New ACS breast cancer screening guidelines: 10 docs speak out

When the American Cancer Society (ACS) announced this week it had shifted its recommendations for mammography, it was sure to prompt a flurry of responses. No longer giving a blanket recommendation to begin mammography screening at age 40, ACS is now saying routine screening for average-risk women could probably wait till age 45, though younger women "should have the opportunity" to begin annual screening if warranted based on individual risk factors and values.

What did physicians have to say in response? Collected here are ten quotables from the coverage that followed the ACS announcement:

“I know we at Memorial Sloan Kettering are not going to change our recommendations, which call for annual mammography starting at 40 for average-risk women.” —    Carol Lee, MD, breast imaging specialist, Memorial Sloan Kettering Cancer Center

“As a doctor and as a female, I am angered and I am concerned. I think there's a lot of confusion about how often women should be screened and when they should begin. … Only 15 percent of the cancers that we find actually have a family history. The remainder are all sporadic events. And now, they're asking us to take these patients, start screening later. That means we’re going to find breast cancers much larger.” —    Susan Drossman, MD, breast imaging specialist, Mount Sinai Hospital

“It’s another in the list of competing recommendations for breast cancer screening. It makes it very confusing for both patients and physicians.” —    Stephen Blaha, MD, Eastover OB/GYN Associates, Charlotte, N.C.

“Would you be up at night wondering, is there anything I could have done that might have lowered my risk? For those people who aren’t comfortable with a small risk, I’d say go ahead and get the mammogram.” —    Nancy Keating, MD, primary care physician, Brigham and Women’s Hospital, and professor of healthcare policy, Harvard Medical School

“At this point I will not change my recommendation for my friends, for my family, for myself. I will continue to recommend having a mammogram every year beginning at age 40.” —    Ermelinda Bonaccio, MD, director, Mammography Center at Roswell Park Cancer Institute

“Statistically speaking, starting at 40, clearly—and this can’t be disputed by the National Cancer Society—saves more lives than if you start at 45. I strongly [feel], and I stand by it, that age 40 is when I recommend it.” —    Leonel A. Vasquez, MD, breast imaging specialist, University of Iowa Hospitals and Clinics

“While the harms of unnecessary biopsies and overtreatment are emphasized, the harms of a missed or late diagnosis from dropping both regular mammography and clinical breast exams was largely overlooked by the guidelines. Saving even a few extra lives is worth more regular screening. Plus, other outcomes besides survival are important—for example, detecting breast cancer early enough to avoid more aggressive treatments such as mastectomy or chemotherapy.” —    Marisa Weiss, MD, director of breast health outreach, Lankenau Medical Center

“Perhaps the committee got lost in all the data and all the science, and didn’t appreciate exactly what the message would be, because I don't think their intent was necessarily to discourage women 40 to 44 from having a mammogram.” — Carol Lee, MD, breast imaging specialist, Memorial Sloan Kettering Cancer Center

“What the American Cancer Society has done is just muddied the waters even further. Even the experts are confused.” —    George Young, MD, radiologist, Asheville Women's Medical Center

“[N]ow we’re acknowledging that the benefits are modest and the harms are real.” — Benjamin Anderson, MD, director, Breast Health Clinic at the Seattle Cancer Care Alliance