So, I’m going to have a mammogram….

So, I have decided. I’m going to get an early mammogram. I’m 37 yo, without any significant family history of breast cancer, fortunately, which generally puts me at low risk. I’ve recently stopped birth control pills and breastfed 2 babies, which also puts me at low risk. However, I’m still nervous.

I treat many female patients, of all ages, and I’ve diagnosed a handful of breast cancers. Some of these women had “classic” or “textbook” risks, such as being in their late 40-60s with a family history or having an abnormal lump they found on exam. However, at least 2 or 3 within the past couple of years, had zero risks. As a matter of fact, one that struck me as a surprise, was one of my patients who was healthy as a horse, in her 30s, didn’t smoke, not on birth control, worked out all the time, no medical issues, with bloody discharge from the nipple, and that was it. We sent her for an ultrasound and mammogram, her first one ever, really just as a precaution, and it was positive for cancer. I was as astounded as she was. She looked just like me.

I’ve asked friends and family and the majority of them know someone who has been affected by cancer in their 30s or 40s, without any family history of cancer. What has caused controversy recently is the change in the recommendations for when to start and how often to do mammograms. Within the last 5 yrs, the guidelines have changed, stating that we should wait until age 50 to start doing mammograms. This would mean not starting at 40, which is what I was accustomed to doing. The frequency was to do them every other year, which would we different for most practice as well. Generally speaking, I would start at age 40 and do them every year or every other year for screening. For those who have significant family history, I would start at age 35. With the new guidelines and waiting, what happens to all of the 30 and 40 year olds that we may miss? Needless to say, I’ve been a bit of a rebel with these new rules. Now, I say maybe waiting until the early 40s is ok, but I’m definitely not waiting until 50 to screen my patients.

Then, there’s this thing with self exams. In general, I would teach all women how to examine their own breasts beginning with young adulthood. You would think, “The earlier, the better,” with being comfortable and becoming comfortable with feeling your breasts. However, with the new mammogram guidelines also came the recommendation AGAINST doing self exams. Yes, you read correctly—-against. I don’t feel great about that one either.

I have the referral, but I haven’t made the appointment yet. My Ob-gyn agrees he thinks it’s a reasonable idea, and thankfully my exam is normal without any lumps. I asked my friend, who is also an Ob-gyn, my age, and she’s already had her first one. I’ll keep you posted, and let you know how it goes.

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