http://www.cnn.com/2003/HEALTH/conditions/05/15/breast.cancer.guidelines/index.html

New guidelines emphasize mammograms

Thursday, May 15, 2003 Posted: 3:41 PM EDT (1941 GMT)

ATLANTA, Georgia (CNN) -- The American Cancer Society issued new breast cancer screening guidelines Thursday, emphasizing the role of mammograms in early detection and downplaying the importance of breast self-examination.

The group said mammography is still the "gold standard" for early detection of breast cancer despite recent controversies over its usefulness.

"Women and doctors need to understand that we are more confident than ever in the benefits of mammography," said Debbie Saslow, the society's director of breast and gynecologic cancers, in a statement.

"The benefit is particularly clear for women in their 40s. We have much more evidence, and much more convincing evidence, that those women benefit."

Under the new guidelines, breast self-examination is now "optional" and no longer an officially recommended technique for early detection of breast cancer.

"Women should be told about the benefits and limitations of BSE [breast self-examination]. It is acceptable for women to choose not to do BSE or to do it occasionally," the guidelines say.

The new guidelines reflect conflicting evidence about breast self-exams. While some studies show they help detect cancer early and cut down on cancer deaths, others show the exams do not help.

This is the first time the breast cancer screening guidelines have been updated in six years. Previous versions of the guidelines recommended that women do self-exams once a month.

Amy Langer, executive director of the National Alliance of Breast Cancer Organizations, called breast self-exams a "dinosaur."

"When you can feel a lump in a breast self-exam, it's usually the size of a quarter. If it's breast cancer, that means it's advanced, and has been growing for years," Langer said.

"We want women to find [possible breast cancer] before they can feel it. Mammograms are the way to do it."

But she doesn't recommend ignoring your body. Langer said self-awareness by women about their bodies and breasts can help them notice any changes, and if they do notice something, be able to have it checked quickly.

Changes draw ire

The new guidelines drew outrage from some. Breast cancer survivor Lyn Wasserman, founder of support group Breast Friends Network, said women should be encouraged to do anything that would help detect cancer as early as possible, including breast self-exams.

"If I hadn't done it and found [lumps], I shudder to think how fast it might have grown," she said of her early discovery of her cancer.

The cancer society noted that not all 10 members of the panel agreed with making breast exams optional, saying some wanted to continue to recommend the exams.

The guidelines continue to recommend that a women in their 20s and 30s have a clinician do a breast exam about every three years, and women 40 and older have a clinical exam every year.

The society's recommendation for annual mammograms remained the same, too: Women of average risk should have their first mammogram at age 40, and women at high risk for breast cancer should start at age 30.

Educating women at high-risk for breast cancer -- such as those who carry the BRCA1 or BRCA2 genes and women with a strong family history of breast cancer -- is also part of the new recommendations. They may benefit from the use of breast ultrasound or MRI.

Some studies have shown those techniques are more effective than mammograms at detecting cancer.

The cancer society noted, however, there are limitations to ultrasound and MRIs, including the lack of standardized exam techniques and interpretation criteria.