Column: Mammogram changes are not radical

Can you believe it? They went and did it again! An influential and trusted organization — the American Cancer Society (ACS) — changed its recommendations for breast cancer screening, announcing the changes in the Journal of the American Medical Association.

One news outlet called the changes “major,” while another used the term “radical.”

So, what’s the deal?

While it’s true that ACS has changed its breast cancer screening recommendations, these changes are hardly radical.

So, what changes were made? And why are they such a surprise?

Let’s start with the new recommendations. Here they are:

1. Instead of recommending routine mammograms for all average risk women beginning at age 40, ACS is recommending women ages 40-44, who are at average risk for breast cancer, should have the opportunity to begin annual screening.

2. Annual, routine mammograms for all average risk women are now recommended only for women between the ages of 45 and 54.

3. Routine screening mammography for women age 55 and older, who are at average risk for breast cancer, should occur every other year instead of every year; however, women over age 55 who want a yearly mammogram should have the opportunity to have one annually.

4. A clinical breast exam, which is a physical exam performed by a healthcare provider, is not recommended as a routine procedure for breast cancer screening.

Now, here is what the new recommendations do not say:

1. The new recommendations do not say that mammograms are worthless. In fact, ACS makes the very important point that screening mammograms save lives.

2. The new recommendations do not say that a clinical or self breast exam is worthless; rather, they simply point out that a clinical or self breast exam has never been scientifically proven to be useful as a breast cancer screening test. It’s important to note, though, that if you are having a problem with your breasts, a clinical breast exam is crucial to helping determine the problem.

3. The recommendations do not tell you if you are “average risk.” Do you know if you are? One of the most important take home messages of this story is that you need to determine your risk for breast cancer. To do that, you need to talk to your doctor.

To those who are unsettled by the changes, I understand. But if it seems like we are changing the rules, remember that change in medicine is nothing new.

I see these changes as a tremendous opportunity for patients, doctors, and indeed, organized medicine.

It’s a chance for us, as healthcare providers, to put our money where our mouths are when it comes to patient-centered care and use these changes as a springboard to have important conversations about what we want health care to be and what we are willing to do to get it.

The discussion of harms and benefits of screening mammography — or any other intervention — cannot be limited to academic publications that are sent down from above.

We need to talk about these changes in doctor’s offices, at cocktail parties and soccer games, because if we want to improve our health, we are going to have to dig in and work on the solutions together.

Dr. Brian McKinley is a surgical oncologist with Greenville Health System’s Breast Health Center.