Did you know in November 2011, the Canadian Task Force on Preventative Health Care (yes, it’s a mouth full) CTFPHC released their updated guidelines on breast cancer screening, including the use of mammography, magnetic resonance imaging, breast self-exam and clinical breast exam to screen for breast cancer? The recommendations apply only to women at average risk of breast cancer aged 40 to 74 years. They do not apply to women at higher risk due to personal history of breast cancer, history of breast cancer in first degree relative, known BRCA1/BRCA2 mutation, or prior chest wall radiation.
Clinician Breast Exam is SO 2011
For women 40 to 74, the task force recommends not routinely performing Clinical Breast Exam alone or in conjunction with mammography to screen for breast cancer. The task force also recommends not advising women to routinely practice Breast Self-Exam. That’s right, you heard us. This is because no evidence was found indicating that Clinical Breast Exam or Breast Self-Exam reduced breast cancer mortality or all-cause mortality.
Back in 2011, two large trials conducted by CTFPHC identified no reduction in breast cancer mortality associated with teaching Breast Self-Exam to women aged 31 to 64, but found evidence of increased harm for benign breast biopsy. We want you to be breast aware! We advocate women get familiar with their breasts and know what feels right so they’ll know if anything feels wrong and discuss it with their doctor.
A picture or no picture says 1000 words
For women aged 40–49, the task force recommends not routinely screening with mammography. A review of the evidence shows that there is no mortality benefit to screening for women of average risk in this age category. According to the results of a study published in 2015 by the International Agency for Research on Cancer, screening mammography in women under age 40 results in high rates of callbacks, low rates of cancer detection, and high rates of false-positive results. Currently, organized breast screening programs in Canada specifically screen women 50 to 69 years old for breast cancer using mammograms.
What about millennials?
As noted above, science tells us that regular mammography to screen for breast cancer is most beneficial for women aged 50 to 69. There is currently no effective breast cancer screening tool for women 40 and younger, most of whom have dense breast tissue preventing routine mammograms from being a useful screening tool. In addition, most experts believe the low risk of developing breast cancer at a young age (5% of breast cancer diagnoses will be women under 40 in Canada (5.7% in the US)does not justify the low-level radiation exposure or the cost of mammography. The good news is that CTFPHC will continue to carefully monitor the scientific development in breast cancer screening and report back to Canadians every 5 years with an update of the 2011 Breast Cancer Screening guidelines. Side-bar: CTFPHC has announced an update on the current guidelines in 2017! Stay tuned…
Early Detection Personalized Med
A Canadian study by Miller et al in 2014 involving 90, 000 women followed over 25 years found that efforts to find breast cancers before they could be felt as a lump in the breast, using screening mammography, did not lead to lower death rates for average-risk women in their 30-50s. Simultaneously, one-in-five of the cancers were found through screening would not have required treatment were it not for the mammogram: resulting in over diagnosis and over treatment. Thus, we think early detection has been overstated: it can help with outcomes for some cancers but not others. Finding it early doesn’t change the stage or how the cancer grows. Rethink believes in personalized medicine that is customized to the individual and believes we need to re-focus our attentions to better personalized treatments for all!
Side-bar: The Globe just gave us the 411 on screening yesterday here.
For more on what you need to know about breast cancer click HERE.