October is Breast Cancer Awareness Month: time to get screened
by Beth Donovan | Special to the Courier
I was really hoping the final updated guidelines for breast cancer screening would be published before this went out, but we can’t always get what we want. The 2016 recommendations are what we have as we find ourselves in the middle of breast cancer awareness month, so I am going with it.
Breast cancer continues to be a leading cause of cancer death among women in the United States, despite advances in treatment options. Like with most cancers, early detection often increases survival. The number one risk factor for breast cancer is being born female and the next is age — unfortunately two things we can do nothing about.
There is an increased risk of getting breast cancer if a first-degree relative had breast cancer, but most women who are diagnosed do not have a family history. If you are uncertain whether you may be at a higher than average risk for breast cancer, you should talk with your healthcare provider. In addition, some people find it helpful to use a risk calculator like the one available from the National Cancer Institute.
The American Cancer Society advocates that all women work to reduce the risk of breast cancer by maintaining a healthy weight, staying physically active, avoiding or limiting alcohol intake, and breastfeeding after childbirth. If you have a strong family history of breast or ovarian cancer, your healthcare provider may recommend testing for a gene mutation which increases your risk of these cancers. A strong family history means a first degree relative (mother, father, sister, brother, or daughter) with breast cancer. Careful consideration through genetic counseling may be a good option if you have a strong family history because there are medications or medical procedures that can lower the risk of cancer if you test positive for the BRCA1 or BRCA2 gene or some less common gene mutations.
The US Preventive Services Task Force recommends all women 50 to 74 be screened with a digital mammogram every other year. Digital mammography is often now paired with digital breast tomosynthesis or “3D” mammography, which allows a radiologist to view “slices” of the breast tissue. Recent studies have indicated we should start screening earlier and this is being considered currently at the USPSTF. In fact, the draft recommendation includes guidance to start screening at 40 years old, but this is not yet a final recommendation.
Lowering the recommended screening age is mostly important for insurance coverage. Only the A and B recommendations must be covered free of charge to all enrollees of most commercial insurance plans. The current B recommendation is only for women 50 to 74. Today, if a woman has a mammogram when she is in her 40s, even with an order from a healthcare provider, her insurance will likely cover the test, but the plan could pay as it would for any medically necessary test. This means that she may be responsible for any copayment or coinsurance allowed by that plan. If the B recommendation is finalized and recommends screening at a younger age, the health plan must cover the test in that age group without any cost to the patient.
The US Preventive Services Task Force is a panel of preventive medicine experts who volunteer to review literature and clinical guidelines; develop recommendations for preventive screenings, medications, and counseling; and assign a grade to their recommendations. It published this recommendation in 2016, assigning it to a grade B, meaning that the net benefit of screening mammography is moderate. You can download an app or go the website to learn which preventive screenings, medications or counseling services are recommended for you.
Claremont resident Beth Donovan, PA-C, practiced as a physician assistant for 20 years and served as chair of legislative affairs for the California Academy of Physician Assistants from 2004 to 2012. She is on the advisory board for Keck Graduate Institute’s Physician Assistant Program.