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ACS Recommendations Change

New American Cancer Society Guidelines
Some Good, Some Not So Good

By Ken L. Smith, Breast Health Facilitator for ACS

The American Cancer Society often recommends guidelines for maintaining healthy breasts, such as how often mammograms should be taken and who should have them taken. As of November, 2015, they have suggested new guidelines to replace their old ones. Those of you that were born about the time President Reagan first took the oath of office (or before) may recall that several organizations have changed these recommendations several times. It does make one wonder just what it is upon which they base these decisions. And invariably, when new recommendations come out, from any of the cancer organizations, they usually cause some concerns.

As a Breast Health Facilitator, I have sought truth in breast care, because my personal and professional families have been seriously impacted by breast cancer. My ‘title’ suggests that I should know something about how to make sure breast health is secured, for both women and men, so you can guess that I will likely have some thoughts about those recommendations. The new guidelines by ACS this month come with a mixed message to those that wish to be diligent about the health of their breasts.

These are the old recommendations that came from ACS:


Maintain a self-care plan for early breast cancer detection, including:

  • Monthly self-exams ...starting literally as early as when you first have breasts... or now!
  • Annual CBE (Clinical Breast Exam) with medical provider (tri-annually under 40 years old)

Mammograms as per recommendations
35-39 — Baseline (your first one, to be used as a reference later)
40-49 — Bi-annually
50 on — Annually

If you have had breast cancer, or you are considered to have an especially high risk of breast cancer, your doctor may ask you to have one done more frequently (actually, there is usually a series of four images, each breast top to bottom and each from side to side).

 

Not too long ago, ACS raised their recommendation for the first mammogram to age 40. Today they have moved it up to 45, with one each year, and then bi-annually after 55. That may sound like it is going in the wrong direction. It is somewhat of a reversal of previous recommendations, but it is said that ACS indicated that “Screening has its benefits, but also its problems.” I have to say that pleases me to hear that. I have had a real problem with the increased indications that mammograms… a source of extremely dangerous radiation… may themselves be a major source of breast cancers (Read 'The Mammogram Scam' here.

There are other cancer-oriented organizations, of course, and each of them have varying recommendations. Confusing? Yes. Very. So what should YOU do? Your best bet is to talk with your oncologist that you normally see, or your breast surgeon/specialist, or your OB/Gyn and ask what they recommend. They know your needs.

The one change in recommendations that I cannot accept, however, is that the ACS stated they no longer recommended women do monthly breast exams, and that CBE (clinical breast exams) are no longer recommended. This really bothers me. Yes, a mammogram can see a smaller mass and see it sooner than it can be felt by the woman or the doctor, but with fewer mammograms being done, those tiny masses can become large masses very quickly, and will be more easily ignored or missed completely until it is large enough to cause major health problems. ACS says that these two non-damaging diagnostic techniques “…show no evidence that they reduce deaths from cancer.”

I know many women that approached their doctor with a question about a mass that they found themselves (or their partner felt it) and 90% of the time it was benign, but the other ten percent avoided more extensive involvement or surgical intervention because their mass was detected early. Both times my wife had breast cancer her masses were too small for her to find herself, but her doctor found them during her CBE.

The ACS does however, “…urge women to be aware of how their breasts normally look and feel and report any changes immediately.” Really? Allow me to remind them what you do when you do a BSE: You examine your breasts visually and you feel them, looking for any changes and reporting them immediately. I wonder how they thought BSE was performed before this?  You can read up on how to do a Breast Self-Exam here:

These simple tests are two very low-cost, non-invasive, non-damaging diagnostic measures that should never be stopped, in my opinion. And I am not alone in feeling this way. The good part about it is that you can still ask for the CBE and you can still do the BSE all you want. You would be well advised to do so.

 

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Image Credit:  Weibliche Brust während der Mammographie. Aufgenommen: November 1990  
Source: National Cancer Institute ; This image is in the public domain and can be freely reused