There has been a lot of discussion in the past about when to start screening mammograms and the frequency in which to have them done. Most of the controversy stemmed from a 25-year follow-up of a Canadian study done to determine if screening mammogram is actually able to identify breast cancer better that Clinical Breast Exams (CBE- a breast exam done by a trained health care professional). The study included almost 90,000 women aged 40-69 years old from 1980-1985. The findings were quite similar between the mammography group and the control group that only received CBE.
During the study in 1980-1985 mammography was able to detect cancer the size of 1.91cm and in the control group breast cancer was identified at 2.10cm. Clearly the difference is very minimal. With today’s technology breast cancer as small as 0.5cm can be detected by digital mammography and there is actually newer technology that is just now becoming available that can detect even small masses with more accurate diagnosis. This new technology is called tomosynthesis and is only available at some mammography sites currently. Current CBEs are typically able to detect a mass as small as 1cm. As you can see, technology and assessment have evolved over the past 25 years as everything else does, therefore looking at a study done a quarter of a decade ago to consider guideline changes makes little sense.
Other important facts we know about breast cancer detection with mammography are:
- Only 15% of breast cancers that are identified on mammogram are actually palpable. In other words, if a mass is not noticed on exam it does not exclude the possibility of one.
- Only 10% of breast cancers are genetic, therefore just because you do not have a family history of breast cancer does not mean you are not at risk. This just means you are at average-risk like the other 90% of women that develop breast cancer.
- There is a 50% increased likelihood of dying from breast cancer if you do not get screening mammograms because the cancer is usually detected at a much later stage.
- Screening mammography should be performed on every woman regardless of risk assessment because more than 75% of women than are diagnosed with breast cancer each year are NOT considered high-risk.
- Annual mammograms should be started at age 40 because almost half of the lives lost to breast cancer are among women in their 40s.
There is a great deal of evidence that suggests that screening mammograms save lives.
American College of Obstetrician and Gynecologists (ACOG), American Cancer Society, and American College of Radiology all recommend annual CBE and mammograms to start at age 40.
We at Women’s Care Specialists encourage our patients to follow these recommendations to reduce the chance of dying from breast cancer. We also take into account your personal, family, medical and social history when determining what type of surveillance and frequency are recommended for you individually.
Yates, J. Does screening mammography save lives? OBG Management 2014;26(4):62-72
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