Navigating the confusing waters of mammogram recommendations

ASK THE DOCTORS

By Eve Glazier, M.D., and Elizabeth Ko, M.D.

Dear Doctors: I keep hearing different things about at what age and how often a woman should be getting a mammogram. Can you please go over the latest advice?

Dear Reader: It’s true that screening guidelines regarding mammography have changed in recent years. These shifts arise when ongoing research, and the collection of data, suggest a new screening approach that is safer for the patient, or one that offers a better outcome. Various organizations, such as the American Cancer Society, the U.S. Preventive Services Task Force and the American College of Physicians, have slightly different guidelines. To avoid confusion, we’ll focus on the newest advice from the American Cancer Society, released in 2015, and then talk about the specific reasons these guidelines changed.

Women between the ages of 40 and 44 years should have the choice to begin having annual mammograms. Those who wish to do so should speak with their health care provider about the potential benefits and risks. For women between the ages of 45 and 54, the American Cancer Society recommends getting a mammogram each year. Starting at age 55, the organization recommends switching to having a mammogram every other year. However, women can still make the choice to continue annual yearly screenings. Women who are 55 and older should continue to have biennial breast cancer screenings if they are in good health and are expected to live another decade or more.

It’s important to note that these guidelines are for women of average risk. This means they don’t have a family history of breast cancer and have not tested positive for certain genes that are associated with elevated risk for breast cancer. Women who are considered to be at high risk for breast cancer are advised to get a mammogram and an MRI each year. Women with dense breasts, which can affect the accuracy of a mammogram, should discuss the potential efficacy of screening with their health care provider. And don’t forget, adult women of all ages are urged to perform a breast self-exam at least once each month, and to also have a clinical breast exam performed by a health care professional every year.

Although very rare, breast cancer can occur in men. It often presents as a firm lump beneath the nipple. Men with this symptom should see their doctor.

Changes to breast cancer screening guidelines were adopted because of a growing body of evidence that the disease occurs less often in women in their early 40s. Because their breasts are denser, younger women are at increased risk of receiving a false positive result in a mammogram. This would not only cause the woman unnecessary anxiety but would also lead to a range of followup procedures. Another concern was over-diagnosis -- that is, the discovery of a cancer that didn’t pose an immediate risk but would then lead to surgery, such as a lumpectomy, and possible follow-up treatments, such as radiation or hormone therapy. The risks of early annual screenings were therefore seen to outweigh the benefits. Ultimately, though, decisions about screening rest with the patient and her health care provider.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.

(Send your questions to askthedoctors@ mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)