For years, the American Cancer Society recommended that women start getting mammograms at age 40, but in 2015, they changed their guidelines to age 45. The American College of Obstetricians and Gynecologists says that starting at age 40 is best, and the U.S. Preventive Services Task Force Services says women can wait until age 50 to begin getting an annual mammogram.
Let’s set the record straight – many medical professionals are confused about the current mammogram screening guidelines. Who wouldn’t be? Just when we think we’ve got it straight and tailor our practices for those recommendations, things change again.
With all the varying recommendations at play, you and your doctor should have a conversation about mammography screening instead of your doctor simply ordering the study. We talk to our patients before starting new medications and suggesting surgeries, so a discussion about a screening test like a mammogram shouldn’t be any different.
The mammography conversation between you and your doctor should include the pros and the cons of the screening and what a positive finding may mean. I’ve found in my practice if I warn women they might get abnormal results for one reason or another, they seem to tolerate that uncertainty better.
Arguments against annual mammography are usually fueled by the anxiety about how the screening can make you feel as well as the minimal radiation exposure. The radiation exposure from a mammogram is less than that of the exposure from flying in an airplane across the country. Any anxiety you may feel from positive findings on a mammogram should be managed efficiently by talking to your doctor. Many times, women will be called back to have additional mammograms to look at small areas of concern on the breast. Usually, your doctor will recommend additional imaging in six months or a yearly screening mammogram.
As a breast cancer surgeon, I tend to bristle and take personal offense to the idea that patients should be screened less frequently. After all, a very large part of my practice is taking care of women who were diagnosed by mammograms – so my biases are real. To some degree, the changes in mammography recommendations are the result of various people looking at different data sets – in essence, it comes down to which studies you find most reliable.
I tell women who are at average risk for breast cancer that they need yearly mammograms starting at age 40. For women who are at high risk for breast cancer with a family history of it, possess the breast cancer gene BRCA 1 or BRCA 2, etc., the mammogram guidelines are very different. They should get an MRI and a mammogram every year beginning at age 30.
So, talk to your doctor about mammography, make sure you are going by guidelines that meet your own health goals, understand the potential downside of a mammogram, and then go for it. They may hurt a little, but they might save your life!
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