Time for a Mammogram?
By KJ Fields
For many years, women could count on having a yearly mammogram to screen for breast cancer, starting at age 40. Recently, though, medical experts are rethinking that recommendation based on new information.
As more is learned about the different types of breast cancer, the benefits and risks of mammograms, and the impact of family history, screening recommendations are becoming more personalized. Have a strong family history of breast cancer? Your doctor may want to start screenings much earlier than age 40. No family history of cancer and no signs of any problems? Waiting until age 50 may make more sense for you.
To help you understand the new landscape of breast cancer screenings, we posed some questions to three Group Health experts: oncologist Janet Chestnut, MD; family physician Michelle Seelig, MD; and genetic counselor Nancy Hanson, MS.
Mammograms used to be routinely recommended for women when they turned 40. Why has this recommendation changed?
The benefit of mammograms for women in the 40 to 49 age group is less than for women aged 50 to 74 and the potential harms are higher. "Women tend to overestimate their risk of breast cancer between ages 40 and 49," says Dr. Chestnut. "At Group Health, our goal is to educate women and help them understand the risks of cancer in this age group, and the benefits and risks of mammograms," she says. Then providers and patients collaborate to make a decision about an appropriate screening schedule.
What is Group Health's current recommendation for breast cancer screening?
For most women with no risk factors, they should begin screening at age 50 and be screened every other year up to age 74.
What about older women? Why aren't mammograms routinely recommended by Group Health for women over age 75?
Older women may have medical problems that are a greater threat to their health than the possibility of breast cancer. If they do have breast cancer and it's of a slow-growing variety, it may never develop to the point that it impacts their quality of life or becomes life threatening. "We recommend that women over 75 discuss their situation with their doctor," says Dr. Chestnut.
For younger women, how are risk factors determined?
At Group Health Medical Centers, when a female patient who is 25 years or older comes in for a regular exam, she and her doctor review a questionnaire together. "The questionnaire looks at the patient's family and personal histories for items such as previous incidents of cancer, abnormal test results, or radiation to the chest at an early age," says Hanson. "It helps identify those women at high risk for breast cancer.
"If a woman is identified as high risk, she is referred to our Genetics or Oncology departments where we further evaluate her history. We may also check a specific gene or genes known to increase susceptibility to breast cancer. If a mutation is present, we want to intervene early and get her on a regular screening schedule. Doctors and patients should revisit this information every three years because the histories can change."
What are the harms that are associated with having mammograms?
"The primary ones are a false-positive mammogram that requires a biopsy for further definitive evaluation, and over-diagnosis — that is, unnecessary diagnosis and treatment," notes Dr. Seelig. "Undergoing a biopsy or treatment for a condition that might never go on to cause symptoms can be stressful, anxiety provoking, and require time away from other responsibilities, like work and family life."
Women used to be advised to do monthly self-exams. Is that still recommended?
"Women are encouraged to become aware of how their breasts look and feel so they can schedule an exam with their health provider if they notice any changes or have concerns about a lump," says Dr. Seelig. But monthly self-exams aren't necessarily helpful. Studies have not found that they reduce the rate of death from breast cancer.