Moffitt Onco Update

Moffitt's Position on Breast Cancer Screening Guidelines

November 01, 2015

Moffitt's Position on Breast Cancer Screening Guidelines.jpg Available at All Moffitt Locations, Tomosythnesis 3D Mammography Can Increase Invasive Cancer Detection Rates by 40% Compared with 2D Mammograms Alone

Background

The American Cancer Society (ACS) released revised guidelines for screening mammography utilization, which were published Oct. 20, 2015, in the Journal of the American Medical Association.

These guidelines apply only to women at average risk of developing breast cancer. The ACS and USPSTF agree that screening mammography saves lives and that the most lives are saved when annual screening mammography begins at age 40. The new guidelines demonstrate that if a woman and her physician want to reduce her risk of dying from breast cancer as much as possible, they would choose annual screening mammography beginning at age 40.  The American College of Radiology (ACR), Society of Breast Imaging (SBI), National Comprehensive Cancer Network (NCCN), and American Congress of Obstetricians and Gynecologists (ACOG) continue to recommend annual screening mammography for average risk women for ages 40 and older.

Resources on the benefits and drawbacks of screening mammography: 

Moffitt Cancer Center’s Position

To maximize the number of lives saved, Moffitt Cancer Center recommends annual screening mammography beginning at age 40 for women at average risk. Consistent with the ACS recommendations, Moffitt supports a woman’s right to choose when to begin screening mammography and the screening interval, provided she is well informed by her doctor about the benefits and drawbacks.

It’s important to note that the ACS and USPSTF guidelines apply only to women at average risk. Women with a family history of breast cancer, a personal history of breast cancer or other high-risk breast lesions, certain genetic mutations, or a history of chest radiation are NOT considered average risk. Women at high risk may require other breast cancer screening tests in addition to annual screening mammography, like breast MRI. Furthermore, high-risk women may need to begin screening mammography and/or other breast cancer screening tests as early as age 25.

Please share these important facts about screening mammography with other health care providers and patients:

  1. Breast cancer deaths have decreased by at least one-third after the introduction of widespread screening mammography, including in women ages 40-49.
  2. Early breast cancer detection saves more lives and also means less extensive surgery, fewer mastectomies, and less need for chemotherapy.
  3. Increasing age is the second most important risk factor for breast cancer development. However, one in six breast cancers are diagnosed in women ages 40-49.
  4. 40 percent of the life-years saved from screening mammography are for women diagnosed in their 40s or younger.
  5. 75 percent of women diagnosed with breast cancer have no family history. Screening only high-risk women, or using a risk-based approach to decide when to begin or how frequently a woman should undergo screening mammography, will miss many breast cancers.
  6. The vast majority of false positive screening mammograms require only additional mammogram or ultrasound images. Only 1-2 percent of women recalled from screening mammography have a subsequent needle biopsy. Almost all (98 percent) patients who have experienced a false positive result still wish to undergo screening, despite the short-term anxiety from a false positive exam. Tomosynthesis, sometimes called 3-D mammography, is increasingly used in conjunction with standard digital mammography for breast cancer screening. Tomosynthesis has been shown to detect 40 percent more invasive cancers than digital mammography alone, reduce the number of women called back for additional imaging by 15 percent, and increase the percentage of breast biopsies that are positive for breast cancer by approximately 20 percent.
  7. Overdiagnosis occurs in 1-10 percent and is predominantly due to ductal carcinoma in situ, the most common type of noninvasive breast cancer. Very few invasive breast cancers are overdiagnosed.

For questions about the new ACS breast cancer screening guidelines, contact: