Many of us have been or will go through the following scenario:
You go in for mammogram and shortly thereafter you get a message that something isn’t quite right and you need to go back in for a follow up.
- Your stomach turns and your heart skips a beat.
- Your mind races with wild thoughts: “Oh my god, they’ll have to operate. Oh my god, I’ll have to go through chemotherapy and radiation. Oh my god, am I going to die? Oh my god, oh my god.”
- You go online and do some “research.” But you don’t search for “my doctor wants me to come back for a second exam” but rather for the much more dire “what to do when you have breast cancer.”
- You become anxious, stressed out and distracted until you have the second exam.
According to the National Cancer Institute, about half of women screened annually for 10 years will experience a false positive. This, and my own experience, has motivated me to become better informed about mammograms and breast cancer.
Yes, women have a very good reason to be concerned about breast cancer.
- After skin cancer, breast cancer is the most common cancer among women in the USA and is the second leading cause of cancer death.
- About 1 in 8 women will develop invasive breast cancer during her lifetime.
- Breast cancer risk increases around menopause, and according to the CDC, the average age at diagnoses is 61.
The good news is that there has been a reduction in breast cancer cases and deaths over time, but what’s behind this seems to be less than certain, possibly a combination of:
- Better diet and healthier lifestyles
- Decreased usage of hormone replacement therapy (HRT)
- Decreased frequency of mammography screening rates
In looking further at what experts say on each of these areas:
- Eating well and exercising is undoubtedly a good thing to do.
- HRT use is an individual choice to be discussed with your doctor.
- The suggested frequency of mammograms continues to change.
So how frequently should one have a mammogram?
I looked at a number of sources, and although there have been much research and discussion around the topic, as well as several updates to suggested guidelines, there is still no clear consensus.
- There is, however, a trend to start later in life (45-50) and less often (semiannual versus annual).
|Approximate Age (range varies slightly by organization)||US Preventive Services Task Force||American Academy of Family Physicians||American Cancer Society||National Comprehensive|
|40-44||Age 40-49 – speak to your doctor||Age under 50 – speak to your doctor||Age 40-44 – speak to your doctor||Annual|
|45-49||Age 45-54 – annual|
|50-54||Age 50-74 – semiannual||Age 50-74 – semiannual|
|55-59||Age 55+ – can transition to semiannual if preferred|
|75+||No evidence for or against||No evidence for|
|Clinical Breast Exam||Insufficient evidence||Insufficient evidence||Not recommended||20-39, every 3 years, annually thereafter|
|Breast Self-Exam||Recommends against||Recommends against||Speak to your doctor||Awareness encouraged|
Additionally, some organizations don’t see a benefit to self or clinical breast exams. This came as a surprise to me.
But all this may change again.
Although mammogram screenings have been shown to reduce breast cancer death anywhere from 15 to 29 percent per the Mayo Clinic, the decline isn’t as much as some would expect. Mammograms seem to have:
- Increased the number of breast cancers found (and treated) at an early stage, but
- Not changed then number of cancers discovered at the advanced stages, and
- may trigger false positives in women 40-50
A new study from the Yale Cancer Center has new insight into what may be going on.
For quite a while, it has been noted that the prognosis for small breast cancers is better than for large breast cancers. This had been attributed to the fact that the cancers were caught at an early stage, but according to the recent Yale Cancer Center study, it looks like these small cancers are more survivable not because they are detected earlier, but because they are slow growing and may never have been a real threat.
It used to be thought that all breast cancers grew at a fairly steady pace, but in fact some are quite slow growing (indolent). The more aggressive cancers grow quickly and are more likely to be felt before discovered in your annual or semiannual mammogram.
We will have to wait and see what this means for recommendations on mammograms, clinical and self breast exams.
For now, what is a woman amidlife to do? For me, I plan to:
- Eat well, stay fit and try not to get so stressed out
- Understand that the breast cancer screening guidelines aren’t set in stone
- Talk to my doctor about what mammogram frequency is right for me
- Monitor my breast health
- Talk to my doctor about any changes in my breast or concerns I have
- Not panic if I have to go in for a follow-up exam
- Keep myself informed on this topic