The Verdict on the Mammogram Debate

In November 2009, the federal Preventative Services Task Force announced its recommendation that most women put off routine mammograms until the age of 50, and receive them biannually instead of once a year. The response for the most part was uproar-not just from the American Cancer Society, many medical professionals and Congress, but also from women across the country. Women who have grown up listening to "cancer prevention is key" were baffled by the new message to put off mammography until later in life and even stop practicing self-exams.

So where does the mammogram debate stand now? A joint study by the American College of Radiology and the Society of Breast Imaging published in this months' issue of the Journal of the American College of Radiology now backs what previous research suggested: That women should begin annual mammography screenings at the age of 40-and even earlier for women with higher risks of breast cancer due to genetic mutations or family history.

Carl D'Orsi, MD, Co-Chair of the American College of Radiology Breast Imaging Commission and Chief of Breast Imaging at Emory University, is one of the researchers who worked on the recent study-which was well underway before the federal Preventative Services Task Force's recommendations were released. He answered some of our questions regarding the study, and also shed light on the risks versus benefits of a mammogram procedure.

WHEN SHOULD I START GETTING MAMMOGRAMS?

The rule of thumb has always been that a typical, healthy woman without risk factors should start getting annual mammograms at 40. However, women with BRCA mutations or a family history should begin as early as 30-but not before the age of 25.

The new mammogram advice that came out in November suggested that every woman have a mammogram procedure starting at age 50 and every other year for cancer prevention purposes. The most recent study, however, backs previous research. "There have been seven trials that have taken two groups of women, where one group gets treated as usual and the other women get that plus mammography," says D'Orsi. "What all these trials found is that the death from breast cancer was significantly decreased in the group of women that got mammography."

WHAT ARE THE RISKS ASSOCIATED WITH RADIATION?

One of the issues raised by the federal Preventative Services Task Force was that too much exposure to radiation from mammograms could actually do more harm than good-hence why the new mammogram advice in November advised women not at an increased risk for breast cancer to receive fewer screenings and wait until later in life. It's true that radiation from mammograms can potentially increase the risk of cancer, but by such a small margin that the benefit-detecting cancer early on-far outweighs the risk-not detecting it, or detecting it too late. So what's your risk? If you have a genetic mutation or family history, your chances of developing breast cancer are higher, but according to the National Cancer Institute, a typical woman without a genetic mutation or family history has a 1 in 233 chance of developing breast cancer in her 30s, a 1 in 69 chance in her 40s, a 1 in 38 chance in her 50s and a 1 in 27 chance in her 60s.

SHOULD I KEEP DOING BREAST SELF-EXAMS?

Chances are, you've been reading about how to give yourself a breast exam since high school-it's been engrained in American women's heads since their teen years. So it's no wonder there was a sense of surprise when the federal Preventative Services Task Force also said that women stop giving themselves regular breast self-exams used for breast cancer prevention. Their reasoning was that data shows that 1 cancer death is prevented for every 1,904 women between the ages of 40 and 49 who received a mammogram. Also, false screenings can lead to painful biopsies, and feeling for lumps that turn out not to be cancerous can lead to anxiety before test results are conclusive.

On the other hand, medical professionals like D'Orsi think the risks of self-exams (essentially, women getting anxious over lumps that are not cancerous and/or "extra" medical tests being conducted) are still practical tools that women should use for cancer prevention. "With everything there's a risk," says D'Orsi. "What are the risks here? Anxiety, unnecessary imaging and biopsies, but the benefit is saving lives."

The verdict? Yes, keep doing exams at home, and if you have any questions (or need to brush up on your technique), consult your doctor.

IS THERE A CHANCE THAT NOW MY HEALTH INSURANCE WON'T COVER A MAMMOGRAM PROCEDURE?

Health insurance companies are still covering mammograms as they always have. In December, the Senate even accepted an amendment protecting women in their 40s from not being covered due to the federal Preventative Services Task Force's report. If you're a woman under the age of 40 and wish to have a mammogram, talk to your doctor. Many insurance companies cover exams for women in their 30s and even late 20s if there's a family history or other risk factor.