When I heard the news that the American Cancer Society revised its guidelines for mammograms and clinical breast exams I thought about my friend Julie. She was diagnosed at the age of 44 with stage 4 breast cancer and died two years later. No family history; average risk. A mammogram found Julie's tumor. Under the new guidelines Julie may not have had that mammogram. Neither would have other women I know diagnosed in their early 40s with early stage breast cancer who are still alive thanks to early detection.
Despite criticisms that mammograms can result in false positive reports, especially for younger women who may have dense breasts which makes tumors harder to detect, they still remain the most reliable test to screen for breast cancer.
Under the new American Cancer Society guidelines women ages 45 to 54 with average risk should have annual mammograms. Women ages 40 to 44 should have the choice to start having annual mammograms if they want. Women age 55 and older should switch to mammograms every two years or can choose to continue yearly screening. So what happens in the "off years" when a tumor may be sprouting?
The ACS also states:
Research does not show a clear benefit of physical breast exams done by either a health professional or by yourself for breast cancer screening. Due to this lack of evidence, regular clinical breast exam and breast self-exam are not recommended. Still, all women should be familiar with how their breasts normally look and feel and report any changes to a health care provider right away.
I found my tumor examining my breasts as did many women I know. Diagnostic screening confirmed it was cancer. Under the guidelines will women think less about examining their breasts? The ACS implies manual screening may not matter.
But it does. The health of your breasts is now more than ever in your hands. This means:
1. Understanding your risk. This includes family history of breast cancer and any other cancers. There was no history of breast cancer in my family but there were other cancer (e.g., prostate, pancreatic) that flagged my doctor to recommend genetic testing.
2. Knowing if you have dense breasts and discussing with your doctor what you can do to be more proactive with your screening. Dense breasts have less fatty tissue and more non-fatty tissue making tumors harder to detect.
3. Discussing other possible factors that may impact genetic risk with your doctor. For example, women with an Ashkenazi Jewish background have a higher risk (8-10 percent) of carrying the BRCA1/2 genetic mutation.
4. Choosing to decide at what age to start having annual mammograms and continuing to have clinical breast exams as well as monitoring your breasts monthly.
The more proactive you can be at an earlier age about your health the better. Breast cancer in younger women can be more aggressive.
But will you? I understand the rationale: False positives can put women through emotional angst and result in unnecessary tests and procedures. Even more concerning than a false positive is the false sense of security women, especially younger women, may have about their breast health. They may be less vigilant about examining their breasts each month or hesitant to undergo mammograms before age 45. But wouldn't you rather know than not know so you can face the facts head on and beat the cancer beast at an early stage rather than a later one if the results are positive?
I know Julie would agree if she were here today.