Mammograms remain the best line of defense in the treatment of breast cancer, but there is still some confusion about when women should go for their first screening test.
A few years ago the U.S. Preventive Services Task Force (USPSTF) — a group of health experts that reviews published research and makes recommendations about preventive health care — issued revised mammogram guidelines which called for women at average risk of cancer to have screening mammograms done every two years beginning at age 50. The task force did not recommend routine mammograms for women before the age of 50.
These guidelines differ from those recommended by the American Cancer Society (ACS), the American Society of Breast Surgeons (ASBS), and the American College of Radiologists (ACR), all of which recommend yearly mammogram screening beginning at age 40 for women at average risk of breast cancer.
The ASBS, the leading organization for surgeons who treat breast disease, supports screening mammography beginning at age 40. Patients with breast cancers detected in an earlier stage, including women age 40-49, are more likely to be candidates for breast-conserving surgery, less likely to require chemotherapy, and more likely to survive compared to those who have their cancers diagnosed at a later stage. The ASBS concluded that mammograms remain the most cost-effective, practical, and accurate screening tool currently available for the early detection of breast cancer.
The USPSTF does point out that women who have screening mammograms die of breast cancer less frequently than do women who don't get them, but points out that the benefits of screening mammograms don't outweigh the harms for women ages 40 to 49. Potential harms may include false-positive results that lead to unneeded breast biopsies and accompanying anxiety and distress.
The National Cancer Institute (NCI), another organization that has weighed in on the issue,recommends that women age 40 or older have screening mammograms every 1 to 2 years.
As always, talk to your doctor about this and other health concerns. Your primary care physician or your gynecologist will help you to decide at what age you should get your first mammogram and how often after that you should have one.
So what is a mammogram? There are two kinds. A screening mammogram checks for breast cancer in women who have no signs or symptoms of the disease. Often done annually, the test involves a specialized X-ray machine that takes pictures of a compressed breast. Women do not wear clothes on the upper body during the exam on each breast. The X-ray images make it possible to detect tumors that cannot be felt. Screening mammograms can also find very small deposits of calcium called microcalcifications that sometimes indicate the presence of breast cancer.
Diagnostic mammograms are done when breast cancer is suspected or when a screening mammogram may be difficult, as can be the case when a woman has breast implants. Besides a lump, signs of breast cancer can include breast pain, thickening of the skin of the breast, nipple discharge, or a change in breast size or shape. Women please note: These do not have to be signs of cancer; they can be symptoms of benign conditions. Diagnostic mammography takes longer than screening mammography because more X-rays are needed to obtain views of the breast from several angles.
Because mammograms are done using X-ray technology, some women express concern about radiation exposure. Mammography requires the use of very small doses of radiation. Nevertheless a mammography technician will always ask if there is any possibility that a patient is pregnant. The risk of harm from this radiation exposure is extremely low, but it is true that repeated X-rays have the potential to cause cancer.
The benefits of mammography nearly always outweigh the potential harm from the radiation exposure. Women should talk to their doctor about this and any other concern.
Courtesy of Lisa Hopkins, M.D., breast surgeon at The Breast Center at Saint Peter’s University Hospital. Visit our website to learn more about our breast center services
