Mammograms Now or Later? Expert Answers to Your FAQs

BCRF’s Chief Mission Officer Dr. Marc Hurlbert answers commons questions surrounding breast cancer screening

This article, written by Dr. Marc Hurlbert, was originally published in Everyday Health 

The goal of the American Cancer Society’s (ACS) mammography recommendations is simple: to save lives through early detection of breast cancer. But the new ACS mammogram guidelines have confused some women, and raised questions about the best breast cancer screening strategy even among doctors. Here are answers to some of the questions we’re getting at the Breast Cancer Research Foundation (BCRF), where I’m the chief mission officer.

What’s behind the latest mammography recommendation?

Guidelines are periodically revised as experts learn more from medical studies. ACS updated its guidelines to recommend that women begin getting annual mammograms at age 45 — instead of 40, as they had previously recommended — if they’re at average risk of breast cancer. The change resulted from evidence showing maximum benefit of annual screening mammography in women ages 45 to 54. Starting at age 55, the ACS recommends screening every two years.

This recommendation has been controversial among experts, so work with your doctor to get the best screening schedule for your situation. Women still have the option of starting annual mammograms at age 40 and going to yearly after 55. There’s no “one size fits all” approach to screening — it’s a personal medical decision based on discussions with your doctor.

What we’re seeing now is personalized medicine applied to breast cancer screening — that is, tailored medical care based on your needs or values, genetics, and family history of disease — just as it is with cancer treatment.

What should you be talking to your doctor about?

Three things:

1. Speak with your doctor about your level of risk (your likelihood of developing breast cancer) so you can make an informed personal decision. The guidelines focus on women at average risk, so if you fall into a higher breast-cancer risk category, you may need a more frequent screening schedule. Your doctor may use a National Cancer Institute questionnaire that was developed by medical experts to calculate your breast cancer risk.

2. Tell your doctor if you have a family history of breast cancer. Risk is higher among women whose close relatives have had this disease, including those with a specific genetic mutation. Ask whether genetic testing is something you should consider.

3. Certain lifestyle factors increase your risk for breast cancer, so your doctor should ask you about your diet, your exercise routine, how much alcohol you drink, whether you have children, whether you breastfed, and related questions. Answer honestly so that you’ll get the best evaluation of your risk.

What are the benefits and risks of screening?

Experts agree that screening provides early detection, increases survival rates, reduces the need for mastectomy or chemotherapy, and reduces the risk of metastasis (when cancer spreads and becomes life-threatening).

Although mammograms are the best current screening tool, they’re not perfect. There is a risk of getting a false positive: when something looks like cancer but is not. False positives can lead to more testing, and sometimes needle biopsies. This may cause you short-term worry for something that turns out to be benign.

Why is breast cancer screening so important?

Early detection of breast cancer not only increases survival rates, but minimizes the amount oftreatment you may need. While every tumor is unique, in general, the smaller the tumor is when it’s discovered, the more treatable it is, providing the best odds for a better outcome. When tumors are found early, many women can have breast-conserving surgery (lumpectomy) instead of mastectomy.

Is mammography the best breast cancer screening option?

Yes. While mammograms may not be perfect, they’re the best screening option available for finding breast cancer early. Researchers supported by BCRF and other groups are working diligently to develop better, more precise, state-of-the-art tests to distinguish between low-risk and high-risk breast lesions and tumors.

What are the key steps I need to take when considering screening?

Know where you stand. Starting in your twenties, talk to your ob-gyn or family physician about your breast health and your family history so you understand the risk factors for breast cancer. Always stay informed  about the best screening recommendations for you.

Research mammogram testing facilities. Find a high-quality mammography facility near you by checking the American College of Radiology’s list of Breast Imaging Centers of Excellence.

Make sure you get your test results. Once you’ve had a mammogram, it’s mandatory that the facility notifies you in writing of the outcome within 30 days. If you haven’t received word, don’t shrug it off — follow up.

Keep your mammogram records. If you change doctors, request that all your mammograms be put on a CD-ROM or flash drive so you can take them to your new mammography facility.