I Still Recommend Screening Mammograms Annually Starting at Age 40

With the USPSTF's recommendations getting all of the press lately, it is important to know that many professionals still do recommend that screening mammograms start at age 40 and should be performed every year. This is what I recommend in my practice.
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Recently, the United States Preventative Services Task Force (USPSTF) issued guidelines recommending that women start screening mammograms for breast cancer detection at age 50, and that these screening exams should be performed every two years for women aged 50 to 74 years old. These guidelines also acknowledge that women may make a personal decision with their doctor to start screening in their 40s if they believe the benefits outweigh the harms. This is not new news -- the recommendations are nearly identical to their prior recommendations.

With the USPSTF's recommendations getting all of the press lately, it is important to know that many professionals still do recommend that screening mammograms start at age 40 and should be performed every year. This is what I recommend in my practice. As a physician, I feel it is imperative that I diagnose potentially life-threatening illnesses early. Breast cancer is one of those illnesses. When it comes to matters of life and death, like cancer, early detection is crucial.

I hear a myriad of excuses why women refuse mammograms. And although I do agree that the decision to get a mammogram is a personal one, I would like to share my responses to some of the most common reasons I hear why women refuse to get mammograms.

1. The USPSTF doesn't recommend that I get a mammogram in my 40s.

The American Cancer Society, American College of Obstetricians and Gynecologists, and American College of Radiology also make recommendations. These organizations recommend annual screening starting at age 40.

The USPSTF is one of several groups that make recommendations. The panel is composed primarily of men. I can only wonder if their recommendations for penis cancer screening would be similar if penis cancer were as prevalent and fatal as breast cancer.

2. Mammograms hurt.

They hurt a lot less than breast cancer.

3. I can't afford a mammogram.

Well, they are a lot less expensive than breast cancer treatments. Also, there are many financial assistance programs for women in need.

4. I don't have a family history of breast cancer, so I'm not at risk.

Most women who are diagnosed with breast cancer do not have a strong family history. Angelina Jolie is the exception, not the rule.

5. Mammograms increase health care costs.

When it comes to preventing cancer deaths, I don't believe that you should put a price on someone's life. I agree that physicians and health providers should spend health dollars responsibly. I disagree that doctors should recommend against breast cancer screenings as a way to decrease health costs.

6. False-positive mammograms lead to unnecessary biopsies.

One of the biggest risks of screening mammograms experts note is that abnormal mammograms can lead to additional procedures that may cause mental, physical and possibly financial stressors. This is a true risk indeed. In my opinion, however, it is less of a risk than actually having a breast cancer that went undiagnosed only to be found at a late stage that decreased your chances of survival.

7. Mammograms over-diagnose breast cancer and find cancers that would have never killed me.

Over-diagnosis is not the same as misdiagnosis. Yes, screening mammograms may identify women with breast cancers that may never progress to be their cause of death. But today we do not have adequate ways to predict what breast cancers will and will not kill someone. The mammogram worked in these cases, it found a cancer. I'd prefer to have breast cancer found early because early detection is crucial for survival.

Ask any breast cancer survivor, and I'm sure you'd hear quite the contrary. Even the USPSTF report acknowledges that one death could be prevented when screening is started in your 40s. Other research has estimated that several thousands of lives are saved each year with annual screening starting at age 40.

9. But the USPSTF recommends I only get a mammogram every two years, not every year.

I have seen far too many patients have normal mammograms one year, followed by an abnormal mammogram the next year that was positive for cancer. I cannot in good conscience recommend that anyone delay the possibility for early detection by an additional 12 months. (Also, see answer to #1.)

10. If I have breast cancer, I'd rather not know about it.

If you don't want to know if you have a cancer until it's spread throughout your body and left you with a terminal diagnosis with limited treatment options, that's your decision. But for me, the stakes are too high. I've been put on this earth to be a wife, mother, daughter, friend and healer. I plan to be around as long as possible to touch as many lives as possible. I'm not willing to die a premature death from breast cancer or from any disease that could potentially be treated successfully through early detection.

As for me and my breasts, we will be screened for cancer every year starting at age 40. If you choose to do otherwise, I hope it is only after discussing the risks and benefits with a physician you know and trust.