American Cancer Society has recently revised the breast cancer screening guidelines and they were featured in the a recent article in JAMA.
The most significant change has been the age of starting mammographic screening, which has been increased from 40 to 45 years. This change has been made after taking into account the lower incidence rate of breast cancer in this age group. Another factor which led to the delay in initiating screening was the higher number of false positive mammograms observed within this age group.
- Women with an average risk for breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation).
- Women aged 45 to 54 years should be screened annually (qualified recommendation).
- Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation).
- Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation).
- Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation).
- The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation)
These guidelines are quite different from those of the US Preventive Services Task Force (USPSTF) and this is a cause of concern & confusion among patients. The following table highlights the differences between the two guidelines:
|Mammography Screening Parameter||ACS||USPSTF|
|Starting age (y)||45||50|
|Screening frequency||Annually to age 54 y, then biennially||Biennially, beginning at age 50 y|
|Stopping age (y)||For as long as a woman is in good health and has a life expectancy of at least 10 y||75|
|Total lifetime mammograms if screening continued to age 74 y (n)||20||13|
|Lifetime risk of dying of breast cancer (%)||1.8-1.9||2.0|
|Lifetime risk of dying of breast cancer with no screening is 2.7%.|
Do these guidelines affect Indian patients?
Well, firstly India has no screening guidelines and only opportunistic screening is practiced by a very small segment of the population. Secondly, there are some studies which say that Indian breast cancer occurs at an earlier age and therefore screening should be initiated early.
These questions be answered if proper trials on this topic are carried out in the country. For the time being, we should lay more stress on creating awareness regarding breast cancer.