When should I get a mammogram?

Posted on Oct 16, 2012 in The Doctor Is In by Josh Allen

Chris Prakash, MD

Q:I am a 40 year old woman. Should I get a screening mammogram now, or wait till I turn 50. I am confused about the various recommendations out there, and so is my doctor.

A: “An ounce of prevention is better than a pound of cure”. This advice from Benjamin Franklin holds true for most things, but more so in breast cancer than anything else. Early detection of cancer is the key to optimal management and a chance of cure. Healthy lifestyle can go a long way in preventing cancer, but some women are destined to get breast cancer for reasons we do not understand yet. A woman born today has about a 1 in 8 chance of being diagnosed with breast cancer at some time during her life.

The mammography technology has improved by leaps and bounds, and combined with the specialized training of breast radiologists, we are able to detect early breast cancer when treatment can be most successful. Mammography may detect over 85% of the breast tumors, and results are still better if the screening is conducted along with a physical examination.

Doctors don’t always agree on when to have a baseline mammogram or who should be screened and when, and guidelines from reputable medical societies differ in their recommendations:

• The US Preventive Services Task Force recommends against routine screening of women under age 50 and screening mammography every 2 years from ages 50-74.
• The American Cancer Society, the American Congress of Obstetricians and Gynecologists and the AmericanCollegeof Radiology recommend annual screening mammograms starting at age 40.

I believe that it is very important to get screening started at age 40, or earlier in some cases of genetic predisposition. Of course, a discussion with your primary care doctor about when you should get routine screening is helpful as well since they will know about your particular risk factors.  Based on my experience, I can tell you that it is a real advantage to diagnose breast cancer in an early stage, when it is possible to remove only a small part of the breast, with high probability of cure.

If you look at the science and data, it has been proven that screening women older than 50 years for sure reduces the number of deaths from breast cancer. However, in women younger than 50 years, breast X-ray screening offers a smaller benefit. But for any individual patient, that benefit may be enormous.

In some women with a personal or family history of breast tumors, more frequent exams are needed and this should be discussed with your doctor or oncologist. A screening program appropriate for the individual situation should be developed. It should be noted that breast tissue in younger women (younger than 30 years) tends to be denser, and this makes it more difficult to detect small changes in the breast on a mammogram.

This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com