Since I started practicing medicine in 1976 the American Cancer Society, The American College of Radiologists, and the American College of Obstetricians and Gynecologists have all been in agreement on the necessity for breast cancer screening in adult women. Annual breast exams by a trained examiner were recommended beginning at age 19. Breast self-exam was taught in most hygiene classes and by educators in physicians’ offices and was felt to be an inexpensive screening test.
It made great sense that early detection saved lives. It made greater sense that individual patients who educated themselves about the normal feeling of their breasts during different phases of the menstrual cycle were more likely to detect an early change and seek medical attention.
Mammograms were recommended for women on an annual or every other year basis beginning at age 40 and then annually from age 50 and above. There were always individual variations for women who were at high risk or who had a family history of breast cancer at a young age but, for the most part, breast cancer screening suggestions were not controversial or forever changing.
In November 2009 the United States Preventive Task Force, the same group who questioned the efficacy of yearly physical exams and chest X rays annually on cigarette smokers, issued its revised guidelines. They cited the large number of biopsies done of women between forty and fifty for what turned out to be benign fibrocystic breast disease rather than cancer. The biopsies were often the result of an abnormal breast self exam finding a new lump, an abnormal professional exam and or a spot on a mammogram which was equivocal.
Citing the cost and anxiety involved in evaluating a breast abnormality and using research studies as evidence they suggested not teaching or using breast self exam. They additionally recommended changing the initial mammogram back to age 50 unless there was agreement between the patient and physician that their individual needs justified the test. With women living longer and breast cancer occurring frequently in the elderly, they suggested no longer performing screening mammograms after age 75.
These recommendations have led to great controversy and confusion in the profession and general public. In a recent Harris Interactive Poll 45% of the women questioned felt the USPTF pushed back the recommended age to 50 to reduce health care costs and avoid administering tests. Eleven percent of those polled thought mammograms should begin at age 20 even for women with no risk factors, while 29 percent believe mammograms should start in their 30’s.
What is clear is that confusion reigns. Consultation with your doctor using your family history, personal history of age at the start of menses, pregnancy history, smoking history and medication history will all contribute to the decision when to start breast imaging screening and how often.
I still support breast self exam and an annual exam by a trained practitioner who examines the same patient annually. As physicians and educators, we need to do a far better job of educating ourselves and the public about the reasoning behind recommended changes to health screenings.
Filed under: Cancer, Concierge Medicine, Diagnosis, Health Care, Health Screenings, Medical Doctors, Prevention and Treatment, Specialist Care, Women's Health | Tagged: American Cancer Society, Breast Cancer Screening, Breast Exam, Mammogram, OBGYN, United States Preventive Task Force, Women | Leave a comment »