What nurses need to know about revised mammogram guidelines from the American Cancer SocietyDate: August 3, 2017
As detailed in a fact sheet from the American Nurses Association, a major component of a registered nurse’s job is to focus on educating patients about preventative health measures, such as smoking cessation, eating a balanced diet, reducing alcohol intake and getting regular exercise.
Another significant preventative health strategy that nurses often are responsible for spreading awareness of is screenings for certain types of cancer. Screening involves looking for signs of a cancer in an otherwise healthy patient, the U.S. Centers for Disease Control and Prevention (CDC) stated in an online resource. The purpose of these screenings is to catch the development of cancer in its earliest stages, when treatment is generally more effective. Research has shown that for specific kinds of cancer such as colorectal, breast, cervical and lung cancer, screening can improve treatment outcomes and reduce mortality rates. Screening for other cancers, such as prostate and skin cancer, is available, although it is not necessarily an effective way to lower mortality rates.
One recent change to preventative care that all nurses should be cognizant of is the revision to the breast cancer screening guidelines implemented by the American Cancer Society (ACS) in October 2015.
A closer look at mammograms
As outlined explicated in a guide from the National Breast Cancer Foundation, breast cancer remains a major killer across the world, and in the U.S., it is a primary reason for early deaths among women. Although it is possible for men to develop the disease, breast cancer is the malignancy that targets women the most — at higher rates than others cancers, such as lung, cervical or skin cancer. Statistically, the likelihood of a U.S. woman developing breast cancer currently stands at around one in eight, which translates to approximately 246,600 new cases each year.
Screening for breast cancer relies on a procedure known as a screening mammogram. Screening mammograms are performed on each one of a patient’s breasts. The procedure is performed using an X-ray machine, which captures images of the breast tissue. The images then can be assessed by health care professionals to determine if there are any early signs of cancer present. Mammograms also can be performed when it is suspected that a patient may indeed have cancer — after she has found a lump in her breast, for example. When mammograms are used to investigate symptoms and confirm a diagnosis, they are termed diagnostic mammograms.
Early detection, a corollary of screening for breast cancer, has been shown to reduce mortality rates among patients. This fact is indicated across a number of studies, researchers Kevin C. Oeffinger and Elizabeth T.H. Fontham et al. explained in the revised ACS mammogram guidelines, published by the Journal of the American Medical Association.
What are the revised ACS guidelines?
Under the revised ACS guidelines for breast cancer, women now are encouraged to start receiving mammograms at the age of 45, and the screening should be performed on a yearly basis. After the age of 55, however, it is advised that mammograms be performed on a biennial basis. ACS researchers recommended, however, that primary care physicians allow women a certain level of autonomy in making this decision, particularly when it comes to requesting earlier or more frequent mammograms. For example, the ACS guidelines note that women should be able to continue with the yearly screenings after the age of 55 if they so choose. Another interesting change to the guidelines is that at home, self-administered breast examinations are no longer advised.
Understanding other screening guidelines
The ACS does not have a monopoly on issuing screening guidelines. The U.S. Preventative Services Task Force (USPSTF) and The American Congress of Obstetricians and Gynecologists also have their own recommendations. The USPSTF guidelines, in particular, have long stood somewhat at odds with those proposed by the ACS, according to journalist Lena H. Sun, writing for The Washington Post. It is crucial, therefore, for nursing staff to have an understanding of all sets of guidelines, so they can provide patients with the most comprehensive information possible.
The USPSTF screening guidelines, revised and issued in January 2016, advise that women receive a mammogram on a biennial basis, and only after the age of 50, Sun detailed. Furthermore, researchers from the organization suggest that biennial mammograms should be discontinued once a woman reaches the age of 74. The American Congress of Obstetricians and Gynecologists recommendations are more cautious in nature: medical professionals for the organization propose that women start routine mammograms when they are younger, around the age of 40.
Why is there a debate over mammogram guidelines?
Klein explained how the guidelines are developed with considerations of the pros and cons of receiving a mammogram in mind — researchers review current evidence regarding the efficacy of mammograms and devise their recommendations based on those findings.
For example, the USPSTF’s recommendation of less intervention in terms of screening likely is informed by the fact that mammograms can cause more harm than good in certain cases. As explained in the online guide published by the National Cancer Institute (NCI), a common risk associated with regular breast cancer screenings is over diagnosis. This situation occurs when health care providers find evidence of cancer cells in mammograms and proceed with treatment, when, in fact, the kind of cancer discovered may not have actually spread or posed a hazard to the patient’s life. Over diagnosis culminates in patients receiving unnecessary treatment, which can be painful and emotionally taxing for the patients and their loved ones.
Other harmful effects of mammograms, as discussed in the NCI guide, include false positive results and false negative results. The former is problematic because false positive results can lead to unnecessary medical intervention and emotional distress in patients who do not need treatment. Conversely, incorrect negative results lure patients and care providers into thinking everything is fine, which can delay the treatment that is necessary to to address the cancer and stop it from spreading.
Given the varying guidelines concerning screening, nursing staff and primary care providers can advise and consult with patients on an individual basis, providing information on the benefits and risks before helping the patient make a decision that best suits her or his needs.
Consider Bradley University
Nurse educators work on the frontlines of informing nursing staff about changes in regulation, such as the aforementioned updates to the ACS mammogram guidelines. If you’re interested in helping educate the nurses of tomorrow or are eager to manage your own nursing team, consider advancing your career by applying to Bradley University’s online Master of Science in Nursing program. With courses and practicums that can be completed on your time, you will find that you have more freedom and flexibility to incorporate studying into your professional schedule.