American Cancer Society’s mammogram guide adopted

by Dr. Reenaben Patel, MD
For The Review

When should a woman start getting mammograms and how often should she have one? Various health organizations and physician societies have offered differing opinions on this important topic in recent years.

This has led to great uncertainty among patients and their providers as to the most appropriate method to screen adult women for breast cancer.

To minimize this uncertainty and establish uniform guidelines for breast cancer screening throughout Aurora Health Care, Aurora’s Breast Cancer Quality Subcommittee — comprising 31 clinicians in primary care, oncology, radiology and breast surgery — now recommends that clinicians and patients follow the American Cancer Society’s (ACS) most recent guidelines for breast cancer screenings.

Why did Aurora breast health specialists decide to endorse the American Cancer Society (ACS) guidelines? Since their publication in 2015, the ACS guidelines have met with almost universal adoption.

They are felt to be a compromise between the very aggressive previous guidelines and the much more conservative 2009 guidelines of the US Preventive Services Task Force.

Medicare covers screening mammograms per the ACS guidelines, as do most private insurers, but patients need to check with their own health insurance plan for coverage details.

Here is a summary of the recommendations:

• Beginning at age 25, women should be regularly asked questions related to family history of breast and other cancers, to determine whether they qualify for consultation with a genetics counselor.

• Beginning at age 30, women should be assessed as to whether they are considered average risk, intermediate risk, or high risk for developing breast cancer in their lifetime.

• Women determined to be high risk should be considered for referral to a breast health specialist for consultation.

• Those patients determined to be intermediate risk should have annual screening mammogram beginning at age 40.

• Women determined to be average risk may be offered screening mammogram at age 40, if the woman and her clinician choose to do so, but annual screening mammograms should start by age 45.

• At age 55, patients can transition to every other year screen- ing if they choose.

• Screening mammograms should be discontinued when a woman is not expected to live more than 10 more years.

As new data has been published, there has been recognition that breast cancer is uncommon in young patients, and systemic therapy is more effective. For example, 1,900 women in their 40s would need to be screened for 10 years to save one life.

Also, because of greater breast density, screening mammograms in young patients are frequently associated with false positives and negative biopsy, with the associated anxiety and pain, risk and inconvenience.

In older patients, screening mammogram every other year is almost as effective as annual mammogram. There is also growing concern that there can be over diagnosis and overtreatment in populations that screened too aggressively.

Your health care provider may ask you questions to determine your individual risk for developing breast cancer, such as:

· Have any of your first or second-degree relatives on either side of your family been diagnosed with breast cancer at age 45 years or younger?

· Is there a family history of male breast cancer on either side of your family?

· Is there a family history of ovarian cancer (not cervical or uterine cancer) on either side of your family?

· Has anyone on either side of your family been diagnosed with a BRCA1 or BRCA2 gene mutation?

· Do you have three or more relatives who have had breast cancer on the same side of your family?

Dr. Reenaben Patel, MD specializes in internal medicine at Aurora Health Center in Sheboygan, 2414 Kohler Memorial Dr. Her office can be reached at 920-457-4461.

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