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Breast Cancer and Mammograms - How often? Latest Mammography Screening Guidelines

Saturday, February 04, 2012
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These new breast cancer screening recommendations have come from the U.S. Preventive Services Task Force. The new breast cancer screening guidelines are the first that this group has issued on breast cancer screening since 2002. The past two weeks a controversy has surged over these guidelines as certain agencies such as the American Cancer Society are standing by earlier recommendations.

The breast cancer screening guidelines were formed by weighing benefits of screening compared with the harms of false positives, such as anxiety and unnecessary additional tests and biopsies, which are expensive and time-consuming.

According to Ms. Diana Petitti, MD, MPH, Vice Chair, U.S. Preventive Services Task Force
"So, what does this mean if you are a woman in your 40s? You should talk to your doctor and make an informed decision about whether a mammography is right for you based on your family history, general health, and personal values."

In fact; the American College of Physicians had similar views to share. It said mammograms should be optional for women ages 40 to 49 and would be preferable talk to their doctors about the pros & cons of breast cancer screening.

However, for the past five years, the American Cancer Society and the National Cancer Institute have been endorsing mammograms every one to two years for women ages 40 to 49. By one estimate, in order to save six women from dying of cancer, about 10,000 women in their 40s need to get mammograms every one to two years.

So what is the problem?

Limited benefit for women in their 40s
About one out of every eight women will get breast cancer during a lifetime. When breast cancer is found early, as mammograms can show, it is usually curable. Some women under 50 do get breast cancer.

So why wouldn't early mammograms be a good idea?
Mammograms are harder to read in young women. For this reason, almost half of women under age 50 who have mammograms are called back for repeat films or biopsies because their test results look suspicious. Most often, these areas of concern turn out to be "false positive," that is, not cancer.

It is important to remember that additional tests and procedures are needed to determine for certain whether these suspicious results are cancer or not. These tests and procedures carry their own risks and for some women, which may prove to be additional and unnecessary risk from biopsy procedures

Now the U.S. Preventive Services Task Force has concluded that screening women in their 40s offers limited benefits and may do more harm than good.

I am a 42 year old mother of three, what changes can I make now?
Most primary care doctors will probably work by the task-force guidelines. The task force did not find a big difference in benefit between having mammograms done every year and every two years. This is why the group strongly recommends a two-year wait between tests. The benefit of office exams by your doctor to feel for breast lumps is hard to calculate. It may not be an important part of our breast-cancer screening plan.

Here are the task-force recommendations, by age group:
Most women under age 50 don't need mammograms. Women who are at high risk for breast cancer are a special case. They should discuss a screening schedule with their doctor.

Women who are at highest risk for breast cancer include those who have:
  • Two first- or second-degree relatives who developed breast cancer before the age of 50
  • Three first- or second-degree relatives who got breast cancer at any age
  • A known gene mutation that is linked with breast cancer.
  • A first-degree relative is a mother, daughter, or sister. Second-degree relatives include aunts and grandmothers.
  • Women aged 50 to 74 should get a mammogram every two years.
  • For women over 74, there is not enough evidence to recommend for or against having mammograms.
The task force did not find enough information to make a strong statement about more tests - such as MRI - for women at high risk.

Although mammograms do detect more early cancers, overall survival is not significantly improved by mammography screening.

While it's very obvious that for many women, getting a mammogram is already one of life's more stressful experiences. With the new guidelines out.. It's not only left them in a quandary but has also added anxiety of trying to figure out if they should even be getting one at all. So, in sum, all that we can say is mammogram, like any other medical interventions/procedures, have their own risks and benefits and it's up to the doctors to help educate their patients adequately to make informed choices about their breast health.

Reference:
Breast Cancer Screening Guidelines 2009 (US Preventive Task Force)

By. Ms. Kanchan Saggi
Dietitian, NutritionVista.com



Related Articles on Breast Cancer: Understanding a Woman's Risk For Developing Breast Cancer (2002 guidelines)


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User Comments

02 December, 2009 | Kanchan Saggi | Reply

Kanchan Saggi Hello Ms. Sheela,

I'm sorry to hear about your 29 yr old sister. But, at the same time I appreciate the early measure that you have taken towards maintaining your breast health.
Mammogram screening, at an early age, becomes even more important when there's a history or sign of cancer occurrences among the first degree family members. Hence it's wise to follow the required screening procedures to be well informed about your health, ahead of time.
Many women are concerned about having regular mammograms and how much radiation this exposes them to over a number of years. In fact, the total amount of radiation is relatively small. Women have two 'views' taken each time they are screened for breast cancer with mammograms. Each view exposes them to less than 0.2 rads (the measure of radiation that is used most commonly).
If you have concerns about your breast screening then talk to your GP about it. But remember, the risks of breast screening are much smaller than the possible benefit of finding a breast cancer early enough to cure it.
Regards, Kanchan Saggi, Dietitian, and Bangalore.

01 December, 2009 | Sheela V | Reply

Sheela V I read today that there is an update on screening studies in younger women. It says that under 40 the risks from radiation go up significantly in those already at high risk.
I am 36 years old and have a sister who had breast cancer at age 29, but for the past 4 years has been clean.
We've had regular mammograms ever since her diagnosis.

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