“In a time of uncertainty about breast cancer screening, the role of the nurse in communicating information to patients about screening’s health risks and benefits is more important than ever.”

Few diagnostic rituals loom as large—or generate as much anxiety—as an upcoming mammogram appointment. Until relatively recently, most of the concern surrounding the procedure was about what it might reveal. What most women older than age 40 haven’t generally questioned since routine screening began in the 1980s was whether they should have a mammogram each year.

Confusion for patients and providers.

Sandra Brennan, director of radiology at Memorial Sloan Kettering Westchester, West Harrison, New York, reads mammogram results with a technician. Photo courtesy Memorial Sloan Kettering Cancer Center Graphics Team.

Yet many women, particularly those in their 40s, are now struggling with this very issue. Recent changes in the breast cancer screening guidelines of major organizations have moved away from a population-based approach to screening, which has historically begun at age 40 and been repeated annually for most women.

Based on data from clinical research and cancer registries, the current recommendations reflect an effort to balance what we now know about the benefits and risks of mammography. Although this has resulted in more individualized guidance—based on a woman’s age and risk factors—the updated guidelines lack consensus. The result has been confusion among patients and providers alike.

A review navigates the maze.

In this month’s issue of AJN, Roberta Baron and colleagues help nurses make sense of what can seem like contradictory advice for woman making decisions about mammography. In “Breast Cancer Screening: A Review of Current Guidelines,” the authors take a close look at the current screening recommendations of three well-regarded organizations: the American Cancer Society (ACS), the U.S. Preventive Services Task Force (USPSTF), and the National Comprehensive Cancer Network (NCCN). They detail the rationale for each guideline, the benefits and risks of screening, and the controversies generated by these updated recommendations.

Understanding the different guidelines and the evidence supporting them, the authors argue, is essential if nurses are to “to help patients navigate the maze of confusion created by the recent changes to the breast cancer screening recommendations.”

Notable differences in terms of screening age, frequency, and type.

The authors highlight the “notable differences in the available screening guidelines, including the age at which women should start and stop screening, the frequency of screening, and the type of screening modalities recommended. . . .” They also stress the continued importance of mammography, which they call “the gold standard. . .[it] continues to be the only method of breast cancer screening proven to reduce mortality.”

It’s hoped that ongoing research will one day resolve the differences among these organizations’ screening recommendations. Until then, “nurses are at the forefront of supporting and educating patients,” Baron and colleagues observe. “In a time of uncertainty about breast cancer screening, the role of the nurse in communicating information to patients about screening’s health risks and benefits is more important than ever.”