U.S. breast cancer screening advice now in line with Canadian guidelines

TORONTO - Some Canadians may be confused by controversy over new U.S. breast cancer screening guidelines, but experts here say the revised recommendations finally conform with what Canada has been advising women for years.
The U.S. Preventive Services Task Force, a panel of independent experts, released revamped recommendations this week, including advice that women in their 40s should not have routine mammograms because there is no evidence they improve survival in that age group.
"It's very encouraging to see that their recent review of the evidence is in line with what we've been recommending to Canadian women," said Heather Chappell, director of cancer control policy at the Canadian Cancer Society.
"Certainly we think that all women in their 40s should talk to their doctors about their breast cancer risk and find out if screening is right for them and have a discussion with their doctor about the benefit and harms of screening in this age group," Chappell said Tuesday.
"And we certainly do recommend that women 50 to 69 have mammograms every two years because we know that there is benefit in that age group."
Meanwhile, some U.S. cancer experts and patient advocacy groups are questioning the new guidelines and predict the reduction in routine mammograms among those 40 to 49 will lead to more deaths from breast cancer. (Previous guidelines recommended routine screening every year or two for all women over 40.)
Chappell said women in their 40s have a lower overall risk for the disease compared to older women, but are often subject to false-positive mammography results, which are followed up by often unneeded breast biopsies that cause undue anxiety.
"You're asking a healthy group of individuals with no symptoms to undergo testing and then if there is a positive result, further testing that could show there was no cancer in the first place," she said, noting that it's not known what risk cumulative radiation from multiple mammograms may carry.
But when it comes to women age 50 to 69, research has shown that routine mammography "does reduce mortality from breast cancer," said Dr. Lavina Lickley, a breast cancer specialist at Women's College Hospital in Toronto.
Lickley said the Ontario Breast Screening Program, for example, starts routine mammograms at age 50 and repeats them every two years.
"If a (younger) person has a lump, does that mean they can't have a mammogram? No. These are screening mammograms, mammograms for people with no known problem," she said.
Chappell advised that younger women with a family history of breast cancer or any suspicious symptoms should talk to their doctors.
"All of this discussion is around screening and that's testing for women with no symptoms," she said. "Women who have any symptoms either around their breasts or in their general health should be talking to their doctor right away and would be undergoing different tests."
The U.S. task force also recommended against routine breast self-examination, saying there is no definitive proof that the practice reduces breast cancer mortality.
Once promoted as de rigueur in breast cancer prevention messaging, monthly self-examination has also been dropped as a must-do by the Canadian Cancer Society.
"We moved away from recommending a prescriptive routine because the research did show that there is no additional benefit ... and could actually cause some anxiety," said Chappell, agreeing that many women were unsure if they were performing the monthly exam correctly or at the proper point in their menstrual cycle.
"So really the strong message there is definitely be aware of your body, be aware of changes in your breasts' textures - lumps, bumps, changes around the nipple - because we do know that is an effective way of detecting cancer early."