Making the Mammogram Decision
Breast cancer is the most common non-skin malignancy among women in the United States and second only to lung cancer as a cause of cancer-related death. The risk for developing breast cancer increases with age and is at its highest after age 50.
Most physicians now agree that annual mammograms are a good idea for women over age 50. There is, however, still some debate over the age at which women should begin having mammograms, as well as how often they should have the procedure performed.
Many organizations, including the American Cancer Society, the National Cancer Institute and the U.S. Preventive Services Task Force, now recommend that women should begin having mammograms at age 40, although there is some disagreement among these groups over how often the breast X-rays should be taken.
Tracey Gaudet, M.D., a physician in the obstetrics and gynecology department and director of the Center for Integrative Medicine at Duke University Medical Center, says she generally follows the guidelines of the U.S. Preventive Services Task Force.
"This is a group of approximately 200 physicians who review the scientific literature based on evidence and advise us on what we should recommend for screening. They basically report that there is evidence that there's benefit to starting screening at age 40," she says. "As for how often, they say every one to two years, because there's not yet enough evidence to actually clarify whether it should be annually or not."
Gaudet says for most women the benefits of a yearly mammogram screening between ages 40 and 50 far outweigh the risks.
"The test is a good test," she says. "Clearly, you're more likely to pick up a breast cancer with a mammogram than without. And in that age group (40 - 49), if you do have breast cancer, it's much more likely to be an aggressive form of the disease. Early detection can be critical."
Gaudet says she counsels her patients that the best strategy, unless other factors are involved, is to start screening early and have it done regularly.
"Most people recognize the value of mammograms in reducing morbidity and mortality from breast cancer," she says. "My advice to patients is to begin screening at 40, and I err on the cautious side and say to screen every year."