Just when you thought you had a handle on the latest breast cancer screening guidelines, a new one is offered. But, there is a new twist to these guidelines of which we are big fans. The American Society of Breast Surgeons (ASBrS) recently released their take on breast cancer screenings, and the shining star is that women over the age of 25 should receive a formal risk assessment for breast cancer in order to develop an individualized screening plan.
We LOVE this because, in our community work, we hear a lot of stories like “My cousin was diagnosed with breast cancer at 28. Why don’t we start mammograms earlier?” or “My breast cancer was caught at my first mammogram at 40. I had no symptoms, and I hate to think what would have happened if it hadn’t been caught as early as it was.” People are concerned that screening recommendations come “too late,” and this issue is being addressed in the ASBrS recommendations.
Starting a conversation about breast cancer risk about 25 years before a person reaches the average age of diagnosis reduces the chance of someone who is high risk of falling through the cracks. If a 25-year-old has this conversation about risk with their doctor, they likely will have time to make decisions regarding genetic testing, any risk reduction methods they want to use (such as surgery, medication, or increased monitoring), and any relevant fertility decisions (like egg freezing) before their risk for breast cancer really increases as they get older.
The rest of the ASBrS recommendations are in line with what we have seen in the past: after the formal assessment, women of average risk should begin receiving annual mammograms at the age of 40, those with higher than average risk should begin screening earlier (exact age based on the nature of their increased risk) and perhaps have screening more than once per year. The last recommendation is that a person shouldn’t continue receiving screening mammograms if their life expectancy is less than 10 years. While it is not new, it warrants some additional explanation.
Some people are upset by the thought that their doctor might suggest they no longer need to get screening mammograms, and others make that decision on their own, perhaps prematurely. People are living longer and are more likely to develop cancer as they age, but as people get into their 70s and 80s, it is more likely that someone will die with breast cancer rather than from breast cancer.
If you are in your 70s and 80s and in good health (like my grandmother, who bragged about driving her 90-year-old friend to bridge every week), then it makes sense to continue screening mammograms because if you are diagnosed, you are a good candidate for surgery, treatment, and recovery. But with dementia or complications of heart disease, stroke, or lung disease in one’s 80s and beyond, screening, testing, and even treatment for breast cancer that is likely very slow-growing (due to the person’s age) can place unnecessary physical and emotional stress on someone who will likely not receive long-term benefits. In either case, it’s good to make these kinds of decisions with your health provider, so everyone’s on the same page.
All of this being said, ASBrS is the latest organization making these recommendations, and there are others out there. For the most part, insurance companies follow the screening recommendations from the US Preventive Services Task Force (USPSTF) when deciding what to cover, except, by law, they are required to start covering screening mammograms at 40 rather than the USPSTF recommended age of 50.
The American Cancer Society, American College of Radiologists and Society for Breast Imaging, American College of Obstetricians and Gynecologists, and National Comprehensive Cancer Network all have their own breast cancer screening recommendations, too. What really makes the ASBrS recommendations stand out is the formal call for an early initial conversation and assessment of breast cancer risk. Hopefully, other organizations will follow their lead and encourage doctors to have early conversations on breast cancer with their patients.
If you are over 25 and haven’t yet had a conversation with your doctor about your breast cancer risk, ask for an assessment. To help guide this discussion, take the 5 minute risk assessment created by the organization Bright Pink and bring those results to your doctor to kick start the conversation.
