En español | The subject of mammograms hit the headlines again recently — with one study concluding that few lives are actually saved by yearly screenings and another finding that a majority of women get false positive results.
These latest findings, debated among doctors, friends and even celebrities, leave many women bewildered about how often — and even if — they should be screened for breast cancer. And current recommendations are of little help because they are based solely on age — a kind of one-size-fits-all approach to having a mammogram. But age alone doesn't determine who will get breast cancer, and some experts are calling for better, more detailed guidelines that will help a woman and her doctor decide on the best mammography screening schedule for her.
See also: Mammograms have high rate of false positives.
Along with age, screening guidelines should take into account a woman's other health risks — from family history to breast density — when recommending when a woman should start having mammograms and how often, according to a key study recently published in the Annals of Internal Medicine. The study pulled together the latest findings on breast cancer risks to help women and their doctors make individual decisions about when screening mammograms are needed.
So the standard one-size-fits-all approach may soon give way to tailor-made screening schedules.
Screenings should be personalized — based on a woman's age, breast density, history of breast biopsy and family history of breast cancer, says Karla Kerlikowske, M.D., coauthor of the study and a breast cancer researcher at the University of California in San Francisco. "We chose those four factors because they're prevalent and strongly associated with breast cancer risk," she says. "We wanted to make it both accurate and straightforward." The researchers also addressed the emotional effects of having mammograms because the screenings often indicate there may be cancer when there is really nothing to worry about.
- Age. The incidence of breast cancer goes up with age. According to the National Cancer Institute, a woman's chance of being diagnosed with breast cancer is:
1 in 69 between the ages of 40 and 49.
1 in 42 between the ages of 50 and 59.
1 in 29 between the ages of 60 and 69.
- Breast density. The study concludes that all women should have a screening mammogram at age 40 to check the density of their breasts.
Density is directly linked to breast cancer risk, which rises as density increases although the reasons are unclear. The size and shape of breasts don't provide a clue; density describes the relative amount of different kinds of tissue present in the breast. As breast density goes up, so does the risk of cancer. Women with extremely dense breasts have a substantially higher risk of cancer than women with mostly fatty breasts.
One widely used measure to assess density is the American College of Radiology's BI-RADS rating scale of 1 to 4. In the scale 1 is mostly fatty and 4 is extremely dense. Radiologists routinely note this information on mammogram results. Patients receive a written summary of findings and doctors get a technical report. If the summary you receive doesn't contain this information, ask your doctor where you are on the spectrum. "Second to age, breast density is the strongest risk factor," Kerlikowske says. "Women should know their breast density score."
- Breast biopsy. Women who have had a biopsy that reveals noncancerous changes in breast tissue may have an increased risk of developing breast cancer. These changes can include abnormal cells in the breast ducts or milk-producing sacs, benign (noncancerous) lumps, and benign cysts. "When you do a mammogram, you may see something that should be biopsied," says Kerlikowske. "Although it's not cancer, there's some underlying process going on that increases the risk. It's a marker." Even if the tissue turns out to be completely normal, the chances of developing cancer go up.
- Family history. A woman's risk of breast cancer doubles if she has a "first-degree" relative — mother, daughter, sister — who has been diagnosed with breast cancer. Two first-degree relatives with breast cancer increase the risk fivefold. Aunts and grandmothers don't count as first-degree relatives.
- Quality of life. Some women find more frequent screenings reassuring. They brush off any anxiety about being called back for another mammogram to check a suspicious image. They're relieved when they are found to be healthy. But other women who receive news that they may have breast cancer are highly stressed. A recent study published in the British Journal of Surgery found that some women who received false positive results felt anxious for at least a year. The emotional effect of mammography is difficult to calculate, notes Kerlikowske, but doctors should take it into account when recommending a screening mammogram.
Personalize your screening plan
A woman, consulting with her doctor, can personalize her own screening plan. She might, for example, choose to have a mammogram at age 40 and then, if she has low or average breast density and no other risk factors, wait until age 50 to start periodic screening, according to Kerlikowske. Or women over age 50 with low breast density and no other risk factors may decide on three or four years between mammograms.
An informed approach to breast cancer screening requires more than counting the candles on a birthday cake. "Women have to become more knowledgeable about their own risks so they can make their own decisions," says Marcus Reidenberg, M.D., an internist at New York's Weill Cornell Medical College.
Nissa Simon is a freelance writer who lives in New Haven, Conn.