International Breast Cancer Awareness Month is not until October, but health authorities are already reminding Israeli women that they are now eligible for mammograms starting at age 45, in line with new Health Ministry guidelines.
Previously, women without any risk factors for breast cancer were told to start getting mammograms at age 50 and have the imaging repeated every two years. Only women with family histories of the disease were advised to start getting mammograms at age 40.
Both the Health Ministry and the Israeli Cancer Association (ICA) now urge women 45-50 to discuss the possibility of a baseline mammogram with their primary care physician, who can provide a referral for the test through a health maintenance organization, or a private clinic or hospital that accepts HMO insurance.
“Every October we have a campaign emphasizing the importance of early detection of breast cancer. This year we are not only reminding women aged 50 and up to get regular mammograms, but we are also letting women aged 45 know that they may be eligible for a mammogram after consulting with their doctor,” Health Ministry Director-General Moshe Bar Siman Tov said in an official statement.
Dr. Rachel Michaelson-Cohen, a gynecologist and the director of the prenatal genetics unit at Jerusalem’s Shaare Zedek Medical Center, told The Times of Israel that she believes these new guidelines are a result of two factors.
“First, we are unfortunately seeing more women diagnosed with breast cancer at younger ages, especially in their 40s,” Michaelson-Cohen said.
“Second, it could be the influence of what is happening in other countries. For instance, in the US the recommendation is to start getting mammograms at age 40,” she said.
A 2018 paper available on a US National Institutes of Health website indicates that as breast cancer cases rise globally, other countries, including Sweden, Austria, Japan, Iceland and New Zealand are recommending mammogram screening begin at age 40 or 45.
The longstanding recommendation that Israeli women start screening at 50 is somewhat surprising given that breast cancer is the most common malignancy among Israeli women. As in the US, one in eight Israeli women will develop the disease in their lifetime.
Not all cases are genetically linked, but the breast cancer rate is higher in Israel than in many other countries because Ashkenazi Jews — men and women — have a 2.5% chance of having a BRCA mutation, which significantly increases the risk of developing breast or ovarian cancer, or both. Genetic testing for anyone with at least one Ashkenazi grandparent was added to Israel’s health basket several years ago, after studies showed its cost-effectiveness.
“We have not succeeded yet in exposing all the BRCA-positive women, and there’s definitely a lot of them out there. So it’s probably a good idea to start screening at younger ages in general so we can catch all those younger women who have breast cancer starting before 50,” Michaelson-Cohen said.
Even before the pink ribbons for breast cancer awareness month start showing up, an ICA-sponsored public service ad can be seen on billboards, social media and television. It shows a Post-it note on a refrigerator reminding the woman who lives in that home to make an appointment with her primary care physician as soon as possible. The PSA emphasizes that the age guidelines have changed.
Michaelson-Cohen said she could not imagine a doctor turning down a patient’s request for a referral for a mammogram, with the only exception being a person with a very rare disease that requires her to minimize her exposure to routine radiation.
“If I were a family doctor I would encourage women [aged 45] to go through with it,” she said.