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 Cancer Network
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 40-49 – speak to your doctor	Age under 50 – speak to your doctor	Age 45-54 – annual
50-54	Age 50-74 – semiannual	Age 50-74 – semiannual	Age 45-54 – annual
55-59			Age 55+ – can transition to semiannual if preferred
60-64
65-69
70-74
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.