Breast Cancer and Mammograms

Breast cancer is the second most frequent cause of death due to cancer in women in the United States. About one in eight women will get breast cancer during their lives. Even though most cases occur after menopause, about 25% (or 1/4) of breast cancer is found in women younger than 50 years of age.

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Risk factors for developing breast cancer include: being a carrier of the BRCA1 or BRCA2 gene mutations, family history of breast cancer (especially with two or more first-degree relatives with breast cancer), older age at the birth of first child, late menopause (age 55 or older) and younger age at the start of periods (younger than age 12). But the most important risk factor of all is age, with increasing risk as one gets older.

Currently, a mammogram is the screening test of choice for breast cancer. It is the most studied breast cancer screening test that is available, and there is evidence supporting its role in reducing the number of breast cancer related deaths (particularly in women aged 50 to 74 years).

The goal of mammograms is to find breast cancer while it is still at an early stage, when it is more likely to be cured completely.

There are potential side effects of mammograms. They include results that are falsely positive (leading to unnecessary treatment of lesions that otherwise would not have an impact to one’s health), radiation exposure (although the dose of x-ray per test is extremely low), and procedure-associated pain.

The American College of Obstetricians and Gynecologists recommends screening mammograms every one to two years for women ages 40 to 49, and yearly thereafter. The American Cancer Society recommends yearly mammograms beginning at age 40.

Recently, the U.S. Preventive Services Task Force (USPSTF) issued its new breast cancer screening guidelines, an update from those they issued in 2002. They recommend waiting until age 50 years to begin routine screening, and changing the screening interval from one to two years. These changes are made by the task force based on a review of previously published data of breast cancer screening tests, looking at evidence for screening in lowering cancer-related death rate as compared to its potential harm.

The important thing to keep in mind is that at this point in time, other organizations and expert groups, such as the American College of Obstetricians and Gynecologists and the American Cancer Society, have not changed their own guidelines based on the U.S. Preventive Services Task Force’s recommendations. The best thing to do to determine when you should begin mammogram screening and screening interval will be to consult your doctor.

Your doctor may also recommend that you get a mammogram at other times. For example, when the clinical breast examination demonstrates an abnormal mass, or when you have complaints of any breast related symptoms. It is also possible that your doctor will recommend ultrasound or MRI of the breasts as additional evaluation tests. Bottom line is when in doubt, always talk to your doctor.
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