October is Breast Cancer Awareness Month, a time when many special events and pink ribbon drives remind us take proper preventive care and have a mammogram.
Physicians groups have discussed for years the best age to begin mammography screening, and their recommendations might leave some patients feeling confused. Some physicians recommend women have their first mammography at age 35, others to begin at age 40 or even 50. Some recommend screening every year, others say every two years.
Doctors and patients long have known that mammograms are effective for early detection of breast cancer, and that combined with effective treatment, they can save lives. There are now at least eight large clinical trials that conclusively show screening saves lives for women aged 50 to 69.
The data for women aged 40 to 49, however, are not as clear – causing confusion about the best age to begin screening and how often to perform it.
Studies have shown that ultrasound and magnetic resonance imaging (MRI) can help find breast cancers that can’t be seen on a mammogram. We offer breast ultrasound and breast biopsies as well as personalized workups for any breast problems along with a nationally recognized breast specialist.
Mammograms are an effective test for older women because it is easier to see a cancerous tumor in mammograms of older women. Older women also are more likely to have cancer, increasing the importance that they have regular screenings.
When the radiologist reads a mammogram image of the breast, cancerous tumors will appear white.
This makes it more difficult to spot cancer in young women, because their breasts tend to have more dense tissue compared to the breasts of older women. A dense breast appears white on a mammogram image, so the radiologist may have more difficulty spotting white tumors against a white background when reading the mammogram of a young woman.
However, the reverse is true for older women because the aging process causes the X-ray image of an older woman’s breast to change from white to black. So for a mammogram of a 65-year-old woman, the radiologist looks for white on a black background.
For women in their 40s, the background color can range from white to gray, depending on the density of the individual’s breasts.
These experiences have led physicians groups to conclude that mammography screenings are more effective on older women, who also are more likely to develop breast cancer than their younger cohorts.
Some physicians groups have reported that mammography screenings are not effective in women aged 20 to 40, and only moderately effective in women aged 40 to 49.
Despite this, every physician has seen breast cancers in women between age 40 and 50 and also in women under age 40. For these women, a mammogram was life-saving.
It is important to remember that women may have an abnormal screening, and that these abnormal screenings require additional testing and, of course, they cause fear and worry. But many of those abnormalities turn out to be clinically insignificant.
According to the National Institutes of Health (NIH), false negative results (when a mammogram appears normal even though there is breast cancer) and false positive results (when a radiologist says a mammogram is abnormal when there is no cancer) are more likely in younger women than older women because younger women are more likely to have dense breasts, making it difficult to get an accurate screening.
Most American medical groups recommend annual, high-quality screening beginning at age 40, a few recommend routine mammography start at age 50.
The NIH recommends women age 40 and over get a mammogram every 1-2 years. The American Cancer Society and the American College of Radiology recommend routine screenings starting at age 40.
No organization recommends mammography screenings for average-risk women under 40.
But even these organizations remind women that the choice is yours.
Women who are concerned about breast cancer or who have a family of history of breast cancer and want to start mammography screenings earlier can do so.
Women without a family history and with average risk should receive a breast exam with their regular gynecologic examination. They also should be aware of changes to their bodies, and seek professional medical assistance if they detect a change in their breast.