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.

But the bottom line is that no two women are the same. Know your body, know your health and family history, and know your options. Talk to your doctor and get informed so that you can make the best decisions for your personal situation.

Below you’ll find general information for women in different age groups that may help you guide your discussions with your doctor. 

Women In Their 40s

  • Women in their 40s need to be informed that the chance of being called back for a biopsy is fairly high while the chance of actually having a cancer is relatively low. On average, if 2,000 women are screened every year for 10 years, 1,100 will have a biopsy during that period, but probably only 10 cancers will be found, and screening would have saved the life of one of the ten.
  • If there is a family history or other risk factors, women should screen in their 40s, but should discuss their risk with their health care practitioner and might consider prevention options such as chemoprevention, surgical prophylaxis and/or lifestyle changes.
  • Women with a strong family history of breast cancer (at early ages), should discuss whether they should undergo genetic testing. In some families, family history can be explained by the presence of an error in a gene that you inherit from either your mother or father. A simple blood test can determine whether it is present or not. Family members who carry the gene should undergo more intensive screening, even before age 40, and have yearly mammograms and MRIs, alternating every six months. It is also important to talk to a genetic counselor or a surgeon about options for preventive surgery.

Women Ages 50-75 

  • Evidence from clinical trials has shown that women aged 50 to 75 receive the greatest benefits of early detection through mammographic screening.
  • Tumors in women in this age range typically have moderate to slow growth rates, and a 1.5 to 2 year interval has been shown to be effective reduce mortality from breast cancer in these women
  • As this data suggests, screening every other year has just about as much benefit as yearly screening. Most countries in Europe recommend screening every 1.5 to 2 years, except the United Kingdom, where screening is recommended for every 3 years.

Women Over 75

There is no evidence that screening women over 75 reduces the chances of dying from breast cancer. As women get older, the cancers that develop tend to be slow growing, and are much less likely to be life threatening. As women age beyond 75, other medical conditions become more important. Screening will certainly not be of benefit for a woman who has multiple other medical conditions such as heart disease or diabetes, for example, as these other diseases are more likely to be the cause of mortality than breast cancer.

 

For Women of Any Age

Be aware of any changes in your body. The best way to do that is to be familiar with your own breast tissue and to do a brief exam once a month or so. Know what the texture is like and whether your tissue is lumpy or not. If you find a new mass and it does not go away, bring it to the attention of your physician. If you are sure it is new, make sure to get a biopsy or tissue sample, regardless of what the mammogram shows. Aggressive cancers grow rapidly and can show up as big breast masses as soon as a few months after a normal mammogram. These kinds of cancers are more likely to show up in younger women but can appear at any age. Again, be sure to bring new changes in your breast to the attention of a clinician.