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Deborah Bershel, MD
Michelle Clark, NP
Carmen Phillips, NP
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Barbara Kaplan, LICSW
Christopher Mulvey, NP
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Breast Cancer: Guidelines for Early Detection
PLEASE NOTE: THE GUIDELINES BELOW ARE THOSE OF THE AMERICAN CANCER SOCIETY AND NOT THE NEW 2009
                         GUIDELINES PROPOSED BY THE PREVENTIVE SERVICES TASK FORCE


The American Cancer Society Guidelines for the Early Detection of Breast Cancer

Finding breast cancer early is the key to successful treatment The American Cancer Society recommends every woman follow this 3-step program to help protect herself.

Mammogram

Annual mammograms are the best way to find breast cancer early.
Have a mammogram every year if you are age 40 or older.
If you have a history of breast cancer in your family, discuss a personal
   mammography screening schedule with your health care provider.

Clinical Breast Examination

After age 40, have a clinical breast exam by your health care
   provider every year.
Between ages 20 and 39, have a clinical breast exam by your health care provider every 3 years

Breast Self-Examination

Ask your health care provider to teach you the proper way to do a
   thorough breast self -exam.
Beginning at age 20, examine your own breasts monthly.
If you find any lumps, thickenings, or changes, tell your doctor right away.
  Most breast lumps are not cancer, but you don't know if you don't ask

Dr. Bershel’s views on breast cancer screening:

Keep in mind that now that up to 1 in 8 women will come down with breast cancer in their lifetimes but as of 2007 was the cause of death in only 2% of US women. 77% of breast cancers are found in women over 50 years of age.

Ideally every woman’s healthcare should be individualized , including how often to have mammography and whether to do breast self exam.

So, for example, if you are a woman with a strong family history of breast cancer then regular mammograms at an earlier age is probably logical. Decisions as to whether a breast MRI is indicated (strong family history and dense breasts may suggest one).

Regular mammography has led to an increase detection of breast masses and fully 1 in 3 women will have an abnormal mammogram in their lifetime. With only 1 in 8 women getting breast cancer, this means a lot of negative biopsies/interventions. These interventions can cause stress and some medical complication (although usually these are minor). The Preventive Services Task Force was also concerned about that fact and also the fact that early detection of cancers in women under the age of 50 seemed to not translate into as high an improvement in survival as expected. They perhaps gave undue equivalency to the stress of a falsely abnormal mammogram with a woman’s anxiety about having an undetected breast cancer.

These complex issues should be discussed with your clinician and a determination can be made as to whether a mammogram prior to the age of 50 is right for you. After age 50 until age 74 a regular mammogram (at least every other year) is indicated. The Task Force is recommending against teaching the breast self exam but in my opinion it may be of value in certain women (for example, high risk women who have relatively small and non-lumpy breasts). Here is the link to the Task Force breast cancer screen recommendations.

Remember the Task Force is not the only organization that makes recommendations of breast cancer screening. There is also the American College of Radiology and the American Cancer Society. The Task Force tends to be very ‘scientific’ about their recommendations and is not affected as much by potential ‘political’  considerations as some other organizations.

For more information about breast cancer, or if you are concerned about breast cancer and would like to talk to a breast cancer survivor, call toll free anytime 1-800-ACS-234 or visit our web site @
www.cancer.org.

Last modified by Dr. Bershel  1/2010