Dr. Swiner’s Medical Note of the Month-December 2009-What’s the deal with mammograms?

Since the news broke in November about the new recommendations on mammogram screening, I have had the discussion frequently as the majority of my time is spent counseling on preventive care.

  1. Whatever the question, let’s review what happened.

The U.S. Preventive Services Task Force presented the recommendations. This is a group of medical experts in primary care that review studies and put together a list of preventive care measures. In 2002, the USPSTF noted that every woman beginning at age 40 should get their first mammogram*. If she had a first-degree relative (i.e. mother, sister) with breast cancer, she should start even earlier. After the first one, we were told to then have them every two years or so. This recommendation was given until age 49. Starting at age 50, we were encouraged to have them yearly.

In November, this changed. Now the recommendation is for “biennial screening mammography for women aged 50 to 74 years.” This means having your first mammogram at 50 and every two years after that until age 74. This was also given a B-grade recommendation score, which means that there is moderate evidence in research supporting it and its benefit.

Starting before age 50 has been given a C grade, which means the USPSTF does not recommend it routinely. However, they do say to consider each patient as an individual and to always have a conversation about it. After the conversation, if it’s reasonable, a doctor and patient may decide to go ahead and have a mammogram.

The big deal seems to be about unnecessary harm. This means mammograms, like most tests, are not perfect. There are many false positives or abnormal results that aren’t really abnormal. Just think about it: How would you feel receiving the news that your breast exam was abnormal and then being told you needed another test or a biopsy to make sure you didn’t have cancer?

Anytime the word cancer is mentioned, stress is produced. And, anytime more studies and tests are done – which then ultimately return normal – unnecessary money, time and energy are spent. In the U.S., this can occur 10 percent to 15 percent of the time in women from age 40-49, and this is where the majority of the debate comes.

This is the discussion I have with my patients:• Let’s come to a reasonable, educated decision together.• We’ll decide together when the first one will be, which will probably be around age 45.• If there’s a strong family history of either breast or ovarian cancer, we will start earlier with the first mammogram. This might be at 35-40.• Remember that the best screening is still a self-breast exam. Despite how wonderful our studies are in these modern times, educating patients to do their own monthly breast exams wins every time.• Starting at age 50, it’s probably a good idea to start having mammograms every one to two years.

* Resource: American Academy of Family Physicians.

  1. Nicole Price Swiner, MD, works for the Durham Family Practice in Durham. Contact her at 220-9800.
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