From Breast Cancer Coilition of Rochester

By Pat Battaglia

cancerdbate

As the Breast Cancer Awareness month of October,
2015 was drawing to a close, the American Cancer Society
(ACS) released new guidelines for breast cancer screening.

Their previous guidelines, in existence since 2003,1
recommended annual screening mammograms for all
women at average risk for breast cancer beginning at age
40. The newly issued guidelines suggest annual screening
mammograms begin at age 45, with bi-annual screenings
from age 55 and on. Women between the ages of 40 and
45 will have the option to undergo yearly screenings after
discussion with their doctors, who will inform them of the
risks and benefits of mammography.2

This news adds fire to the ongoing debate about when
and how often to undergo screening mammography. The
controversy intensified in 2009, when the US Preventative
Services Task Force (USPSTF) released its own set of
guidelines recommending biennial screening for women
age 50 and older. For women between the ages of 40 and 49,
the decision to screen should be individualized. In short, the
advice is to talk to your doctor.

Through it all, the American College of Radiology, the
professional medical society of radiologists, has remained
steadfast in their recommendation that all asymptomatic
women begin annual screening mammograms at age
40.3

Its grassroots Radiology Advocacy Network issued a
call to action in late October 2015 in support of proposed
legislation establishing a two-year moratorium to delay
implementing the USPSTF recommendations for screening
mammography.5

The benefits of mammography are self-evident: detecting
cancers as early as possible in their development, when they
are most treatable, is the goal that has been attained by many.
But mammography isn’t perfect. There can be false positives,
where something that looks suspiciously like a cancer turns
out to be benign upon further testing – a highly stressful
situation for many. Very low-risk cancers can be detected
and subsequently treated that may have never caused health
problems; this is known as overtreatment. But, since it isn’t
currently possible to determine which early-stage cancers will
progress and which will not, all are rightly considered to be a
threat, and all are treated.

And cancers can be missed. Some have found themselves
diagnosed with advanced disease that slipped under the
radar through years of regular screenings. According to the
American Cancer Society, “Despite substantial increases in
the number of cases of early-stage breast cancer detected,
screening mammography has only marginally reduced the
rate at which women present with advanced cancer.”4

All three agencies based the formulation of their
disparate guidelines on solid evidence. Differences can arise
when the same information is reviewed in a different
manner or new information becomes available. And,
despite the quantity of data available for review, not
everything is known that would answer all the questions
arising in this complicated discussion. For instance,
along with those who have been misdiagnosed or
overdiagnosed, there are survivors under the age of 45
or 50 whose cancers were found on routine screening
mammograms. Where do these stories fit into the current
debate? These are voices that need to be heard. And
where do those who, after years of regular screenings, are
devastated to learn of an advanced cancer diagnosis, stand
in this dialogue? Their stories also deserve full attention.

This great debate is confusing for the public and
for those affected by breast cancer. But as the dialogue
continues, there are some important points to remember:

The guidelines in question are for those at average
risk of breast cancer. Average risk is defined as having
no personal history of the disease, or not being a carrier
of a BRCA mutation, or without a history of radiation
to the chest at a young age. The ACS plans to review the
evidence and update its screening recommendations for
women at higher risk for breast cancer.2

The ACS, the USPSTF, and the ACOG all encourage
informed, individualized decision making on breast
cancer screening. Each of us reserves the right to undergo
any screening or other form of health care that we, as well informed
people working with our health care providers,
determine are in our best interest, regardless of age or any
other factors.

Finally, in spite of this often heated debate, we need
to remember we are all in this together. We all seek an
end to this terrible disease that claims the lives of 40,000
women and 400 men every year – a number that has
fluctuated little through the decades. 40,400 people can
fill a medium-sized stadium. Among those 40,400 people
are mothers, fathers, daughters, sons, teachers, lawyers,
doctors, mechanics, builders, poets, artists, scientists;
people with the compassion and energy to make a
difference in our world, who deserved their chance to do
that. It does no one any good to let screening issues divide
us. The most productive dialogue will acknowledge the
strengths and limits of the available evidence and of the
current screening methods while including all points of
view and personal preferences.

When all is said and done, what really matters is to
eventually see the day when breast cancer is no more, or at
least becomes a conquerable nuisance. To that end, finding
the disease in the surest way possible is one very important
piece of the larger picture.

1. http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/chronological-history-of-acsrecommendations
2. http://jama.jamanetwork.com/article.aspx?articleid=2463262
3. http://www.acr.org/
4. http://www.nejm.org/doi/full/10.1056/NEJMoa1206809
5. http://www.acr.org/Advocacy/eNews/20151120-Issue/20151120