Introduction

BreastCancer.org reports that 1 in 8 women will develop breast cancer1 sometime in their life and 40,610 women are expected to die of breast cancer in the year 20171. Breast cancer is a serious disease that deserves well thought out medical policies on both detection and treatment

There is an ongoing debate on best practices when it comes to detection. Detection methods include self-breast exams, clinical-breast exams and mammograms. As more research comes out, it seems that different methods may have different benefits and drawbacks than others for detecting breast cancer as early as possible. It is important that women educate themselves on the different philosophies of breast cancer detection and take the proper steps to maximize their chances of early detection.

 

Current Practices

It’s important to detect breast cancer as early as possible. Early detection leads to early treatment which is more likely to lead to remission. One of the most effective ways to detect breast cancer is by getting a mammogram. Because of this, you might think that the more often a women can get mammograms, the better. However, the minimal risks associated with mammograms need to be balanced with the benefits and a woman’s individual risk of getting breast cancer. Therefore, the question that women need to ask themselves is, “How often do I need a mammogram?”

The American Cancer Society is one of the leading authorities on cancer research and treatment recommendations. In 2015 they updated their recommendations for who and how women should watch for breast cancer. These recommendations include standards for mammogram frequency.

Here’s the American Cancer Society’s recommendations for breast cancer screening.2

  1. Women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years. (Strong Recommendation)
    • Women aged 45 to 54 years should be screened annually. (Qualified Recommendation)
    • Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually. (Qualified Recommendation)
    • Women should have the opportunity to begin annual screening between the ages of 40 and 44 years. (Qualified Recommendation)
  2. Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer. (Qualified Recommendation)
  3. The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age. (Qualified Recommendation)

This is how often you should get a mammogram according to the ACS. It’s important to notice that their recommendations are based on age and not based on menopausal status or other factors.

Many doctors use this method, however, some doctors use a different one. Here’s that different method.

 

Comparing Age to Menopausal Status

Age related recommendations focus on how old a woman is rather than menopausal status. In a way, this makes sense. Breast cancer statistics and age seem to go hand-in-hand1, so it seems reasonable that age would be a factor when it comes to screening frequency. The age method tells women how often they should get a mammogram based off broad population statistics rather than a personalized data.

Studies have shown that there’s a different way to determine how screening recommendations should change for various groups of women. Those who support using menopausal status as an indicator, found hard data in a study called, “Breast Tumor Prognostic Characteristics and Biennial vs Annual Mammography, Age, and Menopausal Status” to support their method. This study shows that there is a different way to determine screening frequency for breast cancer.3

“Premenopausal women diagnosed as having breast cancer following biennial vs annual screening mammography are more likely to have tumors with less favorable prognostic characteristics,” the study found. “Postmenopausal women not using hormone therapy who are diagnosed as having breast cancer following a biennial or annual screen have similar proportions of tumors with less favorable prognostic characteristics.”3

That is the main takeaway from this study. Premenopausal women are more likely to be diagnosed with an aggressive form of breast cancer, and could therefore see a greater benefit from yearly mammograms. Postmenopausal women are more likely to be diagnosed with a less aggressive tumor and can safely reduce the frequency of mammograms to every two years.

Although the age method helps women reduce the number of mammograms they receive, it also gives aggressive tumors a head start. The menopausal status shortens that head start significantly, but also means that women are likely have to get screened more frequently over longer periods of time.

Both methods have benefits and drawbacks and a doctor will be able to best help a woman determine which method is best for her.

 

How Could Practices Be Updated

The way in which breast cancer screenings can be updated centers around the topic of how often should you get a mammogram. If doctors wanted to change from the age method to the menopausal status method, a fundamental change in thinking would need to happen.

No longer would we think of breast cancer detection as an issue related to likelihood and age, but as one related to aggressiveness and menopause. It’s easy to see why breast cancer has been viewed as an age-related issue since the risk of getting breast cancer does increase with age4, but that may only be half of the picture.

