Mammogram Guidelines: Know the Facts

Last fall, there was considerable controversy in the media about how to improve mammographic screening, borne of federal recommendations that changed the way the recommendations are applied.

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On November 16, 2009, The US Preventive Services Task Force (USPSTF) issued a recommendation that confirmed the benefits of screening mammography for women, however, they made some changes to the way in which we use it across the general population. They shifted the recommended age that women without a family (genetic) predisposition for cancer should have their initial mammogram to age 50, in contrast to a previous recommendation of age 40. Furthermore, they stated that healthy women between 50 and 74 should have mammograms less frequently than previously advised: every two years instead of annually.

The task force did not say the women in their forties should not be screened. They recommended that women in their 40’s, and over the age of 74, make their decision regarding screening on an individual basis after talking to their doctors. Women in their forties should know about family and personal history of cancer as well as other breast cancer risk  factors.  Women aged 75 and over should make their decisions in the context of their overall health and other risk factors such as breast density, family risk of breast cancer, and whether they use hormone replacement therapy.

The USPSTF report explained these changes by pointing out that while mammograms reduce breast cancer deaths by about 15 percent, they also lead to a high volume of unnecessary tests and treatment. It also emphasized that while women in their 40s are less likely to have breast cancer than women over 50, younger women are about 60 percent more likely to receive a false-positive result from a mammogram.

When it comes to the mechanics of screening, some women wonder why they have to use the mammogram instead of less-uncomfortable imaging tools, like the ultrasound. Right now, mammograms are our best initial screening tool, and they remain the only test that is proven to help reduce your chance of dying from breast cancer. Ultrasound is best used to investigate a lump you or your doctor might feel, or to learn more if your mammogram shows something abnormal.