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Mammograms and More: Breast Cancer Screening Guidelines

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Breast cancer screening guidelines have been widely debated over the years, resulting in numerous conflicting recommendations. It is important to be aware of the positive impact that adhering to an annual screening schedule can have on your health and on the early detection of this deadly disease.

The argument often made against early and annual screening is that it may lead to false-positive tests or overdiagnosis of insignificant, minimal or noninvasive cancers, causing unnecessary worry. Johns Hopkins breast mammographer Cecilia Brennecke, M.D., says that the American Cancer Society assesses that very few invasive cancers are overdiagnosed, and there is no evidence that invasive cancer goes away on its own without treatment. The information provided in a needle biopsy gives clarity and a plan of action.

Every Woman Is at Risk

What remains undisputed is that early detection can save lives. A National Cancer Institute study found that annual screening for women ages 40 to 84 reduces death from breast cancer by 39.6 percent, and more than one study has shown an up to 49 percent reduction in mortality when comparing screened women to unscreened women. One in six breast cancers occurs in women ages 40 to 49.

While much attention has focused on high-risk patients, such as those with a family history of the disease or with the BRCA1 or BRCA2 gene, the statistics show that screenings for women at low risk are vital. Breast cancer found during screenings was in:

  • 72 percent of women who had no family history.
  • 75 percent of women who had no personal history.
  • 60 percent of women who had nondense breasts.

“We don’t know why low-risk populations get breast cancer,” says Brennecke, “but if we only tailor the screening to the high-risk population, we will miss most cancers. Everyone should be vigilant and get a mammogram every year, with 3-D technology if possible.”

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Breast Cancer Screening Recommendations

The following are the recommended guidelines for breast cancer screening by age and risk factor:

Beginning at 16 to 18:

  • Breast self-exam

Breast cancer is one of the few cancers that can sometimes be felt. It is important to become accustomed to how your breasts naturally feel so that you can recognize any abnormalities. Breast tissue can be lumpy, but if you think you feel something abnormal, you should contact your doctor.

20 onward:

  • Annual clinical breast exam

This is typically conducted at your yearly gynecological or physical exam.

40 onward:

  • Annual clinical breast exam
  • Annual mammogram

There is no recommended age at which you should stop receiving annual mammograms, unless you have less than five years of life expectancy due to old age or other illness.

40 onward, with high-risk factors

Early Detection Means Less Treatment

Brennecke stresses that younger women are less likely to get breast cancer compared to older women, but if they do, the cancer may be more aggressive than in older women. Additionally, cancer found late requires more extensive surgery and more chemotherapy than cancer found early. This is one of the reasons why routine evaluation is recommended. With improved imaging technologies, such as 3-D mammograms or tomosynthesis, screening for cancer has become more accurate and easier than ever before.

“The end results are lower death rate from breast cancer and less treatment needed,” says Brennecke. “Screening saves lives.”

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