Mammograms - Are They Needed, And How Often?

by Jane Ashley

It’s difficult for women to keep up with the latest guidelines for the frequency of mammograms and at what age to begin. There are several organizations that make mammogram recommendations. All but one of these organizations agree that the safest and optimum age to begin having annual mammograms is 40.

Annual Mammograms

Who makes mammogram recommendations?

There are several cancer organizations that make recommendations on mammograms frequency. They include:
American Cancer Society
The National Comprehensive Cancer Network
The American College of Radiology and Society of Breast Imaging
The American College of Obstetricians and Gynecologists

Important Note: The U.S. Preventive Services Task Force (USPSTF) guidelines have been rejected by the federal government — studies show that their guidelines would miss about a third of breast cancers and result in up to 10,000 more breast cancer deaths annually. The federal government has barred Medicare and private insurance companies from using the USPSTF screening recommendations as the basis for insurance coverage. This task force does not recommend regular mammograms for women, ages 40-49 and only recommends mammograms every other year for women ages 50-74.

Mammogram Calendar

Guidelines for Women at Average Risk

The American Cancer Society’s guidelines provides women, at average risk, with options so that they can do what is comfortable for them.
• Women, ages 40-44. These women have the option of beginning annual mammograms as early as age 40. Most insurance policies will cover them.
• Women ages 45-54. These women should have annual mammograms.
• Women over 55. Women over the age of 55 can switch to having a mammogram every other year or continue having annual mammograms.

Breast cancer screening should continue as long as a woman is healthy and expected to live ten more years.

The median age for breast cancer diagnosis is 62 — that means that half of the women diagnosed with breast cancer are under 62 and half are over the age of 62. Breast cancer rates are highest in women over 70. So if you’re over 70, don’t stop your mammograms or change from having them annually.

Guidelines for Women at Higher Risk

Women at a higher risk for breast cancer should have an MRI and a mammogram annually. Higher risk is defined as being 20-25 percent or more likely to develop breast cancer in their lifetime, based mainly on family history.
• BRCA1 or BRCA2 gene mutation. Based on genetic testing.
• First-degree relative with the BRCA1 or BRCA2 mutation. First degree is defined as parent, brother, sister or child.
• Radiation therapy to the chest for Hodgkin’s Lymphoma when you were between 10 and 30 years old.
• Rare genetic syndromes, including Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome. First degree relative of persons with these syndromes are also at higher risk for breast cancer.
• Certain genetic mutations including ATM, CDH1, CHEK2, NBN, NF1, PALB2, PTEN, STK11 or TP53 gene mutations.

There is not enough evidence to recommend routine MRI screening for patients who have been diagnosed with ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH). Nor is there sufficient evidence to recommend annual breast MRI for women with particularly dense breasts. Talk to your healthcare provider about your concerns.

Mammograms after Breast Cancer

Most patients who had bilateral mastectomies won’t need annual mammograms. Neither do women with reconstructed breasts.
But all other breast cancer survivors should have annual mammograms. This includes:

• Women who had breast-conserving surgery (also called BCS or lumpectomy) – patients usually have a new baseline mammogram done 6-12 months after radiation. This mammogram records the changes in their skin and breast tissue caused by their surgery and radiation. Future mammograms will be compared to this baseline mammogram. Some doctors recommend annually while others suggest more frequently.
• Women who had a mastectomy of one breast — these women should have annual mammograms on the other breast.
• Women who has a subcutaneous mastectomy (also called a skin-sparing mastectomy) – this surgery allows a woman to keep her nipple and some underlying tissue. These patients should have annual mammograms.

A Disturbing Trend in Breast Cancer Survivors

Percent Of Women In Us That Have Mammograms

A recent study published in The Journal of the National Comprehensive Cancer Network (NCCN) found that half of the five-year breast cancer survivors were not having post-treatment screening mammograms. Screening mammograms for breast-cancer survivors help detect recurrences before the patient develop symptoms.

The study of over 27,000 breast cancer survivors revealed that as more time elapsed after treatment ended, more patients began skipping their mammograms.

After one year, 13 percent skipped their mammogram. These percentages increased as time went on. After five years, only 50 percent of the breast cancer survivors were having annual mammograms as recommended.

Even those with healthcare insurance were not compliant with the recommendation to have annual mammograms. African-American women were less likely to have follow-up mammograms than Caucasian women. Although Caucasian women are more likely to be diagnosed with breast cancer, African-American women are more likely to die of breast cancer than any other racial or ethnic group. Further research needs to be done to understand the cause of the difference in death rates.

The Bottom Line …

Mammograms detect breast cancer at its earliest stage when cure rates are high. Yet according to Henry J. Kaiser Family Foundation, only 73 percent of women over 40 in the U.S. have had a mammogram in the last two years. Perhaps fear of the diagnosis or complacency contributes to not availing oneself of this proven screening tool. Breast cancer is the most common cancer in women and the second leading cause of death in women. Be a Mammogram Buddy — make a pledge with a friend or co-worker who is not having regular mammograms to pair up and get your mammograms together. Mammograms save lives. Have an annual mammogram.

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