Breast Cancer Action’s Screening Recommendations
The confusion that emerged in response to the new USPSTF screening recommendations in 2009 prompted us to convene a BCA Screening Revisions Taskforce. After five months of review and research, BCA has released its Screening Recommendations and Policy to clarify the benefits of breast cancer screening and to offer recommendations for women of all ages on how to make fully informed decisions about screening.
The recommendations that follow are for women who are not at elevated risk of breast cancer.
Excluded from these recommendations are women with inherited genetic risk for or family history of the disease, women with a history of chest radiation treatment, and African American women. The first two of these groups were specifically excluded from the 2009 U.S. Preventive Services Task Force (USPSTF) Guidelines. The risks facing African American women were, however, not acknowledged, although many of the studies on which the new guidelines were based did include them.
Because we believe these issues to be critically important, the Breast Cancer Action (BCA) policy includes more information specifically on African American women. The specific needs of other women of color are not addressed in this policy because it is unclear at this time to what extent their needs are the same or different from those of African American or white women.
The rationale and support for these recommendations are explained in the accompanying Policy on Breast Cancer Screening and “Early Detection.” There is still a great deal we do not know about risk for breast cancer, and people need to consider their own circumstances as they review these recommendations.
For non-African American women with no family history of breast cancer, no prior history of significant chest radiation, and no elevated risk for breast cancer, BCA recommends the following in terms of breast cancer screening:
• Beginning at menopause (one year following cessation of menstruation).
• Every other year until age 75.
• After 75, at intervals that take into consideration their other health conditions.
Women who are younger than age 50 and particularly concerned about breast cancer may wish to consider earlier mammography but should be aware of the higher risks of false positives, the reality that mammography is less effective in premenopausal women, and the risks of radiation from both screening and unnecessary treatment. These women may want to consider other forms of breast cancer screening, including clinical breast exam.
Clinical Breast Exam
• Ideally, every year or at least once every three years.
Women should begin having a clinical breast exam (CBE) when they begin receiving care from a women’s health provider but at least by age 21. CBE can be performed by anyone who has been formally trained to do it. The provider does not need to be a doctor.
Know Your Body
• How to go about this is a matter of individual choice.
Since a third of all breast cancers are found by women themselves, they should know the size, shape, and feel of their breasts. Any changes should, of course, be reported to a health care provider and pursued according to the wishes of the individual.
Getting Informed, Making Choices
Once a woman is fully informed about the pros and cons of each breast cancer screening method, she should make her own decision about whether or not to make use of the tool. The care a woman receives should not be based on the type of insurance or financial resources to which a woman has or does not have access. BCA believes all women should have access to the same choices about breast cancer screening (see our policy onuniversal access to care).
Women should be informed that mammograms, as well as CBEs and self-examination, do not always detect breast cancer — thereby yielding “false negative” results (when a detection method fails to find a breast cancer that is present). In addition, mammography, CBE, and self-examination yield false positive results, which lead to additional interventions and occasionally unnecessary and harmful treatments. The tools can also detect cancers that can be treated and thus reduce a woman’s risk of dying from the disease.
How women make decisions about the balance between risks and benefits is based on individual values and preferences. The guide below will help women talk to their doctors about breast cancer screening.
Policy Implications/Next Steps
BCA’s work on screening and early detection advances the organization’s overarching goals, recognizing that breast cancer detection requires us to look beyond mammography. Accordingly, we work to (1) promote better tools for detecting breast cancer that are not radiation based, (2) support research to effectively distinguish between types of breast cancer, and (3) make sure that everyone has access to the best tools and care available. This is part of BCA’s work to put patients first. BCA believes that attention and resources should be focused on improving screening methods for both younger and older women, understanding and addressing the experiences of populations with unequal distribution of disease, and developing better treatments for the kinds of breast cancer that we are currently unable to treat effectively.
Talking to Your Doctor
The following questions may help a woman initiate a conversation about breast cancer screening with her health care provider.
- I am interested in your opinion, but I am going to make my own decisions. Can you work with me?
- How do you evaluate my personal risk for breast cancer, and what do you consider in evaluating that risk?
- Do you recommend I get a mammogram? Why?
- At what age do you recommend that all women get a mammogram?
- What do you see as the risks and benefits of a mammogram for me at my age?
- What alternatives might be available to me if I don’t want to get a mammogram?