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Breast Cancer Debate

October 1, 2016 11:45 am Published by

Have you heard about the current debate over breast cancer screening? It is a hot and heated topic. We are all at risk for breast cancer, even our male counterparts. Our risks increase with our age. Well, ladies, age is the current debate. What age is best to start breast cancer screening if you have no family history or risk factors?

Let’s look closely at this debate. This has come about due to the new recommendations by the U.S. Preventive Services Task Force (USPSTF). This task force is now recommending that a woman starts her routine breast cancer screening NOT at age 40, but ten years later, meaning at age 50. To be clear, this is if you have no family history of breast cancer or risk factors like dense breast, history of chest radiation or other medical concerns. The recommendation also states that mammogram screenings not be done annually but every 2 years unless medically indicated otherwise. The reason behind this is that the benefit of a mammogram increases with age and the evidence supporting mammograms truly finding cancer starts at age 50. You may be feeling mixed emotions at this thought, especially if breast cancer has hit close to home.

The USPSTF was created in 1984 as an independent panel of national medical experts who volunteer to review current healthcare practices and then compare this to our evolving knowledge of evidence-based medicine. Based on this review, this panel then makes recommendations that aim to improve the health of all Americans through screening, counseling or primary care medical services offered. Our U.S. Congress has authorized this panel to convene annually to present any needed recommendations to affect change to improve our healthcare practices. The topic at present for them is now breast cancer screening. The Panel believes that the evidence supporting the practice of performing mammograms prior to age 50 in the general population may not warrant the risks to women of a younger age. They now recommend that mammograms done between the ages of 40 to 49 be done after a discussion between Patient and Health Care Provider any then only perform every 2 years. This is a direct contrast to the recommendations by the American College of Obstetrician Gynecologists (ACOG). ACOG recommends that a mammogram be done starting at 40-years old and continue annually. USPSTF has also found that the evidence supporting mammograms after age 75 is “insufficient to assess the balance of benefit and harm.” According to ACOG, it is again a decision between Patient and Provider, as we know the risk of breast cancer does increase with age.

In Medicine, we work hard to keep Patients safe no matter the task at hand. We are constantly assessing the balance of risk and harm, hoping the odds favor true benefit rather than harm. The most common harm that a mammogram could impose on a woman prior to age 50 is an inaccurate result. You may have received that dreaded call, “Ma’am we need you to return for additional imaging.” If an initial mammogram is not conclusive, then additional tests and procedures must follow. For example, if a 40-year old woman is told her mammogram is concerning for breast cancer, she then goes on to have more imaging and ultimately a breast biopsy. The biopsy shows normal breast tissue. The initial mammogram was therefore wrong. Could this biopsy have been avoided? Did this biopsy cause harm? Does this cause unnecessary anxiety or added discomfort to a woman? What are the overall costs to society? Bottom line, is it all worth it? This is the argument. The battery of tests and procedures following this initial inaccurate screening result leads to major costs to our healthcare system.

I can tell you, there is a great divide in medical opinion about how and when breast cancer screening should be done in the United States. As an Obstetrician Gynecologist, our national organization, The American College of Obstetrician Gynecologists, has held firm, that at present, we believe it is best to start breast cancer screening at age 40 for ALL women. We also feel it is a personal decision and discussion between you and your healthcare provider, and the decision to start annual mammograms even sooner is based on your family and medical history. I feel strongly that the present debate might also place our personal choices, access to screening and medical insurance coverage in jeopardy. Many commercial insurance carriers do alter their coverage based on recommendations like that of the USPSTF It is therefore so important that we remain knowledgeable and an active voice in this debate.

Let me show you some of the evidence for breast cancer that we know at present. Unless you have a family history of breast cancer, we all have a 1 in 8 risk of developing breast cancer in our lifetime. Meaning, think of you and 7 other of your girlfriends. One of you will develop breast cancer in your lifetime. If you have a family history, the chances are even higher. To make this even more real to you, let’s look at the evidence.

The lifetime risk of breast cancer by age is as follows:

  • In our 20s, 1 woman in 1,760 has a chance of breast cancer.
  • In our 30s, 1 woman in 220 has a chance of breast cancer.
  • In our 40s, 1 woman in 69 has a chance of breast cancer.
  • In our 50s, 1 woman in 42 has a chance of breast cancer.
  • In our 60s, 1 woman in 29 has a chance of breast cancer.

Do you see how age and our risk of breast cancer relate? If we delay breast cancer screening until age 50 and then only perform a mammogram every other year, how many women would be affected by a missed or delay in diagnosis of their breast cancer? It is important to discuss and consider this debate, not just from a personal perspective, but to help educate and advocate for all women and our health. Breast cancer screening is proven to play an important role in diagnosing breast cancer early, and therefore improving a woman’s chances for survival through early treatment and ultimately a cure. The pain to lose a loved one from a completely detectable and survivable cancer cannot be described.

You have the power to be a part of this ongoing debate and the time is now. One would think it is only logical to find breast cancer fast and find it early, right? Well, unfortunately with this and really any cancer screening, it is not so simple. It is a matter of evidence-based medicine, meaning we track hard evidence about current medical practices and patient outcomes. This information is then used to apply a recommendation or practice, which is best for the entire population. It is not just a matter of medicine sadly, but of access, effectiveness, cost and certainly insurance coverage. The guidelines for insurance coverage follow recommendations created by our national organizations and governmental guidelines. It is therefore important to be a part of the conversation as decisions are made.

For our current debate over breast cancer screening, you may become involved by contacting your local government representative, discussing with your healthcare provider and the U.S. U.S. Preventive Services Task Force has invited you to participate and voice your opinion by going to their website: www.screeningforbreastcancer.org

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This post was written by Marie Rowe

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Dr. Marie Rowe, who is the author of the Greenville Women's Clinic Blog

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