Severna Park Doctor Talks About Mammograms Beginning at age 40

To get mammograms, or not, beginning at age 40?

A Severna Park physician, Dr. Helen Mrose of Bay Radiology, addresses having a mammogram at age 40 and up.

While there has been considerable controversy regarding screening mammography for women in their 40’s, the majority of medical organizations—including the American Cancer Society, the American College of Radiology and the American College of Obstetricians and Gynecologists—recommend annual screening mammography beginning at age 40.  And, most insurances cover the procedure.

The probability that women will develop breast cancer increases as a function of age.  The statistic that we hear of “1 of 8 women will develop breast cancer in their lifetime” pertains to women who reach the age of 80.  Women in their 40’s have a 1 in 69 chance of developing breast cancer; over 25 percent of breast cancers are diagnosed in women under the age of 50.  And, over 75 percent of women diagnosed with breast cancer have no family history of the disease.  So, all women over age 40 need an annual screening.

While the incidence of breast cancer in younger women is lower, cancers in young women tend to grow more quickly than in older women.  Thus, the window of opportunity for detecting a cancer while it is small and curable is shorter for young women. Yearly screening increases the chance of finding early, curable breast cancer. 

Multiple randomized controlled studies have shown a clear mortality reduction for women who are screened with mammography in their 40’s.

So, what are the disadvantages to mammography screening for women ages 40-49?  Most of the arguments against screening are based on emotion, financial considerations and part-truths. I have listed the main arguments below—with explanations as to why the arguments are weak: 

1. Young women have dense breasts, which make the mammogram difficult or impossible to read. 

Answer: While it is true that younger women tend to have denser breasts than older women, this is simply a tendency.  Many young women have little or no density.  Density is based on genetics, weight and to a small extent, menopausal status.  Excellent quality mammography can demonstrate malignancy even in dense tissue—particularly when coupled with breast ultrasound.

2. Mammography leads to false positive readings (in part due to dense tissue) and unnecessary biopsies in young women.

Answer: “Call-backs” after screening mammography are common in all age groups.  Careful work-up of possible abnormalities by skilled radiologists should not lead to excessive biopsies.  If a breast biopsy result is negative for malignancy, this does not mean the biopsy was “inappropriate”.  There is overlap between the appearance of benign and malignant processes in the breast. 

Women can help avoid unnecessary biopsies by doing the following: 

a) Make sure that prior mammograms are available to the radiologist for the radiologist.   Since every woman’s mammogram is unique, comparing to priors is essential. 

B) Choose your mammography facility carefully.  Studies have shown that radiologists who specialize in breast imaging read more accurately—and perform fewer biopsies for benign entities.  Do not simply return to the same facility each year; do your research and find the very best option available.

 3. False positive mammograms lead to anxiety. 

Answer: This statement is true—but not a good reason to avoid detecting early breast cancer.   Women can take action against anxiety by having mammography performed at a site the provides immediate results, or a facility that calls the patient with results, and ensures that any necessary additional imaging is scheduled immediately.

4. The radiation from a mammogram is harmful to younger women.

Answer: It is true that radiation can be harmful—and can possibly induce breast cancer.  However, the risk becomes much less significant with age.  Thus, by the time a woman is in her 40’s, the benefit from mammography far exceeds the risk.  Digital mammography can result in lower doses of radiation than film-screen mammography, but it matters very much how the equipment is being used.   Women should seek the most expert facility, to ensure the highest quality—and lowest radiation—study.

http://www.cancer.org/Healthy/ToolsandCalculators/Videos/mammograms-matter-video