Sorting Out the New Breast Cancer Screening Advice

Women over 40 know the hassle, expense, and discomfort of having a yearly mammogram (breast x-ray). But we figure it's worth the trouble. We all know women touched by breast cancer, and want to do what we can to protect ourselves.

Now a federal health advisory panel says regular mammograms don't need to begin until after age 50. Respected doctors and cancer organizations dispute the panel's new guidelines. Women are left wondering - is it safe to put off these tests?

No Mammograms until Age 50

For years women were told that annual mammograms after age 40 were important for the early detection of breast cancer. In a stunning change of policy, federal health advisors said last week that women should wait until age 50 to begin routine mammograms.

The new breast cancer screening recommendations were made by the U.S. Preventive Services Task Force. This task force is made up of independent doctors and scientists who review medical evidence to determine the effectiveness of various preventative measures such as screening tests, counseling, and medicines. Although the task force does not set federal policy, its recommendations help determine the screening medical tests generally covered by insurance and Medicare.

The task force concluded that the benefits of using mammograms to screen for breast cancer in women in their 40's didn't outweigh the harms. The early screening resulted in too many unnecessary biopsies and complications without significantly improving breast cancer survival.

The task force concluded:

  • Routine screening mammograms is not recommended for women aged 40 to 49
  • Women aged 50 to 74 years should have a screening mammogram every other year
  • The benefits and harms of screening mammograms in women aged 75 and older is unknown
  • There is no benefit in teaching breast self-examination
  • The benefits and harms of clinical breast exams by doctors is unknown
  • The evidence is insufficient to determine the benefits or harms of using digital mammography or MRI (magnetic resonance imaging) instead of film mammography to screen for breast cancer

New Mammogram Recommendations Disputed

Respected cancer organizations, like the American Cancer Society, Susan G. Komen for the Cure, and the National Cancer Institute reject the new recommendations. They are sticking with the advice that women should begin annual routine screening mammograms at age 40.

Although these organizations dont dispute the medical evidence used by the task force, they weigh it differently. Most major cancer organizations conclude that even though the survival benefits of mammography in women aged 40 to 49 are relatively small, they still outweigh the risks of false positive results.

Individual and Informed Decision about Mammograms

Given the conflicting guidelines about mammograms and other breast cancer screening, what should a woman do? Although the task force recommends against general mammogram screening for women in their 40's, it emphasizes that a decision about mammograms must be an individual one.

Discuss the following breast cancer risk factors with your doctor to determine when you need mammography. According to the Centers for Disease Control, factors that increase the risk of breast cancer include:

  • Getting older
  • Being younger when you first had your menstrual period
  • Starting menopause at a later age
  • Being older at the birth of your first child
  • Never giving birth
  • Not breastfeeding
  • Personal history of breast cancer or some non-cancerous breast diseases
  • Family history of breast cancer (mother, sister, daughter)
  • Treatment with radiation therapy to the breast/chest
  • Being overweight (increases risk for breast cancer after menopause)
  • Long-term use of hormone replacement therapy (estrogen and progesterone combined)
  • Having changes in the breast cancer-related genes BRCA1 or BRCA2
  • Using birth control pills (oral contraceptives)
  • Drinking alcohol (more than one drink a day)
  • Not getting regular exercise

Talk to your doctor to determine when mammography is right for you. Your decision should be based upon your family medical history, your general health, your breast cancer risk factors, and your personal feelings about the benefits and risks of the screening procedures.

Questions for Your Attorney

  • Do the new task force recommendations mean that my insurer won't pay for an annual mammogram if I'm under 50 years old?
  • My doctor was slow to diagnose my breast cancer. Do I have a medical malpractice case?
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