At what age should you screen for breast cancer?
Breast cancer screening guidelines can be confusing, especially when the various medical groups update or change their guidelines and are not always aligned with one another.
Recently, the National Comprehensive Cancer Network (NCCN) published new guidelines for breast cancer screening, which stated that women should undergo a breast cancer risk assessment beginning at age 25 and those with average risk should begin annual mammography screening starting at age 40. But, you may not need to revise your screening plans.
“The NCCN guidelines updates are not new, they just revised theirs to fit other guidelines that have been around for a while,” said Jill Oxley, MD, FACS, a breast surgeon at Cape Cod Healthcare Breast Surgery - Hyannis. “One of my pet peeves is how many different guidelines there are.”
The list is long when it comes to organizations who have guidelines for screenings.
There is the NCCN, American Society of Breast Surgeons (ASBrS), the American College of Radiology (ACR), The American College of Obstetricians and Gynecologists (ACOG), the Society of Breast Imaging (SBI), and the American Cancer Society (ACS).
The Centers for Disease Control & Prevention (CDC) has a chart that compares all of the various organizations’ guidelines.
The ACR and SBI updated their recommendations in 2017 followed by the ASBrS in 2019, explained Dr. Oxley. They recommend women start their mammograms at age 40 if they have an average risk for breast cancer. The NCCN guidelines fit with SBI, recommending women have a risk assessment at age 25 and the ACR recommends the assessment is done by age 30, especially women who are Black or have Jewish ancestry.
“Most women will not know their risk without a formal risk assessment,” Dr. Oxley said.
3 Ways to Clear up the Confusion
To help women cut through the confusion about breast cancer screening, Dr. Oxley recommends the following:
- If you are 25 or older, talk with your physician, whether it is your primary care provider or your gynecologist, about doing a formal breast cancer risk assessment. If that is not available to you, the risk assessment can be done at Cape Cod Healthcare Breast Surgery - Hyannis.
- If you are a woman with average risk, most guidelines agree to start annual screening mammograms at age 40.
- Women at a higher risk can have a supplemental screening with MRI as young as 25 and screening mammograms can start at age 30. Higher risk can be due to a family history of breast or ovarian cancer, inherited BRCA 1, BRCA 2 or other genes, or other personal factors.
Four breast cancer misconceptions
Dr. Oxley also noted there are misconceptions about breast cancer screening that can keep women from being proactive with their screening. They include the following:
- If I don’t have a family history of breast cancer, I don’t have to worry. “Most women with breast cancer don’t have a family history and don’t have a genetic mutation,” said Dr. Oxley.
- Radiation exposure can cause cancer. “The dose of radiation is a very low dose,” she said. 3D mammography (breast tomosynthesis) is the gold standard of breast imaging, and is available at all three Cape Cod Healthcare breast imaging centers.
- Breast self-exam causes unnecessary anxiety. “I am a big fan of self-breast exams,” said Dr. Oxley. “I’ve had more than one patient who has found her own cancer, especially in women under 40 who are not having routine screening mammograms. If there is an abnormality found, it is easy to have it evaluated and diagnosed.”
- Women over 70 no longer need mammograms. “The revised NCCN guidelines say there is no upper age limit for mammograms. Most groups agree that if a woman is of average risk, is in good health and her life expectancy is at least 10 years, she can continue to have screening mammograms. For women with a high risk or personal history of breast cancer, they should continue longer.”
“Breast cancer continues to be the most commonly diagnosed cancer in women,” said Dr. Oxley. “Survival is highly dependent on the stage of the diagnosis and with screening mammography, we are able to detect the majority of breast cancers at very early stages, when the disease is limited to the breast and has not spread to lymph nodes or distant body parts.”
