Breast Cancer Screening: Understanding the New Recommendations

An influential medical organization has recently changed its recommendation on how early and how often women should be screened for breast cancer. Here’s what you should know.


The American Cancer Society (ACS) is now recommending women start getting annual mammograms at age 45 rather than at age 40, unless risk factors are present. It also found little value in manual breast checks, saying that an exhaustive review shows they simply aren’t effective in finding anything of concern. And the new guidelines say that women over 55 years old should routinely have a mammogram biannually rather than every single year.


The reason for the recommendation to screen later and less frequently lies in the problem with early testing. Over time, research has shown testing at younger than 45 is not necessarily better when it comes to identifying breast cancer. The chance of a false positive is higher in younger women, as they tend to have denser breast tissue. And there’s a price to pay with those false positives – often patients undergo painful biopsies and suffer unnecessary anxiety that can scare them away from future mammograms when they’re truly needed.


Keep in mind that these recommendations are geared toward women without risk factors and they refer only to routine screenings. (It’s important to know that screenings (i.e., routine checking when you have no symptoms) is different than evaluation if you have a symptom, such as a lump, and require diagnostic testing.) Mammograms are still considered the best way to screen for breast cancer, which is diagnosed in more than 230,000 women each year, according to the ACS. Advances in detection and treatment have meant that the mortality rate from breast cancer has been steadily declining over the last 20 years.


These new recommendations do not come without some controversy, however. Many professional healthcare provider organizations, such as the American College of Obstetricians and Gynecologists (ACOG) and the National Comprehensive Cancer Network (NCCN), disagree with the ACS’s discounting the important of breast exams. Other organizations, such as the American College of Radiation (ACR) and the Society of Breast Imaging, as well as Memorial Sloane Kettering hospital, have stated that they will not change their recommendations from age 40 to 45, as they believe the evidence still supports earlier screenings.


Regardless of an organization’s recommendations, women need to know their own breasts, and see their doctor evaluate any changes. Women also should know whether or not they have “dense breasts” (ask your doctor if you don’t know) and be aware that mammography is less sensitive to detecting issues in those women. Fortunately, the medical community is working to clarify appropriate indications for newer imaging options, especially for younger women, women with risk factors and women with dense breasts — such as whole breast ultrasound, 3D mammography and breast MRI.


As with any test or screening, a patient’s personal cancer risk is something to be discussed with her doctor to make an informed decision on whether to adhere to the new guidelines or determine if there’s reason to be more aggressive.