Start When You Are 50
The standard schedule of starting screening mammograms at age 40 may soon change, and breast cancer prevention strategies would be improved, according to the U.S. Preventative Services Task Force. Women may not begin to have screening mammograms until they are 50, and they may cease doing breast self-exams altogether, if the newest guidelines for breast cancer screening from the USPSTF are widely adopted. In Canada and the United Kingdom, 50 is already the age at which screening mammography is begun. These new guidelines may have an impact on what health insurance providers will pay for.
The U.S. Preventative Services Task Force, a branch of the U.S. Department of Health and Human Services, has updated its recommendations for breast cancer screening. After using computer simulation models to project the results of different screening strategies, the task force said that they recommend the changes because they want to cut down on the "harms" and risks of testing, which they believe do not outweigh the benefits. They cite too many false positives, unnecessary biopsies, anxiety, or in short, overdiagnosis. Their November 2009 guidelines suggest:
- Women between 40 and 49 years old should not be having routine screening mammograms. Instead, they say that women should make an informed decision about screening mammography before 50, and weigh their potential risks and benefits with their doctors.
- Women who are 50 to 74 years old should be having a screening mammogram every other year, because the risk for breast cancer increases as you age.
- Women over 74 years old are not given specific guidelines about routine screening mammography - as their risk of death from heart disease and other ailments is greater than from breast cancer.
- Women of any age should not be taught to do breast self-exams, but BSE is not forbidden.
- Clinical breast exams will not be required before screening mammograms, because CBE appears to add no benefit to the information gained from a mammogram.
In 2002, the USPSTF guidelines for breast cancer screening stated that women 40 and older should have annual mammograms to screen for breast cancer. The American Cancer Society and the National Cancer Institute have also agreed on screening mammograms for women ages 40 to 70. The The American Cancer Society will maintain their recommendation to start screening mammograms at age 40.
Mammography is not a perfect tool and neither is a breast self-exam. But it seems odd to take away these two tools, which we have been told are important, for women aged 40 - 49. This same battle has been fought before, in the mid-1990s. It was resolved by 1997, when the National Cancer Institute agreed to support mammograms for women in their forties.
In an editorial published in Annals of Internal Medicine, Dr. Karla Kerlikowske says that the focus should shift from screening and early detection to breast cancer prevention interventions. But for this to be effective, Dr. Kerlikowske says that we need a better risk model, more research on prevention, and standards "for routinely assessing risk factors, calculating breast cancer risk, and reporting risk to women and providers in an easily understandable format." Couldn't we wait, until more research has been done, before we change screening guidelines? Won't women be more at risk for ten years of their lives, if they are not having a mammogram and doing their self-exams?
I'm all in favor of better prevention - but I want it to include lifestyle changes, diet recommendations, exercise programs, and ways to detoxify your environment, as well as better breast imaging technologies and guidelines, and better risk assessment. Yes, I still want The Cure - but I want to prevent breast cancer even more - so that someday soon, nobody will have to hear the words, "You have breast cancer."
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