American Cancer Society recommends annual mammography starting at age 45

After a little over a decade, the American Cancer Society has published guidelines for screening for the average-risk population. These guidelines provide some flexibility on the initiation of screening mammograms but strongly recommend starting at age 45. As this is an average-risk population, and the rate below this age is low and the rate of false positives is increased (due to dense breast tissue), this recommendation is based on good logic.

The question of frequency of screening is a little more challenging. The authors provide sound rationale for biennial screening after the age of 55. Unfortunately, patients are often hesitant to “skip a year” and this may be harder to enforce. Secondly, practitioners are often slow to adopt new practices as noted by changes in Pap test guidelines. Though this is a reasonable recommendation, it will take some education for patients to understand and will likely be less followed, at least in the beginning.

The final question of when to stop screening is fantastic. As mostly left-brain thinkers, we are often set on an actual age, completely disregarding the health of the patient. As the life expectancy of women in the United States is nearing 80 and many are surviving beyond that age with a high functioning status, consideration of this factor will allow for screening in women who can undergo management (if required) with favorable outcomes. Though practice changes take some time, it is likely that these recommendations will reduce unnecessary costs without impacting outcomes.

Given the substantial reduction in overall mortality, breast cancer screening is an integral part of women’s health. Providers in obstetrics and gynecology are often the primary source of education and the ordering team for breast cancer screening. Thus, it is critical for us to stay current on the recommendations for screening as well as the identification of high-risk women, allowing for well-informed decisions regarding individualized screening.

Dr. Ritu Salani is associate professor in gynecologic oncology at The Ohio State University, Columbus. Dr. Monica Hagan Vetter is a third-year resident in ob.gyn. at The Ohio State University. They reported having no financial disclosures.