Q&A: Mammogram Dispute Leaves Women Fearful, Frustrated

A top group of doctors have recommended that women should start getting annual mammograms at age 40 , much earlier than the government recommends. In 2009, the U.S. Preventive Services Task Force, a federally supported expert panel, came out and said there is no data to show that screening women for breast cancer before the age of 50 saves lives.

With all the back and forth, many women are understandably confused and frustrated. TODAY.com's Facebook fans had some questions about the new guidelines, concerns about radiation exposure and handling fears that their breasts are like ticking time bombs. Read on for Dr. Nancy's Snyderman's answers.

Q. Why is 40 the magic number? Is it because at 40 our hormones begin to significantly change as we prepare to go through menopause?
Lisa Peakovic Monahan

A. Forty isn’t a magic number. Forty was an arbitrary pick and that’s part of the issue. It’s the conventional wisdom that’s when hormone levels would start to decrease and that’s when breast cancer rates have gone up.

Everyone should take a breath. Until I see data proving otherwise, the U.S. Task Force guidelines [from 2009] are the most sound. I say that as a 59-year-old woman who has been having a mammogram now 19 years in a row. If I knew then what I know now, I wouldn’t have started at 40. I would have waited until 50.

Q. Does anyone else ever look down at their breasts like they are ticking time-bombs? What is average woman’s lifetime risk?
Amy Kristine

The average woman’s lifetime risk is 1 in 19 assuming you live to be 100, for all women living to be 100. That doesn’t mean 1 in 9 20-year-olds get sick. If you look at your breasts like ticking bombs, you might as well look at your lungs like ticking time bombs. You shouldn’t be obsessed with cancer. Breast cancer awareness and the Pinking of America? We get it. Women are now afraid of their bodies.

Q. My mom had breast cancer (10 years now cancer free!), I am almost 34 years old. Should I start getting mammograms (at least a baseline) sooner than age 40 since I have a family history of it?
Laurie Shoemaker Houston

A.Women should only get a baseline breast cancer test at 35 if there’s a family history. You didn’t say at what age your mother got breast cancer. Did your mother have breast cancer in her 30s or 40s? What it an aggressive tumor or require aggressive treatment? This goes to the individualization.

If you’re worried, you can can get a screening mammogram at 40 if there’s a strong family history. Just because your mother got breast cancer doesn’t mean you’re going to get breast cancer. That is not a family history. Family history is grandmother, aunt, sister, mother – when you really start to see a tree.

If there’s no family history, getting screened in your 30s is an unnecessary exposure to radiation.

Q. Repeated radiation exposure is not always "safe"...it's not a black and white issue. Cathy Paden Lince

A.We don’t know what the radiation risks are from yearly mammograms. Mammograms have a very low radiation does, but radiation is cumulative. Even people who work in companies that make mammography machines will say they don’t know what the cumulative risk is 15, 20 or 30 years out. Why get radiation if you don’t need it?

Q. Why is it that every year I have to get a mammogram only for them to tell me I will need an ultrasound before they can tell me anything?
Kelly Capozzi Niblock

A.That’s because mammograms tell you some information but not all information. So you may see a lump or a density, but the ultrasound can tell you if it has fluid in it or it’s something to worry about. Sometimes you can feel a lump and the mammogram will be normal, but the ultrasound will tell you not to worry.

The other reason not to do routine screening at 40 is that 40-year-old breasts are very dense. It’s hard for the mammogram to be accurate. If you’re really worried, MRI is the best. But it’s not a perfect screening tool and then you’re talking about using health care dollars inappropriately.

Q. I am 43 and just finished breast-feeding my last kiddo a couple months ago. I breastfed him for 17 months and my OB at my last visit said I should wait at least 6 months after breast-feeding prior to getting my next mammogram (which I haven't had since 40) because he said the milk will light it up. I have really fibrous breast tissue and worry about missing something - is there anything I can do besides waiting?
Sondrah Laden

A. [Your doctor] is right. Let the breasts settle back into being normal. There’s no rush.

Q: I am 40 and pregnant for the first time, I have not yet had a mammogram. When will it be safe for me to do so?
Dolores Rios

If you don’t have a family history, you can wait until you’re 50. You don’t want to get a mammogram while you’re pregnant unless there’s an emergency.

Q. I am considered high risk and I am concerned that 1x a year is not sufficient, if I have my mammo every Jan, and something develops in the next few months that is not palpable, that will be a good 8-9 months that it will have the opportunity to grow and spread.....what else can I do to be proactive?
Jeanette Negron

A. That can happen. And frankly, women are many times pissed off, when they say my mammogram missed a tumor and then I found it. Those are rapidly growing tumors that were there anyway and a mammogram can miss it.


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