Raise Concerns
Waiting to get treatment for breast cancer results is worse survival outcomes.
Currently, there are conflicting recommendations regarding the age women should initiate breast cancer screenings. Some guidelines suggest that screening should start at age 40, while the American Cancer Society (ACS) recommends screenings start at age 45. For patients aged 55 and older, the ACS recommends receiving mammograms every other year to prevent harms associated with screening.
The authors of a new study published by the Journal of the American College of Radiology believe that these breast cancer screening guidelines could result in later stage disease, while not decreasing incidences of overdiagnosis.
In the study, the investigators found that there are no reported cases of breast cancer resolving without treatment, which highlights the importance of early diagnosis and treatment.
Included in the study were data from 42 fellows of the Society of Breast Imaging regarding how untreated biopsy-confirmed breast cancers progressed over time. Data for more than 6.9 million mammograms over 10 years were gathered.
The authors noted there were 240 incidences of untreated invasive breast cancers and 239 cases of untreated ductal carcinoma in situ, according to the study.
The investigators observed that no cases of confirmed, untreated breast cancers regressed, as evident by follow-up examinations.
These results suggest that guidelines recommending less frequent mammograms may delay diagnosis and treatment for breast cancer, according to the study.
“Lengthening the screening interval or waiting until a woman is 45 or 50 to screen will not prevent whatever small amount of overdiagnosis that may exist; it will simply delay it,” said researcher Debra L. Monticciolo, MD. “Most of the improved survival rates of breast cancer are because of early detection.”
The authors also wrote that the risks associated with mammography are limited, since the dose of radiation is relatively low. For a standard mammography, the radiation dose is similar to the amount a person gets every 7 weeks in an everyday setting, according to the study.
Additionally, a large majority of patients receive a normal result from the mammography. Even when breast cancer is suspected, very few need to undergo a needle biopsy after additional imaging tests, according to the study.
“When you weigh the stress and worry for those who have a possible abnormal result against the mortality rates of breast cancer, most women would choose to be tested,” Dr Monticciolo said. “Screening can reduce the mortality from breast cancer by 40%.”
Mammograms can be considered cost effective and are covered by most insurers under the Affordable Care Act. By not receiving breast cancer screening, patients can risk progressing to late stage disease.
“We want women to have the best chances of treatment, and we don’t want women to get the mistaken idea that if they have an invasive breast cancer, they can just let it go,” Dr Monticciolo said. “If you don’t treat it, invasive breast cancer is 100% lethal.”
The authors urge patients to receive breast cancer screenings as early as age 40, according to the study. Patients with an increased risk of the disease should consult their physician to determine the best screening frequency.
“It’s really one of the best things you can do for your health,” Dr Monticciolo said. “Our goal is to save the most lives, and I would encourage women at normal risk to take advantage of the benefits of screening every year, starting at age 40.”