Following the lead of the United States, a Canadian task force of experts on disease screening and prevention (the Canadian Task Force on Preventive Care) made important changes to its breast cancer screening recommendations in November 2011.
The changes are:
- Routine breast cancer mammogram screening for women with an average risk of breast cancer should start at age 50 instead of 40.
- Women age 50 to 74 should be screened every 2 to 3 years instead of every 1 to 2 years.
- MRI should not be used for breast cancer screening in women with average risk.
- Breast self-exam isn't recommended and doctors shouldn't routinely recommend it to any women.
In November 2009, the U.S. Preventive Services Task Force (USPSTF) made similar recommendations. These were very controversial and were not adopted. U.S. guidelines call for all women age 40 and older to have screening mammograms every year. While not ideal, some women may choose to have a screening mammogram every other year.
It might be hard to understand how experts could ever recommend less breast cancer screening. Still, both the U.S. and Canadian recommendations are based on a number of considerations.
The recommendation to delay screening until age 50 is based on information showing that more than 2,100 women age 40 to 49 would have to be screened every 2 to 3 years for 10 years to prevent one breast cancer death. Besides the cost of performing and reading the mammograms, these screenings would result in nearly 700 false positives and 75 unnecessary breast biopsies. A false positive is an area on a mammogram that looks like cancer but turns out to be normal. The cost of a false positive includes the expense of more tests (biopsies, for example), follow-up doctor visits, and possibly even treatment that isn't needed, along with the stress and worry about being diagnosed.
To compare, only 721 women age 50 to 69 would have to be screened every 2 to 3 years for 10 years to prevent one breast cancer death. The Canadian and U.S. experts believe that these statistics show that mammogram screening for women older than 50 makes sense, while demonstrating that mammograms don't make sense for women age 40 to 49.
It's important to know two things about the Canadian task force recommendations:
- While task force members believe the new screening recommendations make sense for women with average breast cancer risk, the recommendations also urge each woman to discuss her screening choices -- such as breast self-exam and mammograms before age 50 -- with her doctor and make a decision based on her unique situation.
- The recommendations only apply to women who have average breast cancer risk. The task force acknowledged that women with higher-than-average risk should have a more aggressive breast cancer screening plan that may start before age 50.
Breastcancer.org acknowledges some of the arguments against routine mammograms, but the evidence against annual mammograms starting at age 40 isn't clear. Breastcancer.org believes that all medical decisions, including if and when to screen for breast cancer, should be made by each woman and her doctor based on the best available information and a woman's beliefs and preferences.
Breastcancer.org continues to recommend that if you're 40 or older and have an average risk of breast cancer, yearly screening mammograms should be part of your healthcare. If your breast cancer risk is higher than average, you should talk to your doctor about a more aggressive breast cancer screening plan that makes the most sense for your particular situation.
There's only one of you and you deserve the best care possible. Don't let any obstacles get in the way of your regular screening mammograms:
- If you're worried about cost, talk to your doctor, a local hospital social worker, or staff members at a mammogram center. Ask about free programs in your area.
- If you're having problems scheduling a mammogram, call the National Cancer Institute (800-4-CANCER) or the American College of Radiology (800-227-5463) to find certified mammogram providers near you.
- If you find mammograms painful, ask the mammography center staff members how the experience can be as easy and as comfortable as possible for you.
For more information, visit the Breastcancer.org Mammograms pages.