Pretty in Pink…

Pretty in Pink…

October is Breast Cancer Awareness month, in case you have missed the pink parties, pink posters, pink NFL attire, and mobile mammogram vans! Personally, I think that the NFL would be better served by taking the money spent on pink socks, pink towels, Bose headphones with pink logos, pink sneakers, etc. and donating it to the Susan G. Komen foundation, but that’s a discussion for another day.

So, in honor of Breast Cancer Awareness month, let’s talk mammograms! This is particularly important, as the American Cancer Society released new guidelines last fall for mammogram screening.  So, here are the current recommendations:

The American College of Obstetricians and Gynecologists recommends yearly mammogram screening for all women starting at age 40. The US Preventive Services Taskforce recommends mammogram screening every other year starting at age 50.  Now, the American Cancer Society has revised its guidelines to recommend yearly mammogram screening starting at age 45, and if all tests are normal the recommendation is for mammograms every two years starting at age 55.  I know, clear as mud, right?

So, what does this mean for us? I can guarantee I will be getting a lot of questions from my patients about what to do, and as a woman who will shortly need to start getting this required test, I have been thinking about what this means for me personally!

First, let’s look at a few key points. The recommendations above are for women of average risk. This is the majority of women in the US today.  Who are high risk women?  If you have a personal history of breast cancer or a pre-cancerous breast lesion you are high risk.  If you have multiple family members with breast or ovarian cancer, a first degree relative (mother or sister) with breast cancer, a family member with breast cancer at a young age (pre-menopause), or have the BRCA gene mutation, you are also in a high risk group.  If you are in this high risk group, the recommendations above do not apply.  Do not pass Go, do not collect $200.  You should discuss the optimal screening strategy with your primary care doctor, and may want to consider seeing a breast specialist for a tailored plan.  For the rest of us, keep reading!

I am often asked, what is the downside to getting mammograms at an earlier age? Well, when we go looking for things we are bound to find them, right?  Performing mammograms on young women who have denser breast tissue may make it more likely to uncover abnormal findings, which leads to more testing, mammograms, ultrasounds, biopsies, and possibly lumpectomies.  These tests are not without pain and complication and can produce a significant amount of anxiety!  So, it’s important to screen deliberately, and with preparation for all possibilities.  In the past 10-20 years there has been a huge spike in the number of women undergoing the procedures above, and many of these turn out to be “false alarms,” or benign problems.

The flip side is that breast cancer is the second most common cancer in women (skin cancer is #1, stay tuned for a future post on sunscreen!). Chances are, we all know someone who has been personally touched by breast cancer, so I think we would all agree that it’s important to do routine screening.  After all, with the advances in treatment over the past decade, breast cancer has become an extremely treatable disease that most women are surviving!

So, what to do? I actually think that the recent revision in the American Cancer Society guidelines makes a lot of sense.  Delay screening until 45, do it annually for about 10 years and if everything is clear start screening every 2 years.  It’s important to note that the scientific literature on the subject would actually indicate that starting at age 50 is reasonable (in Europe and Canada they start screening at age 50 and screen every other year).  However, the literature is old, and all parties involved in making these recommendations would agree we need new studies and newer data.  Those will be underway, but in the meantime we will make decisions based on the best information we have now.

Bottom line: Talk to your primary care doctor or your OBGYN.  Discuss your personal risks, comfort level with screening, and develop a plan.  After all, we’ve only got two breasts, and we need to take care of the girls!



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