Clinical Topics & News

Will New American Cancer Society Mammography Policy Change VHA Practice?

New American Cancer Society guidelines may prompt more conversations between patients and health care providers.


 

The new American Cancer Society (ACS) policy for mammography screening now recommends annual mammograms from age 45 until age 54, suggesting a less aggressive approach to screening than in the 2003 guidelines. The recommendation is for asymptomatic women at average risk of developing breast cancer.

Related: How Much Is Too Much Cancer Screening?

“These recommendations are made with the intent of maximizing reductions in breast cancer mortality and years of life saved while being attentive to the need to minimize harms associated with screening,” said Dr. Kevin C. Oeffinger, chairman of the breast cancer guideline panel.

Related: Advances in Targeted Therapy for Breast Cancer

The guideline, developed by a panel of outside experts, was published October 20, 2015, in The Journal of the American Medical Association.

Other important recommendation changes include:

  • ŸWomen aged 45 to 54 years should receive annual screening mammography and at age 55 women should transition to biennial screening.
  • ŸWomen should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer.
  • ŸClinical breast examination is no longer recommended at any age.
  • ŸThe panel noted that the recommendations are an effort to avoid false positive findings, which can take an emotional toll.

The current VHA recommendations state:

  • Mammography is not recommended for women aged 13 to 39 years.
  • Women aged 40 to 49 years should talk with their health care providers about screening.
  • ŸMammograms are recommended every 2 years for women aged 50 to 74 years.
  • ŸWomen aged > 75 years should talk with their health care providers.

According to Anita Aggarwal, DO, PhD, president of the Association of VA Hematology and Oncology (AVAHO), the VHA recommendations leave a lot of wiggle room; every year starting at age 40 is still acceptable practice at the VA.

Related: Breast Cancer Research Group Aims to Improve Veteran Survival Rates

“Keep in mind that recommendations are just recommendations,” Dr. Aggarwal told Federal Practitioner. “One size may not fit all. I believe we should use our sound judgment based on valid research to recommend what is best for the patient. Based on my literature search, annual screening starting at 40 saves the most lives via early detection.”

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