Mammograms at 40
To Mammogram or Not to Mammogram, That's the Question for Women in Their 40s
By Lisa Santora, M.D.
Chief Medical Officer, BCHD
Mammography recently became a hot topic when, last November, the U.S. Preventative Services Task Force (USPSTF) issued an updated recommendation for screening women in their 40s.
According to the USPSTF, “The decision to start regular biennial screening mammography before the age of 50 should be an individual one that takes patient context into account, including the patient's values regarding specific benefits and harms.”
Upon hearing this, many women felt their right to mammograms might be taken away. Breast cancer screening advocates feared women would be deterred from getting screened at all. But for many in the medical community, this was a logical conclusion based on the efficacy and resource allocation facts.
Screening is a critical step in preventing breast cancer, but it doesn’t come without risks. Mammograms in women under 40 result in more false positives results, which lead to additional x-rays, unnecessary biopsies and other invasive procedures and treatments, not to mention significant anxiety among women and their families. That’s a substantial risk considering women in their 40s, with no identifiable risk factors, are nearly half as likely to have breast cancer than women over 50.
The USPSTF did NOT recommend against mammogram screening. It simply recommends that women ages 40 to 49 should have full discussions with their health care providers about the potential pros and cons of screening. This means incorporating family history, overall health, personal values and preferences, and the best scientific information into the decision-making process. The result is an empowered patient who is able to make an informed decision about whether or not to be tested.
Many women in their 40s may still decide to continue mammography because they value the chance of benefiting from it, but other women will choose to defer beginning mammograms until the balance of benefits and risks is more favorable. In both cases, women should also have discussions with their doctor regarding smoking cessation, diet, exercise and even breastfeeding as methods of significantly reducing the risk of breast cancer.
As the debate pushes on, scientists will continue to study new technologies for improving breast cancer screening. Research is showing 3D digital breast tomosynthesis (x-rays) produces clearer and more accurate images, which may be a better tool for breast cancer screening of women in their 40s. Until technology improves, open and honest discussions with your doctor, weighing all of the risks versus benefits of screening, is still the best advice.
