Major shift in mammogram guidelines

By Shen Gao
Staff Writer

October is Breast Cancer Awareness month. While some may be aware that early detection and diagnosis could save lives, most people are not yet aware that due to a variety of factors, over-diagnosis and over-treatment run rampant among patients with varying stages of breast cancer.

(Photo from BookGirl/Foter.com)
(Photo from BookGirl/Foter.com)

Previously, the American Cancer Society has advised women to start getting mammograms at age 40. Recently, this guideline has been updated to reflect the newly developed understanding that globally, most women will not develop breast cancer during their lifetime, and that screenings may cause more harm than good for women younger than 45. The new guidelines state that women should start to get annual mammograms starting at age 45, and cut back on the frequency to once every two years starting at age 50.

Out of all breast cancer diagnoses through mammogram screenings, DCIS accounts for roughly 20 to 25 percent of the cases. DCIS, also known as Stage O breast cancer, is a form of non-invasive breast cancer in which abnormal cells are confined to milk ducts only. Many breast cancer patients, regardless of their disease stage, are recommended to go through chemotherapy and even mastectomies. However, doctors are learning that the traditional one-size-fits-all technique is not working anymore.

This year, more than 40,000 women will die of breast cancer in the U.S. An interesting thing to note that this annual statistic has, roughly, not changed since 13 years ago. The mortality risk of someone with breast cancer is 3 percent, which is close to the average for the general population. The chance of a woman being diagnosed with invasive breast cancer is 1 in 800 in the U.S.

In addition, some patients with Stage 1 or Stage 2 breast cancer, after receiving a double mastectomy, gain about 1 percent survival benefit in the span of 20 years – not very much. For women ages 70 and older, finding breast cancer and receiving treatment will very unlikely alter their lifespan. In response, the new guidelines also indicate that women should receive regular mammograms as long as they expect another 10 years to live. This may be done to prevent over-diagnosis in older women.

The side effects of chemotherapy are life-altering. The follow-up treatments after surgery are numerous, and an increased risk of depression comes with major treatments and surgery. Undergoing feelings of loss of femininity and sexuality after a mastectomy is not unheard of. Additionally, many patients receive biopsies in response to a suspicious area on the x-ray, which ends up not being cancerous at all.

The traditional belief is that tumors grow at a steady rate, and once they get to a certain size and start spreading, that person is in trouble. This was the rationale behind the “early detection saves lives” belief — which is true, screenings has helped save many lives. But the center of the problem is that, often doctors cannot distinguish between low-risk tumors and invasive ones. What’s more, experts are now stating that many breast cancers are “indolent” — slow-growing and not causing any symptoms, much less put a person’s health in trouble.

In addition, having the mammogram technology translates to the detection of more cases of cancers. This is not to say mammograms are not important; in fact, they are a valuable tool. The problem is, doctors will have to decide with what to do with the additional cases that they find. Ultimately, finding a personalized treatment plan that matches the severity of the disease and corresponds to the patient’s beliefs and desires in regards to risk is what will work — whether it be active surveillance or aggressive treatment.