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    Mammogram at 40? What to Consider


    Next month I’ll turn 40 – time to consider getting a mammogram. As you may have noticed in the headlines and on your FB feed, it’s not a cut-and-dried decision. Though we have more studies on breast cancer screening than any other type of cancer, there’s still a lot of controversy over when to start mammograms and how frequently to have them.

    In general mammograms are pretty awesome. In women over 50, they can detect 85% of cancer masses before the mass is big enough to feel. So, not surprisingly, most organizations agree that yearly breast cancer screening with a breast exam and a mammogram is the way to go for women ages 50-70. But for women 40-50, the conversation can get a little trickier. Most organizations do recommend they get yearly (or every other year) mammograms with a breast exam, but women in this age group tend to have much denser breasts, making the mammograms not work quite as well. (For women under 40, at low risk and with no symptoms, the recommendation is an annual breast exam and not a mammogram. Women at high risk should speak to their doctor about appropriate screening.)

    Still, isn’t it a no-brainer that every woman over 40 should get yearly mammograms? Why all the fuss?

    While the great majority of studies clearly have shown an improved survival for women who got yearly mammograms, a few recent studies have questioned the connection between yearly mammograms and survival rate, suggesting that survival rate might have more to do with how well we’re treating the cancer than how early we’re detecting it. Essentially, the newer studies are suggesting that we’ve gotten good enough at treating breast cancer that detecting it microscopically may not be as vital now. But there’s an important caveat to these studies – the “no yearly mammogram” women in these studies who survived cancer did get a yearly breast exam by a doctor and were very strictly monitored. I question how well we can apply this data to the general population, because most of the women I know who aren’t getting mammograms are also not getting a yearly breast exam – this is dangerous.

    Another reason for the fuss about mammograms? They aren’t without risks.

    The risks of mammograms:

    • False alarms. Up to 10% of women in their 40s will be called back in for additional imaging or biopsies and of those women only 10% will actually have cancer. This can cause some serious anxiety and unnecessary procedures, which carry their own risks. A new type of mammography called tomosynthesis or “3-D mammography” is available in some areas. It has a lower rate of false alarms and call backs. This is NOT to be confused with Thermography (using infrared technology to detect breast cancer) which has not been approved for breast cancer screening.
    • Radiation. Mammograms are x-rays that use a small dose of radiation. Doesn’t radiation cause cancer too? Yes, but for the average at risk woman, she is 100 times more likely to have her life saved from a mammogram than to get cancer from its radiation.
    • Sometimes the mammograms work too well. One of the concerns is that perhaps we are detecting cancers so small and so slow growing that they would have never actually caused harm in the patient’s lifetime. This especially applies to older patients.

    Women who fall into a higher risk for breast cancer might need earlier or more in depth breast cancer screening such as MRI and/ or ultrasound in addition to mammography.

    High risk women include:

    • BRCA carriers
    • Family history of breast cancer
    • Obesity
    • Dense breasts
    • Infertility
    • Young puberty/ late menopause

    I realize that every medical blog ends with the trite saying of “check with your provider,” but never is that more true than it is with mammography. Please don’t base any decisions on the breast cancer headlines of the week or your FB feed, but instead sit down with your doctor and discuss your risk factors for breast cancer and determine which screening test is best for you.

    I’ve already signed up for my first mammogram later this month. I realize there are risks, specifically a 10% chance I’ll get a call back. And no, I’m not looking forward to the squish. But to me personally, the potential benefits of detecting a tumor early are worth it.


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