Sylvester Comprehensive Cancer Center

Updated Breast Cancer Screening Guideline – Q&A with Sylvester Breast Radiologist Dr. Monica Yepes

01.13.2016

The U.S. Preventive Services Task Force released new guidelines about breast cancer screening on January 11, 2016. Sylvester Comprehensive Cancer Center breast radiologist Monica M. Yepes, M.D., answers some commonly asked questions, and discusses the recommendations for screening mammography followed by Sylvester.

The U.S. Preventive Services Task Force has announced new guidelines for breast cancer screenings. What are the key recommendations?

The U.S.P.S. Task Force has reissued recommendations reducing the amount of screening in every age group:

  • For women ages 40 to 49, they do not recommend routine screening. The Task Force has indicated that each woman should make an individual decision based on her preferences and health history.
  • For women ages 50 to 74, they recommend mammography every two years.
  • For ages 75 and older, they stress that there is insufficient evidence to recommend for or against routine screening.

How do these recommendations differ from last year’s American Cancer Society (ACS) recommendations?

In contrast to the Task Force, the ACS strongly recommends yearly mammograms for women aged 45 to 54, but indicates that women should have the opportunity to begin annual screenings between 40 and 44. For women aged 55 and older, the ACS recommends screenings every two years, indicating that women should have the opportunity to get a screen annually. Following the ACS guidelines, women should continue to be screened as long as their overall health is good, and they have a life expectancy of 10 years or longer.

What do the recommendations mean for women in their 40s? Should they get annual screenings or not?

Although breast cancer is less common in women in their 40s, incidence data show that 17 percent of all breast cancers occur in the 40-49 age group, and account for 17 percent of breast cancer deaths. In addition, younger women tend to have more-aggressive cancers and therefore benefit the most from early and yearly screening. The Task Force suggests that women in their 40s with a family history of breast cancer may want to screen earlier, yet only 15 percent of breast cancers occur in women with a family history. Therefore if we follow these guidelines, we may miss the chance of diagnosing life-threating cancers in 85 percent of these younger women.

What do expert breast radiologists at Sylvester Comprehensive Cancer Center recommend?

Our goal at Sylvester is to save as many lives as possible in all age groups, with the least amount of unnecessary tests to our patients. In order to do this, we at Sylvester will continue to uphold the recommendations of the American College of Radiology and the Society of Breast Imaging. That means that women of average risk should have yearly screening beginning at age 40 until they have a life expectancy of less than 10 years.

Patients at higher than average risk, such as those who have genetic mutations or who have strong family histories may need to begin screening at an earlier age

Multiple studies over the years, including those that the Task Force reviewed for these new recommendations, have concluded that earlier and annual screening saves more lives. A recent study published in the British Medical Journal demonstrated that smaller cancers have a better prognosis and higher survival rates, regardless of the type of advanced treatment performed. In addition, smaller cancers mean that less aggressive and deforming surgeries and less aggressive chemotherapies can be administered, therefore causing less harm.

Do insurance companies pay for annual screenings?

Patients should check directly with their insurance company. Thanks to a newly approved congressional act called the Protecting Access to Life-Saving Screenings Act (PALS Act), all annual screening mammograms will be covered by the Affordable Care Act for the next two years. For some of the other recommendations given by the Task Force insurers can do otherwise after two years.

What types of mammograms does Sylvester offer?

Sylvester offers state-of-the-art digital mammography with and without 3-D mammography or tomosynthesis, which has demonstrated an increase in invasive cancer detection in multiple international trials. Our radiologists are breast dedicated, board-certified, fellowship-trained breast imagers who are dedicated to early cancer detection, minimally invasive biopsies when necessary and are part of a world-renowned multidisciplinary group of breast cancer care specialists.

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