What a difference six years make. Back in November 2009, a federal task force recommended, after a careful review of the scientific evidence, that routine mammograms were unnecessary for most women under the age of 50 and that a mammogram every other year was sufficient for women aged 50 to 74.
Those recommendations were widely — and sometimes viciously — attacked, including by top officials at the American Cancer Society, who insisted that women receive annual mammograms from age 40 onward. Delaying mammograms and reducing their frequency would lead to more deaths, those critics claimed.
But that was then. This is now. For on Tuesday, the American Cancer Society released its own updated guidelines for breast cancer screening — guidelines that have inched considerably closer to the ones vilified by the organization and others back in 2009.
The American Cancer Society now recommends that women start having mammograms at age 45 and continue with them annually through age 54 (the age by which almost all women have experienced menopause). At that point, women can switch to every-other-year mammograms — a pattern that can remain in place for as long as the women remain healthy and have a life expectancy of 10 years or longer.
(The results of a study published Tuesday in the journal JAMA Oncology add support to the recommendation that women do not need annual mammograms after menopause. The study found that the interval between mammograms — whether one year or two years — had no significant effect on the size or stage of a tumor at the time of diagnosis.)
The American Cancer Society also said it was no longer recommending clinical breast exams — the physical exams conducted by physicians to look for breast lumps. Previously, the organization had suggested such exams start at age 40.
The new guidelines, which were published in the Journal of the American Medical Association (JAMA), are for women with an average risk of breast cancer. The American Cancer Society will be publishing guidelines next year for women who are at high risk of developing the disease — those with breast-cancer-associated genetic mutations, for example, or who have a personal or strong family history of invasive breast cancer.
Individual decisions
The American Cancer Society emphasizes — as does the United States Preventive Services Task Force (USPSTF), which issued those now-vindicated 2009 guidelines — that women should be allowed to individualize their screening decisions to reflect their own personal concerns and preferences.
Still, after decades of being told incessantly by their doctors and groups like the American Cancer Society that “early detection saves lives,” many women are going to find it difficult to accept the now well-established finding that the annual ritual of a screening mammogram isn’t that important when it comes to breast cancer outcomes.
But it isn’t.
As an editorial that accompanies the new guidelines points out, “the vast majority of women who are diagnosed with breast cancer will do well regardless of whether their cancer was found by mammography.”
The converse is also true, says the editorial: “[A]bout 85% of women in their 40s and 50s who die of breast cancer would have died regardless of mammography screening.”
Indeed, a study published earlier this year in JAMA Internal Medicine found that the most prominent effect of routine mammograms has not been a reduction in deaths, but an increase in the overdiagnosis of breast cancer — the detection of tumors that are not life-threatening and that would have gone unnoticed without the screening. Overdiagnosis leads to unnecessary and sometimes harmful procedures and treatment.
A ‘flawed philosophy’
Many breast cancer advocates have long been frustrated by what Karuna Jaggar, executive director of Breast Cancer Action, has called “the flawed philosophy behind the ‘early detection’ tenet of the breast cancer awareness movement.”
“How will we ever hope to make desperately needed progress in the breast cancer crisis when the mainstream breast cancer movement continues to push an outdated and scientifically debunked agenda?” she wrote last year in the Guardian. “ The evidence has been mounting that the time has come to radically re-think the tenets of the breast cancer awareness movement, because it is clear that the fundamental philosophy behind ‘early detection’ is flawed.”
The American Cancer Society’s new guidelines — and the accompanying editorial — can be read in full on JAMA’s website.
