Mammography screening should start when a woman is 40 years old, and should be offered yearly from that age, says the American College of Obstetricians and Gynecologists (ACOG). The new guidelines are in response to the USA’s high breast cancer rate, ACOG added that the death rate can be significantly reduced if breast cancer is detected early.

Previously, ACOG had recommended screenings start at 40, but then offered every two years, and yearly after 50.

ACOG guidelines co-author, Jennifer Griffin, MD, MPH, explained that the new recommendations are due to three main factors:

  • Current breast cancer incidence
  • The sojourn time for breast cancer growth – the time between identifying it in a mammogram when it is small and before it becomes large enough so that the patient experiences symptoms. The sojourn time varies, depending on the patient. However, age is the main predictor. For women aged 40 to 49 it is about 2 to 2.4 years, while for females aged 70 to 74 it is from 4 to 4.1 years.
  • The potential to reduce death rates

Dr. Griffin said:

“Although women in their 40s have a lower overall incidence of breast cancer compared with older women, the window to detect tumors before they become symptomatic is shorter, on average.”

If a woman’s breast cancer is detected very early on – before the tumor is palpable, and when the cancer is confined to the breast – she has a 98% chance of surviving at least five years.

Dr. Griffin added:

“If women in their 40s have annual mammograms, there is a better chance of detecting and treating the cancer before it has time to spread than if they wait two years between mammograms.”

ACOG now recommends:

  • Yearly CBEs (clinical breast exams) for females aged at least 40 years
  • CBEs every one to three years for those aged from 20 to 39

ACOG also encourages women aged 20+ to be “breast self-aware”. More sophisticated screenings are not in the guidelines for women of average risk under the age of 40. It is only advised for those who are at high risk of breast cancer. Examples of enhanced screenings include MRIs or mammograms.

Breast cancer is the second largest cancer killer of women in the USA, after lung cancer. Breast cancer rates have dropped 2% annually between 1999 though 2006. Death rates have also been falling steadily. ACOG believes that this drop may be masked simply by the fact that fewer women are being screened, and therefore not diagnosed.

Gerald F. Joseph, Jr, MD, Vice President for Practice Activities of ACOG, said:

“The good news is that fewer women are dying from breast cancer because of earlier detection and improved treatments.”

Clinical Breast Exam (CBE) – these can help identify breast cancer earlier on, especially if accompanied with mammograms. ACOG advises all females aged 40+ to have an annual CBE with a qualified doctor. Evidence for the benefits of CBEs for women under 40 is unclear. However, ACOG advises women aged 20 to 29 to have a clinical breast exam every one to three years.

Breast Self-Awareness – the old breast self-exam has developed into a newer concept, known as breast self-awareness. Breast self-exams are done once a month; they are done systematically. Breast self-awareness is more ongoing; the woman is taught to understand what the normal appearance of the breasts should be, what to expect, feel their breasts, but not in specific intervals or using a certain system of examination. ACOG believes that women aged 20+ should be trained for breast self-awareness.

Dr. Griffin said:

“The goal here is for women to be alert to any changes, no matter how small, in their breasts, and report them to their doctor. Although we’ve moved away from routinely recommending BSEs, some women will want to continue doing them and that’s OK.”

“Practice Bulletin #122 “Breast Cancer Screening”
Obstetrics & Gynecology August 2011 issue

Written by Christian Nordqvist