When Do I Get A Mammogram?

 
 
When Do I Get A Mammogram?

The answer depends on several factors; including age, insurance, health factors, acute problems and heredity, to name a few. Below are the usual, prevailing guidelines. I like to     individualize recommendations to my patients’ parameters.

 The usual age span of usefulness for mammography screening is age 40-85. Some are now saying 50 is the appropriate initial age and 74 is the new boundary on the other end of the age spectrum. It’s all about the proverbial bell curve. This is the area where mammography is most likely to find a cancer; thus the “authorities” consider this the time period where money is best spent on this preventive, screening test (i.e. less negatives, more positive readings). Obviously there are always outliers in any bell curve; young women with or without family history who have an “early” breast cancer and older, healthy women who get breast cancer later in their life. I’ve seen both.

There is general concern of screening and finding breast cancer in an older woman (>75 years) who has multiple health problems and short life expectancy. In other words, do they have a medical problem that will kill them before a cancer would? Alternatively, in a woman in her 80’s with good health, breast cancer screening might be more important to find and treat a cancer. So, how’s your health? Do you think you will have at 5-10 years of life expectancy left?

Here are the guidelines per agency; insurance companies have their own parameters based on business needs not healthcare needs. As always, family history and risk factors are important to individualize recommendations.

CBE: clinical breast exam

BSE: breast self exam

AMERICAN CANCER SOCIETY: yearly starting at age 40 and continuing as long as the woman is in good health (or to age 75-80). CBEs (clinical breast exams) are recommended yearly starting at age 40. BSE (breast self examination) is considered optional.

 THE US PREVENTIVE SERVICES TASK FORCE (USPSTF): biennial from age 50-74. The agency also recommends against teaching BSE and concluded there is no evidence of benefit to yearly CBE. My comment here would be that many breast cancers are found by women doing self breast examination.

AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS:  Annual for women age 50 and above. Annual or biennial from age 40-49. All women should have CBEs annually, and recommends SBEs.

 UPDATE AS OF AUGUST 2011

In an article in the August 8, 2011 issue of American Medical News, entitled " ACOG calls for annual mammograms for women starting at age 40", page 18: "The American College of Obstetricians and Gynecologists released a practice bulletin July 20 recommending that doctors offer mammograms annually to women beginning at age 40."

 

AMERICAN GERIATRIC SOCIETY: “For women in average to better health, with an estimated life expectancy of 5 or more years, it is appropriate to offer screening mammograms every 1-2 years up to age 85”. Beyond age 85 it should be customized to situation of health and life expectancy. CBE should be performed “periodically” and BSE is neither recommended nor discouraged.

So why the variations in recommendations?  Several reasons. Randomized controlled studies have not historically included women over age 75. There is thought to be an observational finding that women over age 80 have a decreasing tendency to get breast cancer. This, however, has not been found to be a valid assumption. Perhaps we are screening more under age 75 and not screening enough over age 75. Clear as mud. I feel that when you screen regularly for something, you tend to find more of it.

UPDATE: An article in American Medical News, June 7, 2010 relates that the government, politicians, and the Department of Health and Human Services (the organization promoting these new guidelines by the U.S. Preventive Services Task Force) are doing some back-pedaling over the issue after some physcians' and Womens' groups criticized the guidelines. Here's the problem: 2008 legislation gave HHS the authority to consider Task Force (USPSTF) recommendations in making Medicare coverage determinations.

*Info for this article taken in part from:  Schonberg, M. (2010), Breast Cancer Screening: At What Age to Stop?, Consultant; Vol. 50, #5; pages 196-205.