Cancer
Dear Doc,
I am about to turn 42 and I haven’t had a mammogram. I went to my primary care provider for the first time in several years and she was adamant that I get a mammogram this year. She said my breast exam was normal but the mammogram could detect cancers that are too small to feel on exam. I have no family history of breast cancer. A friend of mine told me that her doctor recommended starting mammograms at age 50. What is the right age to start mammograms and how often should I get one? What are the risks of mammograms?
Answer:
When to start mammograms and how often to perform them has been an area of controversy in recent years. The American College of Obstetrics and Gynecology, the American Medical Association and the American Cancer Society advocate for yearly mammograms starting at the age of 40 for routine screening in women with an average risk of breast cancer. The U.S. Preventative Task Force put the media spotlight on this issue in 2009 when it came out with recommendations to wait to start mammograms until the age of 50 and to perform them every 2 years. This recommendation was based on the risks and benefits of routine mammography in the general population.
The obvious benefit of starting mammograms at 40 and doing them every year is this can increase our ability to detect breast cancers at an earlier stage. If we find cancers at an early stage we can reduce the number of deaths from breast cancer. Studies show that routine screening in women ages 40-69 reduces in deaths from breast cancer by 15-20%. However, others suggest that some of the reduction in deaths is from improved treatment and in fact screening mammograms reduces mortality by a more modest 10%. This does not mean that early detection is not useful since finding a cancer early may mean you are able to treat it with less aggressive means and possibly avoid chemotherapy. This is a significant benefit to many women.
This risk of mammograms may be less obvious at first but these need be considered both by patients and their providers. With any medical test that is performed, there are risks which include risks related to the test itself and risks related to incorrect results; either false positives or false negatives. A false positive (false alarm) is when the mammogram indicates there is a suspicious area but the patient actually has a normal breast. A false negative is when the patient actually has a breast cancer but it is not found on the mammogram. It is estimated that for every 1000 women receiving mammograms yearly for 10 years starting at age 40, there will be 615 false positive mammograms. This may require the woman to have additional testing or a breast biopsy that she would not have otherwise had. As women get older the number of false positive mammograms decreases. This makes sense as the risk of breast cancer does increase with age.
You mentioned that you do not have any family members with breast cancer. I spoke with breast surgeon, Dr. Lori Medeiros from Rochester Regional Health, about the genetic risk of breast cancer. ‘We all know about the BRCA 1 and BRCA 2 gene mutation – the Angelina Jolie mutation. In women positive for one of these mutations, early aggressive screening with breast MRIs, treatment with Tamoxifen or risk reduction surgery may be indicated. Determining personal risk isn’t limited to family history of breast cancer. Other high risk factors include ovarian cancer in the family, along with cancers of the thyroid, prostate, pancreas, melanoma and sarcomas. Gene science is still relatively young is the grand scheme of medical history. As science evolves, additional genes may be discovered. Most breast cancers are actually sporadic meaning not related to any gene mutation that we know of and many women have no family history.’
To summarize current recommendations, most experts agree women with an average risk of breast cancer should NOT have a mammogram until the age of 40. At the age of 40 screening mammograms should be done every 1-2 years based on individual preference/risk. Women at high risk of breast cancer should seek the advice of a gynecologist or breast specialist to develop a customized screening plan. Ultimately the decision of when to start mammograms and how often to perform them is up to you and your physician.
Tara Gellasch, MD, is the Associate Chief of Obstetrics and Gynecology at Newark-Wayne Community Hospital (NWCH) and sees patients at The Women’s Center at NWCH, a Rochester General Medical Group practice. Dr. Gellasch earned her Medical Doctorate from McGill University in Montreal, Quebec and completed her residency in Obstetrics and Gynecology at Emory University. This column is meant to be educational and not intended to be used to make individual treatment decisions. Prior to starting or stopping any treatment, please confer with your own health care provider.
