Updated Screening Guidelines: Incorporating Women’s Values is a Good Thing

There’s been a lot of chatter about the value and importance of screening for breast cancer lately – it was all sparked by an announcement that The Canadian Task Force on Preventative Health Care updated their guidelines on screening for breast cancer.  The recommendations are for women age 40-74 who are not at increased risk.

As Canadians, we’ve been fed marketing messages that screening for cancer is akin to preventing cancer. But really, it’s not. Screening programs can detect cancer, but they don’t stop someone from developing it, be it breast or otherwise.

Doing something may seem better than doing nothing. And if a woman is at increased risk for breast cancer or notices a change in her breasts there are things she should do.

However, it’s not the case for young women at average risk, and that is who the guidelines are for. In fact, 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.

So, back to the recent update. Here is what’s changed and what we think you need to know.

What’s changed?

These guidelines are an update to what was published in 2011. In terms of who, when and how, nothing has changed. What has changed is the role of a woman’s values being incorporated into the decision. The key recommendation states:

“The direction of each recommendation on screening with mammography is the same as in the previous recommendations, but the updated recommendations emphasize shared decision-making and are conditional on the relative value a woman places on possible benefits and harms of screening.”

In our opinion this is good news – we’re always big supporters of a women’s values being part of her health care decision!

Does this mean less screening?

This means smarter screening. The scientific evidence shows that a one-size-fits-all approach to population-based screening with mammograms doesn’t save lives. (Read more about the pros and cons of population-based screening programs here.)

What the update does is help make sure that each woman is getting the screening that’s right for her – based on her personal risk, family history, genetic profile and the value she places on the possible benefits or harms of screening. (Remember, these guidelines are for women between 40 and 74 at average-risk – there are different options for women at high-risk.)

Changes in breast cancer screening are also aligned with what’s happening in other types of cancer (PAP screening tests for cervical cancer and PSA screening test for prostate cancer to name a few). There is also a broader movement in Canadian health care – called Choosing Wisely Canada – focused on reducing unnecessary tests and treatments that do not add value to patients.

So, what now?

First, take a deep breath. The biggest change in the guidelines is about how a woman’s values are incorporated in breast cancer screening, and that is a good thing.

Second, understand your risk for breast cancer. Having a clear view if you are of average- or high-risk will help you understand what’s recommended for you.

Third, be breast aware. Be familiar with how your breasts look and feel and if you notice any change, promptly report it to your health-care provider. This is the time when diagnostic tools like mammograms and ultrasounds can be really important. Also, understand your breast density and how that can play a part of breast cancer screening and awareness.

And last, if you think something’s changed in your breasts or something’s just not right – speak up. Ask for a test or for a second opinion. Trust your gut.

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