While we all understand the importance of breast cancer screening, when to start getting mammograms and how often to get them is still widely debated.
In 2017 the American Congress of Obstetricians and Gynecologists (ACOG) released a response contradicting breast cancer screening guidelines set forth by the U.S. Preventive Services Task Force. Very nice. For some of my patients, this caused anxiety and confusion. One group is telling them to get a mammo every year starting at age 40 while another is saying, 'nah, hold off until age 50 and then only do it every other year.'
I think there is no one-size-fits-all solution here. Breast cancer screening should be customized to answer the question, “How often should I be getting a mammogram?”
Early breast cancer detection saves lives
It is an undisputed fact that mammograms have significantly lowered the number of breast cancer deaths in the United States. Just over 12 percent of all American women will develop breast cancer at some point, and it accounts for 15 percent of all new cancer diagnoses each year.
Why all the debate about mammograms?
If mammograms significantly lower the rate of breast cancer deaths, why don’t we simply encourage every woman to get one each year during her well-woman exam? Because like many medical exams, mammograms do have some associated risks.
First, while mammogram technology continues to improve, it is not a surefire way to diagnose breast cancer if an abnormality is found. An abnormal mammogram result will almost certainly cause some emotional stress for the patient, even if it turns out not to be cancer.
If further testing is ordered beyond the mammogram itself, a woman may have to spend more time and money to undergo more procedures, often only to learn that the suspected abnormality was benign. Worrying over a potential cancer diagnosis and the unpleasant experience of further testing once an abnormality is found may discourage a woman from getting more mammograms from that point forward.
Second, the imaging technology used in mammograms delivers a small dose of radiation. In the most recent research regarding radiation and mammographic screening, this risk has been shown to be minuscule.
Some other commonly cited risk factors and drawbacks include overdiagnosis, overtreatment, pain and discomfort experienced during the mammogram (this is usually very mild, but still worth noting), and the limited ability of mammograms to detect certain types of breast cancers.
My advice to my patients
For patients with average risk for breast cancer I stand by the general ACOG recommendation for yearly mammograms at age 40 because I believe the benefits of early detection outweigh the associated downside of more frequent mammograms. Memorial Sloan Kettering Cancer Center also supports these guidelines. The ACOG guidelines underscore an important concept that should be at the center of women’s healthcare: patient empowerment and shared decision making.
What about patients with above average risk for breast cancer? And by above average risk I mean patients who have a family history of breast cancer in a first degree relative (parent, sibling, child) or who have been diagnosed with a BRCA mutation. For these patients, I recommend a clinical breast exam every six months starting no later than ten years before the age of the earliest diagnosis in the family (but not earlier than age 25 and not later than age 40). Also, I suggest:
an annual mammogram starting no later than ten years before the age of the earliest diagnosis in the family (but not earlier than age 25 and not later than age 40)
possible supplemental imaging (for example, with ultrasound) for women with dense breast tissue
possibly alternating between a breast MRI and a mammogram every six months, as determined by your physician
Even though breast cancer screening guidelines are often confusing and contradictory, a patient’s mind can be put at ease by developing an ongoing relationship with her OB-GYN that allows her to make educated and empowering health decisions.
Related content:
Ten Habits to Lower Breast Cancer Risk.
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