Mammograms-who, when, and why

During Breast Cancer Awareness Month I want to remind you of physician recommendations for screening. Currently, the only test recommended for screening is mammography.

No other test has evidence that its use will decrease breast cancer deaths, although they may be useful for diagnosis in women who have breast symptoms.

These guidelines for screening  apply only to women at average risk of breast cancer, which is most women. They do not apply to women who have ever been diagnosed and/or treated for breast cancer, or to women who currently have symptoms related to their breasts, such as a lump, pain, discharge, or skin changes.

Guidelines for screening come chiefly from two organizations- The American Cancer Society (ACS) and the United States Preventive Services Task Force (USPSTF). Other organizations such as the American Academy of Family Physicians (AAFP) , of which I am a member, usually follow their recommendations .

 guidelines from the ACS

• Offer annual screening to women age 40 to 44 years.
• Perform a mammogram annually in women 45 to 54 years.
• Perform a mammogram annually or every other year starting at age 55 years.
• Continue screen mammography as long as a woman’s overall health is good, with a life expectancy of 10 years or longer.
• Routine breast exams by either the patient  or a physician are not recommended.

 guidelines from the U.S. Preventive Services Task Force (USPSTF)  

• For ages 40-49 years, individualize the decision to screen every 2 years
• For ages 50-74 years, screen every 2 years
• For ages 75 years and older there is no recommendation.

Both organizations recommend that physicians discuss the decision to screen or not to screen with patients and base the decision after considering possible harms versus potential benefit.These are guidelines for physicians to apply to each individual patient, not hard and fast rules.

Screening guidelines  are not used for high risk women- women with 

• a history of previous breast cancer or ovarian cancer
• a suspected or confirmed genetic mutation , BRCA, known to increase breast cancer risk
• a history of radiation to the chest
• a close family history of breast history, usually meaning parent, sibling, child, grandparent, aunt/uncle, or first cousin.

Screening guidelines also do not apply to women with breast symptoms suggestive of cancer.

• a lump in the breast or axilla (armpit)
• pain, especially in only one breast
• nipple discharge
• persistent rash or skin changes over the breast

These women need appropriate diagnostic testing which might include

• mammography,
• ultrasound,
• MRI, 
• biopsy. 

Here are sources for more information

Breast Cancer

“Both women and men can get breast cancer, though it is much more common in women. Other than skin cancer, breast cancer is the most common cancer among women in the United States.”

Mammography 

“You should talk to your doctor about the benefits and drawbacks of mammograms. Together, you can decide when to start and how often to have a mammogram.”

Screening Guidelines

“Mammograms are not perfect tests. They can miss some cancers, and they can find lesions that may look like cancers but are not actually cancers (false-positive results), resulting in additional testing and procedures. They can also find very low-risk cancers that would never have caused any health problems if they were never found or treated (overdiagnosis).”

Breast cancer screening benefits and harms 

“Each woman also has different personal values, especially toward the idea of unnecessary medical tests and treatments.

Talk to your doctor if you are younger than 50 years and have questions about whether you should get a mammogram.”

 

 

 

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