Questions for your Primary Care Physician:
- Am I at a High Risk for breast cancer in my lifetime?
- Should I start mammograms at 40, 45 or 50?
- What are the downsides to screening mammography?
How “Screening Mammograms” save lives
Annual screening mammograms often detect small breast cancers before you may notice them yourself. “Breast screening” can save lives by finding cancers when they are smaller and easier to cure. Mammograms account for much of the improved survival from breast cancer over the last 30 years. Until recently, most guidelines have recommended beginning annual screening mammograms at the age of 40.
At what age should I begin screening?
Screening guidelines are currently evolving towards screening less women in their 40s. These newer guidelines recommend beginning mammography at age 45 or 50. Some suggest every other year rather than every year. The new guidelines have not been widely adopted and are quite controversial and confusing.
The Breast Cancer School for Patients recommends continuing annual screening mammograms for women age 40 and older. We provide an overview of both the wisdom and risks of these controversial recommendations. Consult with your physician to see what mammographic screening program will suit your unique situation. Screening mammograms are now covered by all health insurance plans, including Medicare and Medicaid.
Guidelines now encourage screening later. Why?
The American Cancer Society and the U.S. Preventive Services Task Force now recommend delaying annual screening mammography until 45 or 50 years old. The American College of Obstetricians and Gynecologists continue to recommend beginning at 40 years of age and annually thereafter.
(WSJ, Jan. 11, 2016)
(June 2017: ACOG updated its recommendations to begin screening
“every year or two at age 40, then annually at age 50”)
These new guidelines have created confusion for both physicians and women. As currently written, they have been impossible to implement by medical communities across the country. There is also disagreement amongst physician, patient advocacy and breast cancer organizations.
What are the risks of annual mammograms?
Screening for breast cancer is a balance between benefits (saves lives) and risks (cost, radiation, biopsies, stress). There are distinct risks to mammographic screening. The newer guidelines are based upon re-evaluations of these risks and benefits.
Risks of screening:
- Being “called back” for more imaging and nothing is found
- Most breast biopsies prove to be benign
- Radiation to the breasts from a mammogram
- The “stress & anxiety” when something is detected, but is not a cancer
- The monetary cost to you, insurance, and society
- Some cancers would have been cured anyway, without screening
Make informed screening decisions
All “guidelines” should be used as a starting point for making health care decisions. Make decisions about breast screening with your physicians. One benefit is that the new guidelines have encouraged women to educate themselves and engage their physicians about their personal risk for breast cancer.
One key component of screening is determining if you are at an increased lifetime risk for developing breast cancer. Such “High Risk” women should be more aggressive with breast screening. Seeing a breast surgeon is the best way to determine if you are at an increased risk for breast cancer. Your goal should be to develop a “tailor-made” breast screening approach that fits your unique situation.
This website helps women ages 40 – 49 make decisions about when to start and how often to get screening mammograms. This “Mammogram Decision Aid” (here) was developed by Weill Cornell Medical College.
This page (here) on “Breast Cancer Screening for Women at Average Risk” is excellent and covers all the guidelines in easy to understand terms. The Susan G. Komen organization is a leading advocacy group dedicated to assisting patients, funding research and ensuring quality breast cancer care.
This JAMA Patient Page on “Breast Cancer Screening in the United States” (here) outlines both major guidelines and is good summary of the current recommendations. The Journal of the American Medical Association is a network of publications from the American Medical Association.
Their “Breast Cancer Screening (PDQ)-Patient Version” (here) is an easy to read document on the details of breast screening. It does not deal specifically with the new screening guidelines. The National Cancer Institute is a governmental agency that is dedicated to distributing information to the public about cancer and cancer research trials.
More Detailed References:
This document (here) “Consensus Statement on Screening Mammography” does an excellent job of synthesizing all the different recommendations about when to start breast screening. The American Society of Breast Surgeons is a leading organization of surgeons who treat diseases of the breast.
If you want to get deep into the details about breast screening, this free pdf document has guidelines to help clinicians appropriately screen women for breast cancer. You can easily register (here) as a non-professional to get access. Once registered and logged in, click (here) to view this document.