Halloween past

Mammograms--when & how often should you get one

It is great timing for me that this article came to my attention. Not only is it Breast Cancer Awareness month but it also happens to be time for my annual exam. 

I met a new provider who specializes in Women's Health. We spoke about my confusion regarding how often I should get a mammogram. I know I am not alone when I say there isn't a woman out there that would rather do anything else then stand at the imaging machine and have their body parts squeezed and handled. In short, the doctor gave me her recommendation and I left the office with prescription in hand. 

Now I have to decide if I should or should not schedule the test. I want to make an informed decision and choose wisely. I am going to consider the information posted below, research a little more, and consider my personal situation before deciding to greet the big, cold machine once again. 

When to Get a Mammogram

Consumer Reports untangles all the conflicting advice about when 

to start getting them, and how often to have them done

Consumer Reports / By Catherine Roberts / October 01, 2016

Women have been urged for the last 50 years to have regular mammograms. So you probably think that by now experts agree on the best way to do that. They don’t.

In the past year, the American Cancer Society and the U.S. Preventive Services Task Force came out with new advice, and the American College of Obstetricians and Gynecologists responded by reaffirming its old recommendations.

The three groups disagree on some key questions. When should you start screening? How often should you undergo mammography? At what age should you stop, if ever? They also have different takes on the benefits of clinical breast exams, or having a doctor manually examine breast tissue for lumps or other possible signs of cancer.

In the face of such inconsistent advice, what should you do?

First, don’t use the squabble as an excuse to skip breast-cancer screening. “Yes, the groups differ on some particulars, but they agree on this: Regular screening saves lives,” says Consumer Reports’ chief medical adviser, Marvin M. Lipman, M.D.

And while our experts lean toward the task force’s more conservative approach to breast-cancer screening—mammograms every other year, starting at age 50—they acknowledge that personal preference matters, too. “Women need to understand the evidence, and they should consider their own cancer worries so they make informed choices that are right for them,” Lipman says.

The questions below summarize the positions of the three groups, as well as our take. First, we discuss the other factors you should consider when choosing your breast-cancer-screening strategy.

Weigh the Benefits and Harms

Breast-cancer experts all look at essentially the same evidence, and all want to help women. So how do they end up with such different advice?

One reason is that some of them focus more on the benefits of screening while others are more concerned about the possible risks. Your approach also depends on how you balance those two issues.

The benefits of the test are obvious: fewer deaths from breast cancer. The American Cancer Society, for example, in its new recommendations points to research involving hundreds of thousands of women showing that regular screening has cut breast-cancer deaths by 35 to 50 percent.

The risks of breast cancer screening, while less familiar to many women and even some doctors, are of increasing concern to many experts. Here are the two main ones for you to consider:

• False alarms. Mammograms often cause false positives, or results that initially seem worrisome but prove to be harmless after follow-up tests. For example, a recent review by the task force found that 42 percent of women who get screened every two years for 10 years starting at age 50 will have at least one false positive mammography. Getting screened every year makes it more likely that you'll experience a false alarm, as does starting in your 40s. False alarms are worrisome not only because they can cause needless anxiety, but also because they can lead to more mammograms, which expose you to more radiation, and sometimes biopsies, which can cause infection.
• Overtreatment. Some cancers detected by mammography and then treated are unaggressive tumors that would have never harmed a woman. That's a problem, because treating those cancers exposes women to the potential harms of cancer therapy—surgery, chemotherapy, radiation, and the stress of a cancer diagnosis—with any benefits. While it's hard to know exactly how often that happens, the task force estimates that at least one in eight tumors detected by mammography are unaggressive ones that would never spread, and that for every woman whose life is save by mammography, two or three will be treated unnecessarily.

Factor In Your Risks

Your approach to breast cancer screening can depend not only on how you balance those risks and benefits but also on your chance of developing breast cancer, based on your personal and family health history.

The greater your risk, the more aggressive you may want to be by, for example, starting at age 40 or 45 instead of 50, or getting screened once a year instead of every two years.

What puts you at greater risk? Here are some of the most important risk factors:
• A family history of breast cancer.
• A personal history of noncancerous breast conditions, including atypical hyperplasia or dense breasts.
• Menstrual periods that started before age 12 or continued after 55, or not having a child before 30.
• A history of hormone replacement therapy.
• Obesity, smoking, or excessive alcohol consumption.
• A history of multiple chest X-rays to diagnose, for example, pneumonia or an injury.

4 Key Questions to Consider

Below are the key questions to think about when considering your approach to breast cancer screening, along with the positions of leading health groups on each issue, plus our advice.

1. When Should You Start Screening?

American College of Obstetricians and Gynecologists: 40
American Cancer Society: 45
U.S. Preventive Services Task Force: 50
Comments: Breast cancer becomes much more common after age 50, and starting sooner increases the chance of having false alarms and possibly unnecessary treatment. On the other hand, cancers that develop before menopause tend to be more aggressive, making it more important to catch them early.
CR's take: The more risk factors you have for breast cancer, the more reasonable it is to start getting the exams in your 40s.

2. How Often Should You Have a Mammogram?

American College of Obstetricians and Gynecologists: Every year.
American Cancer Society: Every year from 45-54, then every two years.
U.S. Preventive Services Task Force: Every two years.
Comments: Breast cancer that appears before menopause tends to spread faster. But frequent tests make false alarms and unnecessary treatment more likely.
CR's take: If you opt to screen in your 40s because you are at high risk, annual tests make sense, switching to tests every other year when you reach age 50 or so. People who start screening in their 50s may be better off with testing every other year.  

3. When Should You Stop?

American College of Obstetricians and Gynecologists: Women 75 or older should talk with their doctor about whether testing makes sense for them.
American Cancer Society: Continue as long as you have a life expectancy of 10 or more years.
U.S. Preventive Services Task Force: 74
Comments: There's little hard evidence about the benefits of breast cancer screening in women 75 and older. While researchers know that about a quarter of breast-cancer deaths occur in women over that age, they also say that the older and sicker you are, the less likely it is that mammography will extend your life.
CR's take: The Cancer Society’s advice to factor in your overall health and life expectancy makes sense. A woman already diagnosed with a different kind of cancer or dealing with another serious health problem such as COPD or heart failure might want to focus more on managing those problems; someone in good health, on the other hand, might prefer to continue screening, especially if she has risk factors for breast cancer.

4. What About Breast Exams?

American College of Obstetricians and Gynecologists: Every year starting at 19.
American Cancer Society: Not recommended.
U.S. Preventive Services Task Force: Not enough evidence for or against to make a recommendation.
American College of Obstetricians and Gynecologists: Every year starting at 19.
American Cancer Society: Not recommended.
U.S. Preventive Services Task Force: Not enough evidence for or against to make a recommendation.
Comments: Though checking your breasts for lumps or having your doctor do it may seem sensible, little research backs up the practice. Instead, it may create anxiety and lead to needless follow-up tests.
CR's take: They make most sense for women at high risk. And if you notice something abnormal, tell your doctor.

Click for more info about a variety of screenings: 

www.consumerreports.org / www.consumerhealthchoices.org / www.choosingwisely.org/