Today, the American Cancer Society made a long-overdue shift in its breast-cancer screening recommendations, finally aligning itself with scores of studies that have documented the pitfalls of mammograms for decades. Since 2003, the ACS has suggested that women get annual mammograms and clinical breast exams after age 40, making it one of the most prominent cheerleaders for early and frequent screenings.
The new guidelines advise that women without heightened risk of breast cancer begin annual mammograms at age 45 and switch to every other year when they reach age 54, as long as they’re expected to live for another decade. This recommended decrease in screenings may seem backwards, but it makes sense in the arc of a woman’s aging body. After menopause, tumors that arise are less likely to be the more dangerous, fast-growing kind; and a woman’s breast tissue changes, making her mammograms easier for doctors to decode. The ACS has also categorically withdrawn its support for clinical breast exams, wherein a medical practitioner feels for breast abnormalities with his or her hands.
If young women never get clinical breast exams or mammograms, how will they ever find out if they develop breast cancer? The ACS’s new recommendations seem to leave breast self-exams as the only option; a doctor who sees and feels a person’s breasts once a year (and many, many more breasts in the interim) may not be able to recognize the kinds of suspicious changes that the patient could identify by feeling her own breasts every month. But self-exams have been widely discredited by medical authorities, too, for begetting the same kinds of unnecessary biopsies and treatment for non-life-threatening cancers that mammograms do.
In the end, it comes down to a numbers game. Of course, some lives would be saved by more frequent breast screenings, but the breast cancers most likely to be found in a screening mammogram (that is, not a diagnostic one, which is performed when a patient already has symptoms or a lump) are ones that are never fated to become invasive or life-threatening. And by the time a screening detects the most aggressive, metastasizing cancer, it’s nearly always too late. The cancers in the middle—the life-threatening ones that a mammogram can catch early enough to halt—are extraordinarily rare. One thousand 50-year-old women have to get annual mammograms for an entire decade to save just one life.
As an advocacy group, the ACS’s power is directly proportional to the number of people who have had cancer or believe themselves to be at risk for cancer; it is not an impartial scientific or medical organization. Like the Susan G. Komen organization, which has pushed aggressive breast-cancer screening under the philosophy that only you can prevent your own death from breast cancer—and reiterated that position in response to the ACS’s new standards—the ACS has endorsed early-and-often mammograms despite their risk of false positives and over-diagnosis. Over-diagnosis by mammogram can perpetuate a cycle of pro-mammogram myth, too. A person whose mammogram caught a slow-growing cancer that would have never caused her health problems becomes a cancer survivor; she believes that the mammogram saved her life, and testifies to the efficacy of the test.
Medical research provides no satisfying answer for concerned patients looking for the best way to reduce their risk of suffering and dying of undiagnosed breast cancer. Mammograms, breast self-exams, and clinical breast exams have all led to unnecessary medical treatment for benign breast abnormalities or non-invasive cancers. When we’ve been told over and over again that it’s our responsibility to prevent our own death from breast cancer, it’s hard to turn around and kick our vigilance down a notch—but for now, that’s the best we can do.