What to know about new mammogram guidelines

Questions remain but sometimes common sense still works best.

What guidelines are we talking about?

The American Cancer Society has issued new recommendations on when women should get mammograms and how frequently they should get them. It isn’t the only group that issues guidelines on this screening test but it is considered among the most influential.

Question: Why did they make these changes?

Answer: There’s some research that shows a woman’s risk of getting breast cancer and dying from it goes up at around age 45. While the risk still exists at 40, it’s somewhat lower but the risks from false positives are somewhat greater.

The decision about stopping screening for women with a shorter life expectancy is a recognition of the unnecessary emotional and physical toll interventions may have on someone who may be more likely to die with a breast cancer tumor than from it.

The recommendation against manual breast exams doesn’t mean that doctors shouldn’t do them if they want to — just that they shouldn’t feel obligated to do so.

Q: How do I know if I’m at average risk or not?

A: There isn’t a consensus about what this means, but there are a few different methods of calculating your risk in the medical literature. If you have a gene variant like BRCA1 or BRCA2, a family history of breast cancer, or have had cancer in other parts of your body, you are likely at higher than average risk.

Q: Why is there so much disagreement about mammograms?

A: Medical experts agree that mammograms save lives and that they are the best thing a woman can do to reduce her risk of dying from breast cancer. What they disagree on is how many lives are being saved (whether it’s a huge number of lives or a really huge number of lives), the extent of the problems with over diagnosis and false positives and what this means about when the benefits outweigh the risks.

Q: Wait — what harms? I thought mammograms were just X-rays and non-invasive.

A: They are. Part of the issue is emotional. The science of mammograms isn’t exact and a significant number of women are recalled to take another mammogram after the first, causing a lot of anxiety. Sometimes those second mammograms are inconclusive or show something that might be a tumor and the doctor orders a biopsy to make sure.

Q: I still don’t know what to do. What advice is the ‘best’?

A: The best thing you can do is to learn more about the potential benefits, limitations and harms associated with breast cancer screening and to make sure to talk to your doctors about what makes sense for you.