Adhering to cancer screening recommendations can save lives and empower women to take control of their health. But different options and recommendations have left some patients confused at best; at worst, they are so frustrated that they dismiss their screenings all together.
"In the interest of scientific integrity, people want to know the definitive answer for screening," said Dr. Harry Bear, chairman of the division of surgical oncology at Virginia Commonwealth University. "But as long as we keep arguing, we continue to keep women confused."
Early detection has been the mantra in preventing cancer deaths. The following pages intend to clear up any confusion that some women may have regarding their own screenings.
The American Cancer Society currently recommends that women in good health start getting yearly mammograms at 40 years old. Women should also get a clinical breast exam at least every three years starting at age 20, and every year after age 40.
But some oncologists question the recommendation by the ACS.
"There are some uncertainties," said Dr. Harold Burstein, a medical oncologist at Dana-Farber Cancer Institute. "Everyone agrees that, by age 50, women should start screening mammograms. The utility of mammograms in women aged 40 to 50 is more controversial."
Burstein said that the incidence of breast cancer is lower in younger women, so the test is less likely to find a real cancer. Younger women also tend to have greater density in their breasts, which can reduce the ability for the mammogram to find small lesions.
"Finally, younger women are more likely to develop breast cancers that are more aggressive, which means that early detection may be slightly less valuable," continued Burstein.
Despite the limitations, Burstein, along with many other breast oncologists, follow ACS guidelines and encourage women to start their screening around 40 years old. That is, if the woman is not at an elevated risk of the disease.
Women who have a mother or sister who had breast cancer or carry the BRCA1 or BRCA2 genetic mutations are at a substantially higher risk of the cancer.
"Women who are at particularly high risk based on family history or known genetic mutations should consider starting at a younger age," said Bear. "One suggestion is that those women who are at high risk should start getting mammograms five years earlier than (the age when) their youngest, close relative was diagnosed with breast cancer."
The American Cancer Society also recommends that women who are at high risk be screened with an MRI in addition to a standard mammogram. But that number is small: only about 2 percent of American women will need to have the supplemental tests.
For years, breast oncologists highly recommended the monthly breast self-exam, but recent research shows that the self-exams may do more harm than good by increasing anxiety and causing unnecessary biopsies and follow-ups in women.
"Doctors have gone back and forth on the self-exam," said Bear. "I think it's worthwhile for women to know what their own breast feels like, but there has been less emphasis on the monthly self-exam, as it generated more anxiety than useful information."