October 20, 2015

New take on screening mammography: What’s a woman to do?

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When To Have Screening Mammography

Sorting out yet another guideline for when to start and how often to have screening mammograms

We women were in need of clarity when the American Cancer Society issued a new guideline this week about when women should start screening mammography and how often they should have them.

No wonder we’re confused. Many organizations, including ACS, the American College of Obstetrics and Gynecology and the National Comprehensive Cancer Network, recommended starting at 40. The United States Preventative Services Task Force (USPSTF) recommended starting at 50.

If I was hoping for a tie breaker, I was disappointed. As I scoured news sources, I read that the new recommendation from ACS was to start at age 45.

So I turned to an expert, radiologist John Huff, M.D., to help me sort this out. I’m glad I did because there is more to the story than the headlines.

Huff not only leads breast imaging at the Vanderbilt Breast Center, but he also is a member of the screening and diagnostics guidelines panel for the NCCN. The NCCN is a group of the nation’s leading cancer centers, including the Vanderbilt-Ingram Cancer Center, whose experts review the medical evidence regularly. Their clinical practice guidelines in turn help set the standard of cancer care across the country.

That panel met by conference call a few hours before release of the new ACS guideline on Tuesday. Huff said the panel reiterated its recommendation that annual screening mammography begin for women of average risk (most women) at age 40.

“I’m afraid this guideline from ACS does introduce more confusion,” Huff said. “But the important take-away is that the new guideline reaffirms a woman’s prerogative to have screening mammograms — on an annual basis.”

Based on what Huff shared with me and what is reported on the ACS website, here are some key take-aways about the new guideline:

  • Breast cancer deaths are reduced by yearly screening mammography among women ages 40-69.
  • Women of average risk — most women — should begin having screening mammograms every year between the ages of 45 and 54.
  • A woman should be able to have screening mammograms between the ages of 40-44 but it should be her choice in consultation with her health care provider.
  • Women should continue screening mammography every other year after age 55, and should be able to have them every year if they choose.

“Nothing in the guideline says a woman shouldn’t have annual screening mammograms and nothing suggests that insurance plans shouldn’t cover them,” Huff said.

It is important to note that “screening” means check-ups for people who do not have any symptoms (such as a lump) and that the guideline is for women of “average” risk.

On its website, the ACS encourages you to discuss screening mammography with your health care provider by age 40.

The society also recommends sharing family and personal medical history to determine whether you are average or higher risk. And you should make sure you fully understand risks and benefits of screening so whatever choice you make is an informed one.

Asked how he would advise his own wife, sister or daughter about the issue, Huff said he would tell them to begin screening mammography at age 40.

“I believe that the benefits of having a screening mammogram every year, starting at age 40, outweigh any potential harms of doing so.”

Schedule your screening mammogram at the Vanderbilt Breast Center.

Information about the new guideline from the American Cancer Society and how it was developed was published in the Oct. 20, 2015, issue of the Journal of the American Medical Association.