The American Cancer Society’s new guidelines calling for less frequent mammography is “wrong” and could cost some women their lives, a breast cancer expert says.
“Since the 1990s, annual breast cancer screening is the only thing that has been proven to decrease breast cancer rates,” Kathleen A. Ward, M.D., medical director of breast imaging at the Loyola University School of Medicine, tells Newsmax Health.
The ACS announcement on Tuesday signaled a major shift in the organization’s stance in the continuing controversy over mammography. The advocacy organization is recommending that women at average risk of breast cancer get annual mammograms starting at age 45 rather than at age 40, and that women 55 and older scale back screening to every other year.
Previously, the society had been in the forefront of recommending an aggressive, annual screening program for women beginning at the age of 40. But that earlier stance had put the ACS at odds with the United States Preventive Services Task Force, which is the government health agency charged with putting out health guidelines.
The Task Force recommends mammograms very other year for women ages 50 to 74. In 2009, the agency ignited a firestorm of protest when it advised against routine annual mammograms for women in the age 40 to 49, drawing protests from the ACS, among others.
At that time, women’s health advocates had charged that the Task Force’s recommendations had been economically motivated, and Dr. Ward says now she is concerned that the ACS is following suit.
“I think it is likely that this decision is economically motivated and comes from a desire to cut healthcare costs, but there are other places that we could be doing that,” she says.
Breast cancer is one of the four most common cancers, and the second most frequently diagnosed form of the disease, after lung cancer. This year, 231,840 new cases of invasive breast cancer will be diagnosed and 40,290 deaths are expected in the United States.
In issuing its new guidelines this week, the ACS stressed that the recommendations apply only to women at average risk for breast cancer — those with no history of the disease or known risk factors based on genetic mutations, family history, or other medical problems that would make them more likely to develop the disease.
Women at greater risk for breast cancer should consult their doctors about the benefits of annual mammograms, and other screening techniques, as early as young adulthood, experts advise.
Although Dr. Ward had been expecting the ACS to issue new guidelines, she was “very surprised and disappointed,” to learn them on Tuesday, she says.
“This is the wrong thing to do,” she adds. “When I started in this field, the recommendation was to do a baseline mammogram between the ages of 35 and 40, and to do annual mammograms in recognition that these cancers grow more quickly in younger women.”
But, even though such cancers grow more slowly in older women, not getting an annual mammogram will put them at risk, Dr. Ward says.
“There are subtle changes in a woman’s breast that takes place and they are going to be missed,” she notes.
Dr. Ward acknowledges that part of the controversy leading to the call for later and less frequent mammograms is a concern over the large percentage of “false positives,” which can lead to overtreatment, such as biopsies, that put not only an economic cost on the healthcare system but extract an emotional toll on the women themselves.
“Having spent 30 years in the field, I am very concerned about the issue of overtreatment,” says Dr. Wade, but she firmly believes that the benefits of mammography outweigh the drawbacks.
“Annual mammography is the best tool we have to find breast cancer early, so it can be treated without the need for disfiguring surgery or toxic chemotherapy.”
Although these new ACS guidelines are more in line with those of the Task Force, the majority of major health organizations still call for annual mammograms, including the American College of Radiology, the Society of Breast Imaging, the American College of Obstetrics and Gynecology and the American College of Surgeons, Dr. Wade notes.
In announcing the new guidelines, the ACS was careful to stress that women should still make the final decisions in conjunction with their doctor. Although the organization no longer recommends mammograms for women ages 40 to 44, it said those women should still “have the opportunity” to have the test if they choose to, and that women 55 and older should be able to keep having mammograms once a year.
Also, the Task Force has been inching towards a more conciliatory stand on mammograms.
In a recent draft of updated guidelines that have not yet been finalized, the agency acknowledged some women in their 40s may benefit, and said the decision of screening women in their 40s should be based on individual discussions between a woman and her doctor.
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