It seems to be a topic that is coming up a lot in the news, and people keep asking me about when they should get mammograms, if they should get mammograms, and if there are better tests. It really is a highly discussed topic, for numerous reasons, but for years the National Cancer Institute recommendation is for women over the age of 40 to get mammograms every 1 to 2 years, and women with a strong family history you may need to start at a younger age, have them more frequently, and also have genetic testing performed.
What is a mammogram?
Well, a mammogram is basically a very low dose x-ray looking at the dense breast tissues for any changes in the tissues, that may not be able to be felt upon either SBE (self breast exam) or when your HCP performs a manual exam. It is read by a radiologist and it can show slight to small changes in the dense tissues that are best compared over time. It is usually the first choice in women who have no symptoms of anything, as it is simple, relatively cheap, and noninvasive. There are risks of false positive results based on the normal aging changes of breast tissues and false negatives, where changes are not seen on the exam.
What’s the debate?
With mammograms, it was always touted that along with a thorough physical exam by your HCP, a high-density mammogram was the best way to detect breast cancer, and detect it early. Because breast tissue is so dense, and depending on the time of the month, breasts can feel lumpy, but it is usually just due to hormonal changes. Mammograms can pick up calcium deposits in the breast, which are totally normal, but when they layer upon each other, they can look like a growth, which would require more invasive testing. This is known as a false positive. Because mammograms are very sensitive to changes but not for specific changes, there are many “false positives” which can require people to have an MRI, biopsy, or an ultrasound (all depends on the size, density, etc) and which follow-up exams is all based upon your presentation, symptoms, and the changes in your mammogram. False positive rates can range from 30% to 77%, with an average of 62% false positive in a 10 year period of screening, which puts women at risk for many unnecessary and invasive procedures. And, that is a high percentage of every woman that will have false positives! Recent research, looking at the National Cancer Institute registry, showed that women who had every other year mammogram had a lower rate of false positives around 41%. There is still a decent risk of false positives, but it is lower than annual exams. Also, they found that of the false positive results on women with annual mammograms, 9% were recommended to have biopsies based on the findings versus 4% with mammograms every other year. And, there was no real difference in diagnosis of cancer, women were still diagnosed at the same stages of cancer, whether they had annual mammograms or not.
What should I do?
You should talk to your HCP about your risks of breast cancer and the risk benefit of every other year mammograms to decrease your rate of false positives and invasive procedures. And with every mammogram, you are exposing yourself to a low level of radiation, and depending on your HCPs level of comfort with physical exams yearly, it might be in your best interest to go with mammograms every other year. So talk to your HCP, get the scoop, and do what is best for you!
Yours in Good Health