The question of how often you need a mammogram isn’t just about how likely you are to develop cancer, but how likely is it that the cancer is going to be aggressive if left untreated for a prolonged time. The study described previously showed that in premenopausal women, it’s much more likely that their cancer will become aggressive with time, whereas that’s not the case in postmenopausal women.

Continuing annual screenings until menopause is not a matter of dismissing age, but potentially catch more aggressive cancers sooner than later.

 

Questions To Consider Asking Your Doctor

Cancer is all about managing your risk factors, early detection and early treatment. In order to help more women win the fight against breast cancer, we need to encourage women to do those three things. That’s why it’s so important to detect breast cancer as early as possible, especially in premenopausal women.

Here are some questions to ask your doctor about your prevention plan;

  • How often do I need a mammogram and why?
  • What lifestyle changes can I make to lower my risks?
  • What can my genetic history tell me about my risks?
  • How likely am I to experience a more aggressive type of breast cancer?
  • Do you prefer the age or menopausal status method and why?
  • What are the benefits and drawbacks to each method?
  • What can I do to take care of myself between screenings?
  • What’s the harm if I’d prefer extra/less screenings?

Studies have found that breast cancer mortality is reduced by as much as 20 percent5 thanks to screening. It’s such an important tool in the breast cancer detection toolkit that you should talk to your doctor to fully understand his or her screening strategy.

 

Conclusions

So how likely are you to develop breast cancer? The answer is that it depends. Your risk of developing breast cancer depends on pre-existing risk factors like genetic mutations and breast density.6 It depends on lifestyle choices such as level of fitness and alcohol consumption.  It depends on past medical treatments and their respective risks.

There are steps you can take to reduce your risk of breast cancer but, in reality, predicting breast cancer is challenging. The next best thing you can do is get regular screenings.

So how often do you need a mammogram?

Talk to your doctor and ask about annual mammograms until you enter menopause. This maximizes the chance for early detection and allows for early treatment. After that, as if spacing out your mammograms to once every other year is an option for you if your chance of developing an aggressive cancer becomes reduced after menopause.

Take advantage of available opportunities to reduce your risk of breast cancer. Next time you have an appointment, talk to your doctor about how your menopausal status can affect your risk of developing breast cancer.

 


Sources:

  1. U.S. Breast Cancer Statistics. BreastCancer.org March 10 2017. http://www.breastcancer.org/symptoms/understand_bc/statistics
  1. Oeffinger KC, Fontham ETH, Etzioni R, Herzig A, Michaelson JS, Shih YT, Walter LC, Church TR, Flowers CR, LaMonte SJ, Wolf AMD, DeSantis C, Lortet-Tieulent J, Andrews K, Manassaram-Baptiste D, Saslow D, Smith RA, Brawley OW, Wender R. Breast Cancer Screening for Women at Average Risk. 2015 Guideline Update From the American Cancer Society. JAMA. 2015;314(15):1599-1614. doi:10.1001/jama.2015.12783
  1. Miglioretti DL, Zhu W, Kerlikowske K, Sprague BL, Onega T, Buist DSM, Henderson LM, Smith RA, for the Breast Cancer Surveillance Consortium. Breast Tumor Prognostic Characteristics and Biennial vs Annual Mammography, Age, and Menopausal Status. JAMA Oncol. 2015;1(8):1069-1077. doi:10.1001/jamaoncol.2015.3084
  1. Breast Cancer Risk By Age. Centers for Disease Control and Prevention. Dec. 14 2015. https://www.cdc.gov/cancer/breast/statistics/age.htm
  1. Myers ER, Moorman P, Gierisch JM, Havrilesky LJ, Grimm LJ, Ghate S, Davidson B, Mongtomery RC, Crowley MJ, McCrory DC, Kendrick A, Sanders GD. Benefits and Harms of Breast Cancer Screening A Systematic Review. JAMA. 2015;314(15):1615-1634. doi:10.1001/jama.2015.13183
  1. What Are The Risk Factors for Breast Cancer? Centers for Disease Control and Prevention. April 4. 2016. https://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm