Navigate Breast Cancer Screening Guidelines

If you’re confused about breast cancer screening guidelines — how often to get mammograms and when to start — your instinct might be to head to the Centers for Disease Control and Prevention. website for some clarification. But you might not get the answers you’re looking for because you’ll see a matrix with a confusing mix of recommendations from seven different organizations.

“Overall, they all agree that women should be screened, but there’s some disagreement about whether they should start at 40 or 50,” says Dennis Citrin, MB ChB, PhD, medical oncologist specializing in breast cancer at Cancer Treatment Centers of America.

There is also disagreement about how often women should get tested. Some professional groups recommend annual mammogramwhile others say women should have a mammogram every two years.

Because of this confusion, a new nationwide study aims to determine the best approach by following two groups of women: a group that receives an annual mammogram and another group that receives a personalized recommendation, based on their medical history, lifestyle and genetics. Some of the women in the personalized group will have mammograms every year, while others will have them more often or less often, depending on their personal risk factors.

Know your risk

To know how often to get screened, you need to know if you are at increased risk for breast cancer. But as we now know, there are many risk factors for breast cancer, including one very obvious risk factor. “The most important risk factor for breast cancer is being female,” says Olufunmilayo I. Olopade, MD, an oncologist at Chicago Medical Universitydirector of the Center for Clinical Cancer Genetics and Global Health and principal investigator of the WISDOM study.

But besides this risk factor, family medical history, genes, and lifestyle choices all affect breast cancer risk. If you have no apparent risk besides being female, you may be tempted to skip screening altogether. It wouldn’t be a good idea.

“Every woman should recognize that she is at risk for developing breast cancer and should at least consider a screening mammogram,” Citrin says. “At what age and how often is something she should discuss with her personal doctor.”

But with so many variables and so much confusing information, it’s hard to determine which screening protocol is best.

Enter the WISDOM study. WISDOM — meaning Women Informed to screen based on risk measures – recruits 100,000 women in a large national study comparing the benefits of an annual mammogram (the traditional screening counseling) to a more personalized approach.

Olopade brought WISDOM to Chicago and encourages all eligible women to join the study, which is currently recruiting participants. Eligibility requirements are simple: you must be female, between the ages of 40 and 74, and have no previous diagnosis of breast cancer or ductal carcinoma in situ.

Olopade is particularly interested in seeing underrepresented groups participate in the study to ensure its results are relevant to everyone.

“Chicago is a very diverse city,” says Olopade. “We want to involve women on the south side, on the west side, women who have not traditionally been included in research studies. U.S. too [recruiting] Black women, Hispanic women, immigrant women, Muslim women. This is for all of us to gain wisdom on what we should be doing for our breast health.

Participants can choose to participate in the Randomized Cohort, Annual Screening Cohort, or Personalized Screening Cohort, which will receive more specific guidance on appropriate breast cancer screening. An individual participant may possibly learn that she has to be screened more or less intensively and may also avoid unnecessary biopsies.

Those in the personalized group donate a sample for genetic analysis and ultimately receive a polygenic risk score, based on nine related genes and their lifestyle factors, to help them make informed decisions about breast cancer screening, said Olopade.

Take charge of breast health

Unless you join the WISDOM study, there are a few basic steps all women can take to put their health first, especially when it comes to breast cancer.

Until the findings of the WISDOM study are available, Citrin says mammograms are currently the best screening test available, although they are far from perfect. He urges women between the ages of 50 and 75 to continue getting them every year.

Women should also be aware of any changes in their breasts. “If you are in any way concerned about your breasts, be sure to bring this to the attention of your doctor,” he says.

During the pandemic, many people postponed doctor’s appointments and missed important health issues as a result. “With Covid, we’ve seen patients delay, and that’s a tragedy,” Citrin says.

Olopade goes even further: “Know your risk. Don’t wait to find out your risk. [Find it out] at 30 and for sure at 40. You have to make it your personal mission to know your risk,” she says.

The WISDOM study can contribute to this. You can apply to join the study hereor ask your doctor how to complete your risk assessment and genetic testing.

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