What New Breast Cancer Screening Recommendations Mean for You
The latest debate over breast cancer screenings may leave you with more questions than answers. At what age should you begin mammography screenings? And how regularly do you need them? Are breast self-exams really a useful early intervention? Are clinical breast exams a beneficial supplement to mammography?
New recommendations released in November 2009 from the U.S. Preventive Services Task Force (USPSTF) have called breast cancer screening recommendations into question and have sparked debate and disagreement among breast health experts. So what does it all mean for you?
First, let's break down the new recommendations from the USPSTF. These recommendations are for women at an average risk for breast cancer. Specifically, the new guidelines:
- Recommend against routine screening mammography in women ages 40 to 49. The guidelines suggest that when women reach age 40, they talk with their doctors about the best time to start regular, every-other-year mammography. Other groups -- including the American Cancer Society (ACS) -- disagree, recommending yearly mammography beginning at age 40 for women who are at average risk for breast cancer.
- Recommend that women ages 50 to 74 have screening mammography every other year, rather than yearly
- Say that there's not enough evidence to determine if the benefits of mammography outweigh the risks for women 75 and older
- Recommend against breast self-exams, which women have been urged to do routinely, because evidence does not show that they have helped lower breast cancer death rates
- Say that there's not enough evidence to measure the value of clinical breast exams for women ages 40 and older. A clinical breast exam is a physical inspection of the breast to check for lumps or other changes. It is performed by a health care provider
The ACS and the American College of Radiology (ACR) strongly disagree with the new guidelines. The ACR considers the new guidelines a reversal of progress.
But a USPSTF spokeswoman says the new guidelines are part of the task force's standard re-review of all preventive health topics every five years, and are the result of a careful analysis of benefits and risks. For instance, early detection and reduced breast cancer deaths were compared with false-positive results, which can cause anxiety and require more testing.
While the debate rages on among experts, here's what you need to know about breast cancer screenings:
- Mammography. Mammography is an important tool for detecting breast cancer early on, when it's easiest to treat. But the benefits and limitations of mammography vary based on factors like age and personal risk. Women should talk with their doctors about their personal risk factors before making a decision about when to start getting mammograms or how often they should get them.
- Breast self-exams. While the USPSTF does not recommend breast self-exams, the ACS says they are an option for women 20 and older as a means of familiarizing themselves with their breasts so they can notice changes more easily. Talking with your doctor about the benefits and limitations can help you decide if you should start performing these self-exams.
- Clinical breast exams. The ACS recommends clinical breast exams at least every three years for all women in their 20s and 30s, and annually for women ages 40 and older. The USPSTF, however, believes there is not enough evidence to assess their value for women ages 40 and older. The new recommendations do not address clinical breast exams for women younger than 40. Women should talk with their doctors about their personal risk factors and make a decision about whether they should have a clinical breast exam.
Always consult your physician for more information.
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The American College of Obstetricians and Gynecologists (ACOG) is a professional organization of women's health care physicians. Its new guidelines on cervical cancer screenings were also released in November 2009.
The old rules: Previously, ACOG advised women to start annual cervical cancer screening with Pap tests three years after beginning sexual activity, or at age 21, whichever came first.
The new rules: Starting at age 21, a woman should begin having Pap tests every other year. At 30, she can cut back to every three years if she's had three normal results in a row. Most women can safely stop at age 65 or 70, or after a total hysterectomy.
Why they changed: Only one in a million cases of cervical cancer is spotted before age 21. Screening can cause anxiety and unnecessary treatments in younger women. In addition, some follow-up tests and treatments could affect a woman's ability to have children later on.
What other experts say: About 25 medical organizations, including ACOG and ACS, met in 2009 and agreed: Pap tests before age 21 have little benefit. Several groups, including the ACS, will update guidelines accordingly in 2010.
The bottom line: Women with HIV, weak immune systems, or other risk factors for cervical cancer should still get annual Pap tests. And a yearly gynecological exam could benefit the rest. Ask your doctor about the best schedule for you.
Always consult your physician for more information.
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