As guidelines change, gynecologists urged to educate patients

Drs. Elizabeth Knepp (left) and Natasha Singh are shown at Somerset Women’s Health Center, 867 W. Main St., on Sept. 5.

A woman’s annual gynecologist appointment can be her front line of defense against breast cancer.

That’s where women are most likely to have a clinical breast exam, and the gynecologist often orders the annual mammogram screenings.

Drs. Elizabeth Knepp and Natasha Singh, obstetrician/gynecologists at Somerset Women’s Health Center, 867 W. Main St., agree that regular checkups are important for early detection of breast cancer, but recognize that newer studies raise questions about various tests’ value.

“It has changed a lot over the years,” Knepp said.

The American College of Obstetricians and Gynecologists revised its guidelines this year, encouraging doctors to help patients make their own decisions on screening.

“Our new guidance considers each individual patient and her values,” Dr. Christopher M. Zahn, ACOG vice president for practice affairs, said in a press release.

“Given the range of current recommendations, we have moved toward encouraging obstetrician–gynecologists to help their patients make personal screening choices from a range of reasonable options,” Zahn said.

The doctors’ group is among the latest organizations to update guidelines in the wake of studies such as a 2009 review by the U.S. Preventive Services Task Force and a 2013 United Kingdom study of cancer death. 

The recent research has raised questions about the value of screening mammograms, breast self-exams and clinical breast exams.

Prior to the task-force study, guidelines issued by almost every organization suggested annual screening mammograms beginning at age 40, along with an annual clinical exam by a medical professional beginning around age 20. Monthly breast self-exams were included in some organizations’ guidelines.

In issuing its new guidelines, ACOG calls for annual screening mammograms after age 50 for women with average cancer risk. The guidelines, however, also say doctors should discuss the annual screening and offer mammograms to women beginning at age 40.

The guidelines, published in the July issue of Obstetrics and Gynecology journal, say doctors’ discussions with average-risk patients should include offering clinical breast examinations every one to three years for patients ages 25 to 39 years, and annually for women 40 years and older. 

Instead of breast self–exams, the guidelines call for “breast self-awareness.”

The ACOG says screenings should be based on what the organization calls “shared decision making” – with the doctor helping the patient understand the pros and cons of each test.

“Shared decision making is particularly important for decisions regarding breast cancer screening, because many choices involve personal preferences related to potential benefits and adverse consequences,”the guidelines say.

Somerset Women’s Health, which is part of Allegheny Health Network of Pittsburgh, encourages women to be aware of the normal feel and texture of their breasts, Singh said.

“The culture before was for breast self-exams,” Singh said. “Now we advocate breast awareness.”

Screening mammograms, clinical breast exams and breast self-exams have all been criticized for false alarms and unnecessary treatment.

“We are doing too many biopsies,” Knepp said, adding that the monthly exams help women be aware of what’s normal.

“Many women still pick up their own cancer,” Knepp said. “We encourage them to call if they have persistent pain, feel a mass or have nipple discharge.”  

Randy Griffith is a multimedia reporter for The Tribune-Democrat. He can be reached at 532-5057. Follow him on Twitter @PhotoGriffer57.