Mammogram guidelines: Which should women follow?

breast cancer screening mammogram

By Catherine Tucker, M.D.
Medford and Stoneham – Surgical Oncology – Breast Surgery

breast cancer screening mammogram

Regular mammograms save lives by detecting breast cancer as early as possible.

If you’re unsure about when you should get your first mammogram and how often you should get them, you’re not alone. Even the organizations responsible for setting those guidelines can’t agree.

I’ve reviewed the guidelines as they’ve been updated over the years, and I admit they can be confusing. And if breast specialists and general practitioners are confused, it’s easy to see why our patients would be, too.

The latest guidelines from national health organizations for women of average risk for breast cancer include:

So what’s a woman to do? Let’s take a closer look at the conflicting information, and I’ll tell you how I advise my patients.

Why the disagreement over mammogram guidelines?

There is one thing almost everyone can agree on: Mammograms are an effective tool for early breast cancer detection. One study showed that regular mammograms can reduce breast cancer mortality rates by nearly 30 percent. What these groups can’t agree on is at what age a woman at average risk for breast cancer should begin screening, and how often should she have them.

For many years, the consensus was to get a mammogram once a year starting at age 40. However, we began to realize that because younger women have denser breast tissue, we were seeing more false positives and doing more unnecessary biopsies. In 2009, the U.S. Preventive Services Task Force began recommending women of average risk to begin screening at age 50, and every other year instead of yearly.

At the heart of the debate is a disagreement over whether it’s worth subjecting a woman to potentially unnecessary procedures in order to catch every possible cancer, or whether the downsides of overtreating cause more harm than good.

When and how often should I get a mammogram?

I advise my patients who are at average risk for breast cancer to start getting a yearly mammogram at age 40, and continue as long as they have 10 years of life expectancy left. This could mean annual screening continues into your 70s or 80s. An individualized plan for screening, taking your input into account is desired.

The problem with limiting mammograms during your 40s is that the No. 1 cause of death for women in their 40s is cancer in various forms. Your chance of developing breast cancer jumps from 1 in 227 in your 30s to 1 in 68 in your 40s. At 50, that risk increases to 1 in 42. That jump from your 30s to 40s is huge, and in the prime of your life – you possibly have children, a booming career, or active lifestyle. It just doesn’t make sense to say, “Oh well, there are too many false positives. I’ll skip the mammogram.” I think most women would say, “I want to be safe.”

Because the risk of cancer increases as we age, I can’t advise women to wait two years between screenings and allow a cancer to grow larger and become more difficult to treat.

Mammograms are fairly quick and accessible, and they are the best test we have to detect breast cancer. Similarly, initial biopsies often are minimally invasive – accomplished by inserting a needle to withdraw some tissue. A patient recently commented that she couldn’t believe how easy the procedure is today compared with 20 years ago, when a biopsy required surgery to remove a chunk of breast tissue. It was like cutting off your foot to see if you had an ingrown toenail!

What if I have additional risk factors for breast cancer?

These breast cancer screening recommendations are for women of average risk. If you have a family history of breast cancer or other risk factors, you may need to start being screened earlier and more often. For example, 5 percent to 10 percent all hereditary breast cancers are caused by the BRCA1 or BRCA2 genes. These inherited genes put women at increased risk of breast and ovarian cancers.

Talk with your clinician about your breast cancer risk and how it could affect when you should begin screening. You also may want to discuss if you are a candidate for advanced breast cancer screening tests such as breast MRI or 3-D mammography.

You can’t do anything about risk factors such as aging or your genetics, but there are some actions you can take to help lower your breast cancer risk:

  • Maintain a healthy weight
  • Eat a balanced diet
  • Get regular exercise
  • Watch your vitamin D level (there is a correlation between low vitamin D and breast cancer)
  • Quit smoking
  • Reduce alcohol consumption

Discuss your breast cancer risk and when you should begin regular screening with your physician. Schedule an appointment online or call 855-446-2362.

Tags: breast cancer, cancer prevention, women's health

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