Breast cancer is the most commonly diagnosed cancer and the second leading cause of death in women. In the United States, a woman’s lifetime risk of being diagnosed with breast cancer is 12 percent. A screening mammogram is a low-energy X-ray of your breast that is used to check for cancer before signs and symptoms develop. Recently, there have been many schools of thought about what age to start getting mammograms, how often to do them and when to stop.
The American College of Gynecology, United States Preventative Services Task Force, American College of Physicians, American Cancer Society and the National Comprehensive Cancer Network Guidelines each has its own recommendations and guidelines. All this can be confusing to the average female who has an average risk of being diagnosed with breast cancer. There are different recommendations for women who have a high risk of breast cancer. For example, women with the breast cancer gene, or who have a family history of breast cancer are considered high risk. For women with an average risk, when to start mammograms becomes a shared decision-making process with their doctors.
Shared decision-making means having a conversation with your doctor about your experiences, concerns and priorities about screening for breast cancer. Your doctor will have to weigh the harms and benefits of a screening mammogram with your personal values. Together, you can come up with a screening plan about when to start and how often to do it. Most organizations recommend that by age 50, a woman with average risk should have started or should start screening. A woman between the ages of 40 and 49 should talk to her physician about her lifetime risk and weigh the benefits and harm of undergoing a mammogram.
How often a woman should have a screening mammogram also varies from one organization to another. Some recommend annual mammograms, while others recommend every two years for average-risk women. Some studies reveal that the chances for false positive results are less when mammograms are done every two years. (A false-positive result can occur when a suspicious lesion on mammogram doesn’t turn out to be cancerous.) There is also a small increase in discovering advanced cancers in women who get screening mammograms every two years. The right interval for your screening mammogram should be explored with your physician.
If you’re a woman with average risk, when to stop screening is another conversation you should have with your physician. Most organizations recommend routine screening until age 75 and beyond, depending on your quality of life and prognosis of any chronic conditions. It’s a balance of the potential benefit and harm of undergoing mammography beyond age 75.
Mammograms can save lives, but they also have unintended effects. The amount of radiation used in a mammogram is lower than that of a regular X-ray. The dose of radiation a woman who gets a two-view mammogram of both breasts is similar to that of a woman who would get them from her natural surroundings over seven weeks. The benefits of mammography outweighs any possible harm from this radiation exposure.
X-rays don’t go through tissue easily so two plates are used to flatten the breast to spread the tissue apart when taking the image. For many women, this can be uncomfortable, but for others it’s painful. Other women don’t experience any discomfort at all. Still others find the process of discovering they don’t have any suspicious lesions comforting. If there is something suspicious noted in the breast tissue, on a screening mammogram, you may be called back for a diagnostic mammogram. Diagnostic mammograms take additional images of the breast that has the suspicious area. If the images remain concerning, you may be called back for a biopsy. This can be anxiety provoking. For some women, it can persist well after the results have returned as normal. Some women choose not to return for their next screening mammogram because of a negative experience. Other women prefer the reassurance that the negative test results provide them.
The current five-year survival rate of a patient diagnosed with breast cancer is 90 percent. This amazing achievement is due to early detection and improved treatment. Advances in treatment have helped change the screening paradigm in average-risk women by allowing the initiation, interval and termination of screening mammography to be a shared decision-making process with their physicians.
