On Tuesday, the American Cancer Society published new Breast Cancer Screening guidelines reducing the recommended frequency of mammograms for women over 54 to every 2 years and increasing the age for a first mammogram to 45 for women with an average risk of breast cancer. They also kicked the clinical breast exam to the curb. How much can a physician know about my boobs and my “normal” by feeling them once a year? Now me, I can touch them every day if I want, and I certainly see them during my daily ritual. Early diagnosis is key to beating breast cancer and many are triggered by women who notice a change in the look or feel of their boobs. Our breasts feel differently in each decade. Natural changes occur, especially as we bear children and get older. Tiny, swollen, lumpy, I know intimately the phases my boobs passed through to land happily at soft tissue. I know what my skin looks like, where there are stretch marks from pregnancy, and the color of my areola, however I need to use the mirror more often with arms raised. Rashes, dimpling, or swelling also occurs in the breast tissue on our sides, and is more likely to go unnoticed.
The American Cancer Society is careful in its language, stating a woman should have the choice at 40 to request a screening mammogram and become educated on mammography limitations. Women at high risk (20-25% lifetime risk) should begin annual screenings at 30. They recommend breast MRI in conjunction with mammography for women at high risk because the two detect different types of cancer, so if I found a lump or had other breast cancer symptoms such as skin or nipple changes, my plan is to request both. False positives are more likely with breast MRI, but despite the American Cancer Society’s concern about causing me ” a lot of worry and anxiety”, I prefer an unnecessary biopsy with a huge slice of peace of mind to later-stage cancer. And despite a statement that self exams do not show a clear benefit, I trust my judgement on this one and will continue to feel myself up in the mirror on a regular basis because self-love is a beautiful thing and the new guidelines for breast cancer screening are not definitive, but leave the responsibility with me.