When Should I Start Having Mammograms & How Frequently?

When Should I Start Having Mammograms & How Frequently?

There has been a great deal of controversy in the press recently about mammography – specifically when to start having mammograms and how often after that? Let’s try to break it all down so that it makes sense and enables you to make an informed decision on when you want to begin mammography and how often you want to be screened, because ultimately the decision is yours.

The following American groups recommend annual mammograms for women over 40:

·         The National Cancer Institute

·         The American Cancer Society

·         The American College of Physicians and Gynecologists

·         The American College of Radiology

·         The Society of Breast Imaging

·         Radiological Society of North America (RSNA)

Why: According to the American Cancer Society (ACS) the data shows that mammography screening does reduce breast cancer death—by 15% for women ages 39 to 49. To prevent one cancer death in this group, 1,904 women would have to be screened. Among women 50 to 59, one death is avoided per 1,339 screenings.

Women in their 40s with no family history of breast cancer are just as likely to develop invasive breast cancer as are women with a family history of the disease, according to a study presented in November 2011 at the annual meeting of the Radiological Society of North America (RSNA). These findings indicate that women in this age group would benefit from annual screening mammography.

A new case-control study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, shows that women who participated in at least three screening mammograms had a 49 percent lower risk for breast cancer mortality.

This all sounds pretty straight forward doesn’t it? It was all straight forward until the U.S. Preventive Services Task Force (USPSTF), an independent panel sponsored by the federal Agency for Healthcare Research and Quality issued new guidelines:

·         Women should have a mammogram every 2 years starting at age 50—not 40.

·         Screening should continue every 2 years through to age 74.

No recommendations on screening women 75 and older, the value of clinical breast exams beyond mammography in women 40 and older or on the value of other imaging techniques, such as digital mammography or magnetic resonance imaging were issued because they didn’t have sufficient evidence to make a determination. They did however recommend against teaching women how to perform breast self-examination, citing that there is no evidence that it reduces breast cancer deaths.

Why? The USPSTF concluded that the benefit gained by starting screening at 40 versus 50 is small and that the decision to start screening before 50 should be an individual one. They are also concerned that mammograms in women in their 40s produce more false-positive mammograms, resulting in biopsies and/or other tests.

Dr. Brawley of the American Cancer Society responded to this by saying, “The USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.”

This has now spilled over into Canada. These are the new guidelines in the Canadian Medical Association Journal that apply to healthy women who have never had breast cancer, don't have a first-degree relative (such as a mother or sister) with a history of the disease, and no known genetic risks:

• No routine mammograms are needed in women aged 40 to 49
• Women aged 50 to 74 can cut back on the frequency of screening mammograms from every 2 years to "every 2 to 3 years"
• Women age 70 to 74 should also have mammograms every two to three years
• No recommendations for women aged 75 years and older because of a lack of data on this age group
• There is no need for regular breast self-examination
• There is no need for routine clinical breast examinations, either alone or in conjunction with screening mammograms

Why? They’ve bought into the story about more false positive mammograms and therefore more biopsies and/or other tests.

The reality:

In the United States, breast cancer is the second-leading cause of cancer death in women, after lung cancer. In 2009, an estimated 254,650 breast cancer cases will be diagnosed and 40,170 women will die from the disease.

In Canada, one in nine women is expected to develop breast cancer in her lifetime; one in 29 is expected to die from the disease.

The choice:

Discuss this information with your doctor. If you feel that the risk of a false positive mammogram is worth the risk, get yourself screened. I think you’ll find that doctors will still be doing breast exams as part of a routine physical, regardless of the new guidelines. If annual mammography will give you peace of mind, insist upon it.