breast cancer screeningAmerican Cancer Societydense breast tissuedigital breast tomosynthesisDeciding when to begin routine mammograms can be confusing.
Some health organisations recommend women start screening at 40 or 45, while another recently advised beginning at 50.
Women aged 55 and above can either continue annual screening or switch to screening every two years.The American College of Physicians also suggests doctors discuss stopping routine screening with women aged 75 and older.
Age has traditionally been used as a guide because breast cancer risk increases over time.Mammograms are not perfect.
However, she noted that the balance between benefits and harms is narrower for women aged 40 to 49.
breast cancer screening
American Cancer Society
dense breast tissue
digital breast tomosynthesis
Deciding when to begin routine mammograms can be confusing. Some health organisations recommend women start screening at 40 or 45, while another recently advised beginning at 50. Experts also disagree on whether screening should be annual or every other year.The differing advice is partly because breast cancer screening guidelines are designed for women considered to be at average risk and without symptoms. However, breast cancer is so common that defining who is truly “average” remains difficult, as does balancing the benefits and drawbacks of screening.“Breast cancer is not one disease,” said Dr Laura Esserman of the University of California, San Francisco. “So how does it make sense to screen everybody the same when everyone does not have the same risk?”Esserman is leading research aimed at understanding who falls into low-, moderate- or high-risk categories, with the goal of providing more personalised screening advice.More than 320,000 women in the US are expected to be diagnosed with breast cancer this year, according to the. Death rates have declined for decades, largely because of improved treatments, but it remains the second most common cause of cancer deaths among women in the country. Diagnoses are also continuing to rise slowly.The latest guidance comes from the American College of Physicians, which recommends that average-risk women aged 50 to 74 undergo mammograms every two years.Women aged 40 to 49 are advised to discuss the benefits and risks with their doctor and, if they choose screening, to have it every other year.The guidance, issued last month, surprised many experts because most major US health organisations recommend starting screening earlier, during a woman’s 40s. The US Preventive Services Task Force recently updated its advice to recommend biennial mammograms beginning at age 40 instead of 50.The American Cancer Society has long advised annual mammograms for women aged 45 to 54, although it says screening may begin at 40 if preferred. Women aged 55 and above can either continue annual screening or switch to screening every two years.The American College of Physicians also suggests doctors discuss stopping routine screening with women aged 75 and older. In contrast, the American Cancer Society says healthy women may continue screening for as long as they choose.The greater a woman’s risk of developing breast cancer, the more likely she is to benefit from regular screening. However, beyond well-known risk factors such as the BRCA1 and BRCA2 genes, determining individual risk is difficult. Age has traditionally been used as a guide because breast cancer risk increases over time.Mammograms are not perfect. They can sometimes miss cancer, or an aggressive tumour may appear after a routine screening. Guidelines therefore try to balance the benefits of early detection against possible harms, including stress, unnecessary tests and painful follow-up procedures for suspicious areas that later prove harmless.“We’re not saying there’s no benefit” from mammograms in women in their 40s, said Dr Carolyn Crandall of the University of California, Los Angeles, who chaired the American College of Physicians report. However, she noted that the balance between benefits and harms is narrower for women aged 40 to 49. The American Cancer Society recommends annual mammograms from age 45 because breast cancer rates in women aged 45 to 49 are closer to those seen in women aged 50 to 54 than those in the early 40s, according to the society’s cancer detection expert, Robert Smith.Smith said one major challenge is the lack of reliable ways to predict whether a woman is likely to develop an aggressive cancer or a slower-growing form of the disease.Nearly half of women over 40 have. This can make tumours harder to detect on mammograms and may slightly increase cancer risk. Women are informed about breast density after a mammogram. However, experts are still uncertain whether women with dense breasts would benefit from additional screening through ultrasound scans or MRI. The new guidance from the American College of Physicians recommends considering 3D mammography, also known as(DBT).Researchers believe future screening may involve broader genetic testing alongside lifestyle and health factors to create more personalised screening plans.A recent study involving nearly 46,000 women, known as the WISDOM trial, used factors such as age, genetics, breast density, lifestyle and medical history to classify women into different risk groups. Depending on their risk, women either delayed screening until age 50, underwent screening every two years, or had annual mammograms.Women at the highest risk also received MRI screening.Researchers found that risk-based screening was as effective as annual mammograms. Around 30% of women with higher genetic risk had no family history of breastcancer. AI tools may soon help predict future risk through mammograms. Experts advise women to discuss risk factors with doctors and maintain regular screening, as consistency remains key.
