The latest recommendations for breast cancer screening

Apr 29, 2017

For many women, breast cancer screenings are an important consideration for their health and peace of mind. In recent years, however, screening recommendations have changed, and some may be left unsure of what to do. When is the right time for a baseline mammogram? And how often again after that?

To answer these questions and more, “Take Care” was joined by Dr. Jane Charlamb, director of the Division of Breast Health and Lactation Medicine in the Obstetrics and Gynecology Department at SUNY Upstate Medical University. Charlamb’s clinical practice focuses on benign breast disease, breast cancer screening, and prevention in high risk women.

First and foremost, Charlamb explains, screening is meant to find cancer in a healthy individual while it is still easily treatable, so it is more likely her life will be saved. So what does it mean when screenings aren’t meeting these goals, but rather causing more problems than they solve?

False alarms, for example, are a big issue in cancer screenings. It is, undoubtedly, quite alarming for your doctor to tell you they want to run a biopsy because they might have found something. How frustrating, then, only to have the biopsy show there was nothing to worry about. Not only are these appointments time consuming, but they can be costly and of course, stressful.

Further, over diagnoses are not unheard of. Sometimes, Charlamb says, the body can rid itself of small cancers on its own. But if that cancer is uncovered in a screening, the patient may undergo chemotherapy, radiation, and even surgery, when it wasn’t actually necessary. Again, this is costly, very time consuming, and unimaginably stressful for the patient.

These issues, among others, have led to a shift in thinking surrounding breast cancer screenings. Previously, the recommendation for a baseline mammogram was during a woman’s 30s. And once she reached her 40s, annual screenings were the norm. But new research suggests mammograms aren’t a one-size-fits-all for every woman.

Nowadays, no one recommends mammograms in an average-risk woman during her 30s, according to Charlamb. Today, from the American Cancer Society to the United States Preventive Services Taskforce, it is widely accepted for a woman to have a baseline mammogram in her 40s. And from 40 to 50, the frequency of screenings should ultimately depend on the individual. Talking to your doctor, Charlamb says, is the best recommendation she can give in the decision to screen or not to screen. 

Another norm that’s beginning to change is the monthly breast self-exam. According to Charlamb, women who conduct self-exams do indeed find more lumps than those who don’t, and thus, undergo more biopsies. Unfortunately, however, they aren’t finding more cancer. The new thinking, she says, is that women who are aware of their own bodies are often the ones who find genuinely problematic cancers. The key, she says, is knowing how your body felt before, so you can feel the difference when something isn’t right.

The recommendations will likely always change, Charlamb adds. But thankfully, with all the advancements in biomedical technology, new screening options are changing how doctors and patients find cancer. For instance, 3-D mammography, or tomosynthesis, is a mammogram option that provides a much better visual. Unlike a standard 2-D mammogram, a 3-D mammogram is a series of small X-rays pieced together to make one organized 3-D image, making it much easier to see through dense tissue as well as prevent further unnecessary studies.

There are also breast ultrasound (or breast sonogram) technologies, which use sound waves to develop an image of the breasts. The ultrasound on its own is not the strongest screening option, but for women with dense breast tissue, it can support a mammogram in developing an accurate visual. MRIs are another method as well, although Charlamb notes that they are typically reserved for high-risk individuals, as it is such a strong screening option. The good news is, these technologies are only improving with time.

“It’s all a moving target,” Charlamb says. In another 10-15 years, doctors will likely be making different recommendations as research and technology continually change. But while the screening possibilities may change, and age recommendations may fluctuate, the important thing is to speak with your doctor. Through conversations regarding individual risk, the pros and cons of screening, and the options available, patients are able to make the best decision for themselves.