by Dr. Joseph Ebner, Plymouth OB/GYN

It seems that every couple years a new study is published that calls into question the timing of breast cancer screening with mammograms.  This is because medicine is a science, and as a science, our knowledge continues to grow, often adding to current knowledge, but at times replacing our understanding with new information.

To assist physicians and patients in incorporating this new information into clinical practice, health organizations periodically gather their scientific members to review all the data and create clinical guidelines.  Clinical guidelines are recommendations for clinicians about the care of patients with specific conditions.  They are based upon the best available research evidence and practice experience.  Sometimes, the different medical organizations— The American Cancer Society, The American College of Obstetricians and Gynecologists, The World Health Organization, and the U.S. Preventative Task Force (among others)— agree, but at times, they arrive at different conclusions . . .even when reviewing the same scientific studies.

The majority or breast cancers in the US are diagnosed as a result of an abnormal mammogram screening study.  There was an increase in breast cancer incidence through the 1990s, mostly in early stage cancers, that was attributed to increased detection of early stage disease because of screening.  The mortality (death) rate has been decreasing since this same time period, and is currently at its lowest level since 1969 when national statistics began.

Not all women have the same risk for developing breast cancer.  Various prediction tools have been developed that combine major risk factors such as race, ethnicity, family history, and estrogen exposure.  The most widely used tool to calculate breast cancer risk is the Breast Cancer Risk Assessment Tool (BCRAT), sometimes called the Gail Model.  It is available online at www.cancer.gov/bcrisktool/.  This can assist patients and clinicians in developing a customized approach to breast cancer screening with mammography.  A woman with a higher risk of developing breast cancer might choose to have her mammograms performed earlier and more frequently that a woman of lower risk.

At Plymouth OB/GYN we recommend:

• Average-risk women between the ages of 50 – 70 be screened yearly with mammography.
• Women age 40 – 50 should discuss the risks and benefits of mammography with your health care provider.
• The ideal interval screening for women in their 40s is not known, but we suggest screening every one to two years.   Women getting screened for breast cancer also undergo clinical breast examination.
• Women over the age of 70 be screened with mammography if their life expectancy is at least 10 years.

If you have questions or want more information, call Plymouth OB/GYN at (603) 536-1104 to schedule an appointment with Dr. Banister, Dr. Haller or me.