What is the Best Age to Begin Mammograms?
In recent years, several studies have examined the most appropriate age for women to begin getting mammograms, the x-ray exam that screens for breast cancer. Last year, the U.S. Preventive Services Task Force issued new guidelines for breast cancer screening that recommended against routine screening mammography in women aged 40 to 49 years. Now, a new study has reached different conclusions: that women who receive mammograms in their forties may be less likely to die from breast cancer than women who wait until their fifties or beyond to get mammograms. The study seems to add confusion to when is the best age for women to get mammograms and underscore the fact that breast cancer screening is an individual medical issue that may best decided between a woman and her physician, based on individual medical factors.
For years, leading cancer organizations such as the American Cancer Society have recommended that all women begin receiving mammograms at age 40 and continue to receive annual exams thereafter to screen for breast cancer. Mammograms can detect breast cancer at very early stages, often before a lump can be felt by touch. In general, the earlier breast cancer is detected, the greater the chances for successful treatment and survival. The National Cancer Institute had previously recommended biannual mammograms for women beginning at age 40, and annual mammograms beginning at age 50.
In November 2009, the U.S. Preventive Services Task Force issued new guidelines for breast cancer screening that caused significant controversy among the medical community, women's advocacy groups, the worldwide media, and others. They have also caused significant confusion for millions of women. Here is a summary of those guidelines:
- Recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial (every 2 years) screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.
- Recommends biennial screening mammography for women aged 50 to 74 years.
- Concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.
- Recommends against teaching breast self-examination.
- Concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older.
- Concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.
Click here for more information about the guidelines.
Nearly a year later, another study has further complicated the story. Reporting in a recent issue of the journal, Cancer, HÃ¥kan Jonsson, PhD, of the UmeÃ¥ University in Sweden and colleagues studied more than one million women. They compared deaths from breast cancer from 1986 to 2005 among women who received mammograms every 18 to 24 months and those who did not get screened.
The study results found that death rate from breast cancer was 29% lower in the women who got mammograms in their forties. The benefit was greater in women aged 45 to 49 than in those aged 40 to 44. Dr. Jonsson and the researchers estimated that the number of women that 1 life was saved for every 1.252 women aged 40 to 49 who received mammograms.
The American Cancer Society reported on the findings, noting that the study finds benefits for women to get mammograms in their forties. However, the Society warns that mammography can miss some breast cancers and therefore also recommends that women in their forties receive annual breast exams from their physicians. The American Cancer Society recommends breast exams every three years for women aged 20-39.
The results of this latest study underscore the need for women to talk to their doctors to develop an appropriate breast cancer screening regimen based on their individual medical situations. Many health experts agree, for example, that women at high risk of breast cancer, such as those with a family history or genetic predisposition to the disease, receive screening at a younger age, often before age 40. Other screening tests, such as ultrasound or MRI, have been recommended as screening methods for certain women depending on medical circumstances. These tests are also often used as diagnostic tools if an abnormality is first detected with mammography, a breast exam, or other method.
Additional Resources and References
- This article refers the study, "Effectiveness of population-based service screening with mammography for women ages 40 to 49 years,â€ which was published September 29, 2010 by Cancer, http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1097-0142
- Learn more about U.S. Preventive Services Task Force mammogram guidelines.
- Learn more about mammography