Breast cancer screening recommendations: an update

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Breast cancer is a diagnosis every woman fears, and is the leading cause of cancer in women worldwide. Most of us know someone who has had this disease or has been affected by it. The statistics are downright scary. According to the National Cancer Institute, it is estimated that about 1 in 8 American women will be diagnosed with invasive breast cancer during their lifetime. Most women look to their health care providers for recommendations on screening. What many women discover is that the recommendations are not as straightforward as they had believed them to be.

For women who are at average risk of developing breast cancer, the screening recommendations vary depending on who you ask. Recommendations vary because different professional organizations have different opinions. Traditionally, mammograms have started at age 40 and are done annually as long as the woman is in good health and expected to live longer than 10 years. Due to improved research and screening techniques, these recommendations have started to vary from starting at 40 years of age to as late as 50 years of age and having it done annually or every other year.

The biggest concern with screening too early and too often is over-diagnosis and over-treatment. This can be a hard concept to grasp since any diagnosis and treatment of breast cancer sounds like a good thing, right? Yes, but, research has found that as many as 50 percent of small breast cancers found with mammography are likely to never progress to invasive breast cancer, and would never have caused problems. Unfortunately, there isn’t a way to know which of these small cancers will progress and which ones will not, so treatment is typically recommended via lumpectomy, mastectomy, radiation and/or chemotherapy. The good news is that researchers are working to identify which small cancers are more likely to progress and which are not.

So, how do you determine the best screening option for you? Have a conversation with your health care provider. Let him or her know your preferences and values. Together, you can work to make decisions and select screening options and care plans based on clinical evidence.

Emily Proulx, MSN, APRN is a Women’s Health Nurse Practitioner at Dartmouth Hitchcock in Nashua in the Ob/Gyn department. Dartmouth Hitchcock offers full obstetric and gynecological care to women of all ages. For more information, please visit www.dartmouth-hitchcock.org/obgyn.html.

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