Reducing The Breast Cancer Risk: Are Mammograms Still Best? And When Should You Start?Danielle Sullivan
When will you have your first mammogram? It seems every doctor has a different opinion, not only on when women should start having mammograms but also if mammograms are the best way to go in the detection of breast cancer.
The U.S. Preventive Services Task Force (USPSTF) threw the medical community into a stir two years ago, when in 2009 they changed their breast cancer scanning guidelines recommending that screening begin at age 50 and even then, only every other year until age 75. The new guidelines, recommend “against routine screening mammography in women aged 40-49 years” as well as “concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.” The USPSTF says this protocol is based on women of average risk.
This single recommendation caused fury in the medical world because many believe that the recommendation was based on cost-effectiveness rather than the early detection of almost 14,000 women aged 40 to 49 (below their supposed screening age) who are diagnosed with breast cancer each year.
But what if your doctor recommends much earlier scanning, as many doctors do? And what scans should every woman get? When should they start?
The American Cancer Society and many breast cancer centers continue to recommend annual mammograms starting at 40.
“Women with no family history should get their first mammogram at 40 and then every other year until they reach 50”, says radiologist Dr. Steven Mendelsohn, Medical Director at New York’s Zwanger Pesiri Radiology. At age 50, he says they should seek an annual mammogram.
While Dr. Abraham Port, Medical Director at Complete Women’s Imaging in New York says that while he agrees that all women should obtain a mammogram beginning at age 40, he says a woman should have an annual mammogram after age 40, with a baseline mammogram performed somewhere between the ages of 35 and 40.
But are mammograms enough? Mammograms have a well-known, two-folded shortcoming: they produce a high number of false positives and the scans often miss very small tumors. Yet with all the false positives combined with the mammograms that have missed small tumors, is a mammogram still the safest means of protection for women?
Dr. Mendelsohn says yes, and believes that if a mammogram shows suspicion, then an ultrasound should be performed. “Mammograms are safe as reasonably possible. Could every woman have an ultrasound? Theoretically, yes, but financially the cost would be huge compared to the very little benefit.”
“Mammography is the starting point”, says Dr. Port. “Thorough breast evaluation and early breast cancer detection often requires additional tests minimizing false positives and the need for biopsies that result in benign pathology.”
Other tests such as tomosynthesis (3-D scans), MRIs, molecular breast imaging and thermography are more thorough but also costly and most of them aren’t covered by your typical medical insurance plan.
Do you feel safe relying on mammograms alone? When will you get your first mammogram?
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