DOVER — The medical community has pushed back after the American Cancer Society released new guidelines for breast cancer detection earlier this month. Women have long been encouraged to have an annual mammogram starting at age 40 and regular breast exams, but the new guidelines suggest annual mammograms from ages 45 to 55 and mammograms every other year after that. Dr. Wendy Newell, a surgeon at Wolf Creek Surgeons, in Dover with 21 years experience in cancer surgery, said the new recommendations do not align with what she has seen as a physician over the years. “Women between 40 and 50 are still very productive members of society and we’re seeing increasing rates of breast cancer in these women,” she said. “It’s important to start screening early because it isn’t necessarily breast cancer that’s becoming more common, it’s that the cancer is diagnosed earlier.” And along with earlier detection comes better outcomes. It could be the difference between having radiation a few times a week or chemotherapy and minimally invasive surgery or a mastectomy. The cancer society said its new guidelines were determined by a detailed evidence review by an external group to study new data from which a guideline committee conducted a comparison of screening benefits versus harms. Although breast cancer is more difficult to detect in younger women because they typically have denser breast tissue, Dr. Newell said studies have shown about nine in every 1,000 mammograms for women between 40 and 50 years old will diagnose cancer. “Even though the chances are small, even if it’s only nine in a thousand, that’s nine more lives we can save,” she said. Dr. Newell isn’t the only one advocating starting annual mammograms at age 40, the Delaware Breast Cancer Coalition, the state’s leading breast cancer network and source of breast cancer information, is doing the same, following the cue of the Delaware Cancer Consortium. Mammogram Guidelines
The revised guidelines from the American Cancer Society:
• Women with an average risk of breast cancer should begin yearly mammograms at age 45
• Women should be able to start the screening as early as age 40, if they want to. It’s a good idea to start talking to your health care provider at age 40 about when you should begin screening.
• At age 55, women should have mammograms every other year — though women who want to keep having yearly mammograms should be able to do so.
• Regular mammograms should continue for as long as a woman is in good health.
• Breast exams, either from a medical provider or self-exams, are no longer recommended.
— Information provided by the American Cancer Society.[/caption] The American Cancer Society argues that for younger, low-risk women, a regular mammograms could be physically uncomfortable, and perhaps painful for some, and waiting for a call back on a suspicious area could cause anxiety. According to the society, less than 10 percent of those called back for additional tests are diagnosed with cancer. “Although guidelines may differ regarding the age at which routine screening should begin, there is agreement that mammography is the best available tool for detecting breast cancer and that women and their health care providers should decide when those screenings should begin for individuals,” Dr. Judy Salerno, CEO of Susan G. Komen, said of the new guidelines. Another problem Dr. Newell sees with the new recommendations is that more frequent screening is suggested for women at a higher risk of breast cancer. “The reality is that 80 to 90 percent of women who get breast cancer have no one else in their family who’s had it,” she said. “So it’s really difficult for a doctor to pick who is high risk and should have more frequent screenings if most women have no family history.” The good news is that physicians aren’t mandated to follow American Cancer Society recommendations so doctors like Dr. Newell can continue to advise their patients to follow the traditional annual screening guidelines. Dr. Newell also added insurance companies will continue to cover annual mammograms beginning at age 40 and some will cover the test beginning at 35. But Susan G. Komen for the Cure mentioned in its statement that even though the society’s guidelines don’t bind doctors to any screening regulation, they are concerned the guidelines have the potential to influence future coverage of screening and mammograms, reducing accessibility and coverage for many women. But for now, the cancer society’s new guidelines are nothing more than that: guidelines. Patients should continue to follow their physicians’ advice. Patients are advised to consult with your doctor beginning at age 40 about screening options and alert them to any changes in your breasts, either in appearance or abnormalities you may feel.   Editor's Note: To read more about the fight against breast cancer in Delaware, visit Hope, our recent special section on breast cancer awareness.