Debate Continues Over Breast Cancer Screening

Categories: Winter 2015
The American Cancer Society (ACS) released new breast cancer screening guidelines in October. This has added to a continuing discussion over balancing the advantages of early detection with the risks of overdiagnosis and overtreatment of breast cancer, which is the second leading cause of cancer death among women in the U.S.

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The new ACS guidelines recommend that most women start mammography screening annually at age 45 years. At age 55 years, women can undergo screening every 2 years, or choose to continue screening annually. Screening should stop when a woman’s life expectancy is less than 10 years.

The ACS recommendations differ from the U.S. Preventive Services Task Force (USPSTF)’s breast cancer screening guidelines released in 2009. The USPSTF recommends that women wait until age 50 to begin having mammograms, and that screening should be every other year instead of annually. Screening should stop at age 75, regardless of life expectancy.

Both groups say that women younger than the recommended age to start screening can choose to undergo screening based on individual risk factors that put women at high risk of developing breast cancer. Examples of risk factors are family history of the disease or certain genetic mutations.

Differing views of harms and benefits

The two groups’ differences in recommendations stem from their contrasting views about balancing the benefits and potential harms of screening. Panel members in both groups reviewed a large amount of data from many studies, yet came to different conclusions.

The benefit of detecting cancer early is that early-stage cancers are easier to treat, and the chance of survival is higher. However, mammograms are not perfect in younger women because the breast tissue is denser, making it harder to see potential cancers. This can increase the chances of having a falsepositive test that results in additional testing and procedures, such as biopsies that later prove to be unnecessary. Mammograms can also find low-risk cancers that would not cause any health problems if they hadn’t been detected or treated.

Similar debates are ongoing regarding early detection for prostate cancer. The USPSTF currently does not recommend PSA screening, yet other groups, such as the National Comprehensive Cancer Network (NCCN) recommends using a baseline PSA test to determine risk level, then basing the age at which to start screening and screening intervals upon this risk stratification.

Ultimately, cancer screening should be an individual decision based on personal risk factors. Discuss with your doctor the best screening approach for you.

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