eOncology Report

Statement on breast health and breast cancer screening

Breast health experts at Providence Health & Services recognize the importance and complexity of counseling women on breast health and screening recommendations. In November 2009, the U.S. Preventive Services Task Force issued updated guidelines for breast cancer screening.

These updated recommendations have prompted a range of reactions from various foundations, professional organizations and breast health providers. We have reviewed these new recommendations carefully, and have engaged a number of concerned providers, physicians and advocates for women’s health to gain consensus around this important issue.

In general, Providence endorses the thorough, professional and evidence-based effort put forth by the national task force. We also recognize that these are difficult issues to analyze.

We have considered the following:

• In women with ordinary risk, with no signs or symptoms of breast cancer, the incidence of breast cancer increases with age. The disease is very uncommon in younger women and becomes more common in older women.
• Conversely, breast cancers tend to advance more rapidly in younger women than in older women.
• Screening mammography has been shown to reduce the death rate from breast cancer. It allows cancers to be found when they are smaller and less likely to have spread. The survival benefit conferred by screening mammography has been proven in women age 40 to 70.

However, in any screening program, there is a tradeoff between harm and benefit. The harms documented from screening mammography include callbacks, anxiety, expense and the possibility of a biopsy when cancer is not actually present. The benefits of screening mammography are earlier diagnosis, potentially less-aggressive treatment and a lower risk of dying from breast cancer.

The table below summarizes Providence Health & Services’ position on breast health and screening, particularly in reference to the U.S. task force’s recommendations for women with no signs or symptoms of breast disease (lumps, pain, unusual tenderness, nipple discharge or skin changes).

We also remind providers and patients that these guidelines do not apply to women at higher risk for developing breast cancer, such as those with a personal or strong family history of breast cancer, or those with a biopsy-proven high-risk lesion.

	Education	Interventions
Up to age 40	Define breast cancer risk profile Discuss primary prevention strategies Promote breast awareness	Lifestyle interventions (diet, moderation of alcohol consumption, weight control) Provider may consider clinical breast exam
Age 40-49	Discuss breast cancer risk profile Discuss primary prevention strategies Promote breast awareness Individualize preferences for screening services	Discuss primary prevention strategies Screening mammography every year if, after discussion of risks and benefits with the provider, the patient requests it Provider may consider clinical breast exam
Age 50-74	Discuss breast cancer risk profile Discuss primary prevention strategies Promote breast awareness Initiate screening mammography for all women age 50 to 74	Lifestyle interventions Screening mammography every one to two years Provider may consider clinical breast exam
75 and older	Discuss breast health in the context of overall health with primary physician Consider screening healthy women. Harm may outweigh benefits in patients with significant medical illnesses	Lifestyle interventions Consider screening mammography every one to two years if, after evaluation of the patient’s overall health, screening may be beneficial Provider may consider clinical breast exam