Cancer Society Issues New Mammography Guidelines
In a major shift, the American Cancer Society (ACS) is scaling back its mammogram guidelines, advising women to start them later in life and to have them less often. The new guidelines say most women should start having yearly breast x-rays at age 45. Then at 55, they should switch to mammograms every other year. And they should stick with this timetable for as long as they're healthy.
In another big change, the ACS no longer recommends clinical breast exams at any age. During these exams, a health care provider checks a woman's breasts for changes that might be a sign of cancer. This is the first time the ACS has updated its guidelines since 2003. Previously, it called for yearly mammograms starting at age 40 and regular clinical exams starting at 20. The new guidelines apply only to women at average risk for breast cancer. Women at high risk-for example, because of certain genetic mutations-need stepped-up screening.
Why the shift?
Though mammograms do find most breast cancers, the x-rays aren't perfect. They sometimes cause false alarms that can lead to unnecessary biopsies. And they can pick up tumors that would never cause harm but are still treated. The ACS revised its guidelines after a thorough review of the benefits and risks of mammograms. That review found that at ages 40 to 44, the risks of false positives and overtreatment were somewhat higher than the risk of getting breast cancer.
But by age 45, this trade-off changed. Mammograms become more beneficial for most women, the review showed. As a result, the ACS pushed back the start of screening to 45. The ACS also now advises less frequent screening at 55 and older since breast tumors typically grow more slowly after menopause. Research also failed to show a benefit to yearly screening after menopause.
As for clinical breast exams, research suggests that they add very little to early breast cancer detection. And they may raise the risk of false alarms.
Room for choice
The ACS encourages women at average risk of breast cancer to talk to their doctors about the benefits and risks of mammograms by age 40.
And the guidelines emphasize that women who want to start yearly screening at 40 should still have that choice. They also say that women 55 and older who want to continue yearly mammograms should have this option too.
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