I have always felt that part of my medical title is a gender misnomer: “Fellow of the American College of Obstetricians and Gynecologists” (abbreviated FACOG). But then I guess “Fellowette” would sound weird. Every gynecologist who finishes her or his accredited residency and subsequently passes the written and oral boards becomes a FACOG of what we, the initiated, fondly call the College.
The College has recently issued new breast cancer screening guidelines, which, indeed, comply with what most physicians were already suggesting to our patients. But to do away with any confusion, I want to officially pronounce them…
They now recommend that mammogram screenings be offered annually to women from the age of 40. Previous College guidelines recommended mammograms every one to two years starting at 40 and annually beginning at age 50. The chief reason for this change is the issue of “sojourn time”. This is defined as the time between when breast cancer may be detected by a mammogram while it is very small, and before it grows big enough to become symptomatic (and can be felt). The greatest predictor of sojourn time is age. Women ages 40 to 49 have the shortest average sojourn time (2-2.4 years), while women ages 70 to 74 have the longest average sojourn time (4-4.1 years). So although the incidence of breast cancer is less in women in their 40′s, the window of opportunity to detect tumors before they grow is shorter than that of women after the age of 50. The five-year survival rate is 98% for women whose breast cancer tumors are discovered at their earlier stages. Waiting two years between mammograms in this younger age group may be too late for early detection and treatment.
Having stated this, the College does not recommend mammograms before 40 unless a woman is high risk for breast cancer. If she is, then earlier mammograms, frequent clinical breast exams and annual MRI (magnetic resonance imaging) may be recommended. Breast MRI is not recommended for women at average risk for developing breast cancer.
Other recommendations of the College include:
Clinical Breast Exams (CBE): This should be done by your physician annually after the age of 40. CBE is felt to help detect breast cancer, particularly when used along with mammograms. Although the benefit of CBE isn’t clear for those younger than 40, the College continues to recommend CBE every one to three years in women ages 20-39.
Breast Self Awareness (BSA): This is the new term used instead of self-breast exams. Studies have indicated that the oft taught self breast exam, (you know start at 12:00 and kneed all your breast tissue with the opposite hand, either in quadrants or clockwise), has not shown a decrease in breast cancer mortality. On the other hand, we can’t discount all the women who have found their own lump and proceeded to have breast conserving and life saving surgery. So the College now recommends that women “understand” the normal appearance and feel of their breasts, and if they sense a change, no matter how small, that they report it to their physician.
Age Limit for Mammograms: The College has not reached a consensus on this, although, apparently the benefits of screening decline with increasing age compared with the harms of over treatment. So women over 75 should discuss whether to continue getting mammograms. (I feel that if a woman at that or greater age is otherwise healthy and expects to maintain her relative health for the next decade or more, she should continue to get those mammograms!)
We’re seeing fewer deaths from breast cancer… early detection as well as better therapies are helping. So let’s keep abreast of guidelines for both and maintain this trend.