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Ask the expert:
breast_cancer_ate_big.jpgI'm confused about the new recommendations about mammography. What do you recommend? 

Breast cancer is the most common cancer diagnosed in women in the United States. Because outcomes are dependent on stage at diagnosis, if the tumor is found early by a screening mammogram, lives may be saved. When and how often women should have screening mammograms is confusing as different groups that we turn to for guidelines (recommendations) offer very different suggestions. Recent news reports about new guidelines from the U.S. Preventive Services Task Force (USPSTF), a group of experts who publish guidelines about screening tests, have added to this understandable confusion.

Unlike earlier guidelines, they recommended that women at average risk of breast cancer have a first mammogram at the age of 50 instead of 40 and check mammograms every two years after that instead of yearly. They also recommended stopping mammograms after the age of 74.

This is different from their earlier USPSTF guidelines and the current guidelines from the American Cancer Society (ACS) who still recommend a first mammogram at the age of 40 and yearly mammograms after that in women who have an average risk of breast cancer. The changes are based on the concern that as breast cancer is uncommon between 40 and 49 the mammograms find very few breast cancers, but lead to complications with overdiagnosis and overtreatment. However, it is estimated that if 1,000 women have mammograms from age 40 to 50 one breast cancer related death could be prevented.

The benefit of yearly mammograms for women between age 50 and 70 is strongest and yearly mammography between these ages is strongly recommended.

There is also controversy about when to stop mammograms. The new USPSTF guidelines recommend stopping at 74 years old, but no upper limit is recommended by other groups including the ACS and recommendations are based on a woman’s overall health and life expectancy.

In general I agree with the ACS guidelines as although starting mammograms earlier and doing them more frequently does not find many breast cancers, it can save lives. However, these guidelines are based on population risk, so I also recommend personalizing recommendations by reviewing your particular risks for breast cancer (which depend on your personal and family history and characteristics) with your provider to decide on the screening regimen which is most appropriate for you.
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