Why Mammograms Need to Begin at 40

Nurse giving woman mammogram
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You may be considering delaying having your first mammogram until you are 50 years old based on the 2009 guidelines of the U.S. Preventative Services Task Force (USPSTF) for women of average risk for breast cancer. You may think 50 is too long to wait, and feel the recently released American Cancer Society guidelines that recommend waiting until you are 45 to get your first mammogram are a fit for you.

You may be in your 50s and relieved to hear that the USPSTF and the American Cancer Society recommend having a mammogram every other year. You are seriously considering an every other year schedule, even though you know that the risk of breast cancer increases with age, and that most breast cancers occur in women over 50.

The USPSTF cites the incidence of false-positives and the need for additional testing and expense of testing as well as patient anxiety as some of the causes for raising the screening age for beginning mammograms.

The changes in guidelines for getting mammograms are continuing to cause great debates between professionals in the field. New research, for and against raising the age for beginning mammograms and scheduling mammograms every other year once a woman is in her 50’s, come out every few months. The results make decision-making confusing for women who must decide when they will schedule their mammograms.

A recent study, conducted in Copenhagen, Denmark, offers another perspective on false-positives. A report on the study appeared an article in this column, Is A False Positive Mammogram an Indicator of a Future Breast Cancer? The study suggests that a false-positive finding on mammography indicates a greater chance of breast cancer long-term, due to underlying pathology or initial misclassification.

Mammography is still is the best tool to screen for breast cancer. There are no tests that can replace mammography. For this reason, experts at the American College of Radiology (ACR), and Society of Breast Imaging (SBI) both recommend that women have annual mammograms starting at age 40.

Before making these decisions, please consider the information and recommendations coming from these two organizations of and for radiologists that read and interpret mammograms. They want you to know that:

  • 1 in 6 breast cancers occur in women ages 40–49
  • 3 out of 4 women who receive a breast cancer diagnosis have no prior family history of the disease.
  • Since mammography came into widespread use, in the 1990s, there has been a 1/3 reduction in breast cancer deaths since.
  • Women in their 40s account for 40% of all the years of life saved by mammography.
  • An every other year schedule for mammograms in women 50+ will result in missing 30% of breast cancers.

While a mammogram may be an uncomfortable screening, it is a life saver. It can detect a breast cancer at an early stage, long before it is large enough to be felt during a physical exam. When a mammogram catches a breast cancer early, a woman has the opportunity to have breast conserving surgery and may not need chemotherapy. Being spared a more extensive surgery and not having chemotherapy makes recovery a faster, less difficult experience.

It has been 17 years since a mammogram found my first breast cancer. A mammogram found it before it could be felt by a breast surgeon, when it was an early, stage cancer that didn’t require chemotherapy. It’s been 7 years since a mammogram detected a second primary breast cancer, which also didn’t need chemotherapy. So, yes, I support starting mammograms at 40 and having them annually thereafter.

According to the American College of Radiology, mammograms can and do find cancers early, at a stage when the cancer is easily treated and requires less invasive procedures such as a lumpectomy followed by radiation therapy. Mammograms have proven not only to saves lives, but they can help preserve a quality of life. To learn more about the benefits of regular mammography screening, visit the American College of Radiology site at www.MammographySavesLives.org and the Society of Breast Imaging (SBI) site at Endtheconfusion.org.

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