As Chair of the American Cancer Society (ACS) panel that issued an updated guideline for breast cancer screening, Kevin C. Oeffinger, MD, has answered questions and offered perspective on the updated guideline and its development for The New York Times, USA Today, and other major media outlets. As Director of the Cancer Survivorship Center, Memorial Sloan Kettering Cancer, New York, he has welcomed and answered questions about the guideline from colleagues and patients.
“I hoped and anticipated that I would get questions, because that always gives us the opportunity to expand upon the media coverage,” Dr. Oeffinger said in an interview with The ASCO Post. “This allows us to explain the details of the recommendations to people who may have only read the headlines or heard brief snippets about the updated guideline.”
Two Categories of Concern
Dr. Oeffinger said that patients’ concerns generally fall into two major categories that directly impact decisions about screening. “One is typified by the comment, ‘I want to avoid a breast cancer diagnosis that is late by any means possible.’ That suggests an easy decision for screening,” he said.
“But just as many women tell me, ‘I really want to avoid overtesting. I understand what you say about the numbers, and the likelihood is that I will live my life without having breast cancer.’”
In both of these scenarios, “it is the woman herself who should decide, not me,” Dr. Oeffinger said. “The tradeoff is best defined by the individual woman.”
Clinical Encounter Context
The guideline “is especially designed for use in the context of a clinical encounter,” the Guideline Development Group stated, so that screening decisions reflect an individual’s values and preferences. By the time women need to make a decision about breast cancer screening, most understand what is most important to them and what they most want to avoid—a late or missed diagnosis of breast cancer or overtesting.
“It is not difficult for a physician or other health-care provider to ascertain a woman’s preferences and values. This is not a 30-minute conversation,” Dr. Oeffinger said, “but it tends to be relatively brief.”
Physicians should also periodically establish whether a woman’s risk-factor profile has changed. “We have to move away from taking a family history or assessing comorbidities just once,” Dr. Oeffinger said. “Health is dynamic. People’s family histories are changing. Their comorbidities are changing. We need to think of a woman as being on a continuum and assess what her needs are during that individual visit and at that point in time, not just one time.” ■
Disclosure: Dr. Oeffinger is Chair of the American Cancer Society’s breast cancer guideline panel.
