Sep 25, 2013

Dr. Kirtly Parker Jones: Should women have mammograms before the age of 50? This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at University of Utah Health Care, and this is The Scope.

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Dr. Kirtly Parker Jones: It seems like in the last couple of years that there are new recommendations, or new debates, about when women should get mammograms. You may have heard in the news about a recent study that suggests that pushing mammograms back to 40 would save lives. Well, we are going to talk about this in The Scope today.

When Should You Start Getting Mammograms?

What is the data? Where are we coming from? And where we're left. How do we make decisions about cancer? A study on women who died of breast cancer from 1990 to 1999, a while ago, found that 71% had not had a mammogram, and many of these women were under 50.
The authors recommend screening before 50. Now this argument has been evaluated by many organizations and many countries. The recommendation still stands for most national organizations to screen at 50.

Disadvantages of Screening Too Early

The difficulty in getting mammography before 50 is young women, premenopausal women's, breasts are dense. They have a lot more breast tissue in them and not so much fat, and it's hard for mammography to see through them. This being the case, it is harder to see the cancers that might be there.
Secondly, there are lots of things in women's breast that aren't cancer that can show up to be suspicious in young women's breasts. So many women will have biopsies; have surgical procedures, for areas which aren't cancer.
So how many women need to have a biopsy, a surgical procedure, for noncancerous area, to pick up one that really is cancerous? So the combination of young women's breast cancer being relatively rare and that breasts are hard to see through, and a lot more women are going to have biopsies and surgical procedures that don't need them, make us really want to consider what are the tradeoffs of early mammography before 50, in normal risk women, versus the regular recommendations?

Exceptions to the Screening-at-50 Rule

And the tradeoff is there are going to be some women who will be getting breast cancers either because of their family history, their genes, or just bad luck before the age of screening. So these are uncommon, but very aggressive tumors that may start in the 20s, 30s and 40s. The difficulty for screening millions and millions of women is to come up with the recommendation that does the best good for the least harm.
So far, the trade off, the best good for the least harm looks like starting at 50. However, if you have a close family relative, a mom or a sister, who develop breast cancer before 50; if breast cancer "runs in your family", you should talk to your doctor about earlier screening mammography and maybe do genetic testing for genes that are associated with breast cancer. Breast cancer is frightening and it is literally close to our hearts. But we do best by doing the screening we should be doing. Get your mammogram at 50.
This is Dr. Kirtly Jones, and this is The Scope.

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