Multiple respected experts and organizations have issued mixed recommendations regarding mammogram screening, resulting in confusion for many women. We believe that mammogram screening needs to be individualized based on the patient’s personal and family history and values. All experts who have evaluated mammogram screening agree that screening mammography in women starting at age 40 is associated with a reduction in breast cancer deaths across a range of study designs. Data from Swedish Cancer Institute shows that annual screening mammography can reduce the need for chemotherapy and more extensive surgical treatment. However, it is also clear that increased screening can lead to additional testing. Consequently, it is important for women and their providers to weigh the benefits and the risks.
The resulting confusion has made it difficult for women to take an informed role in their healthcare decisions. The current American Cancer Society and US Preventive Services Task Force recommendations are for women at “average risk” for breast cancer. Group Health Cooperative of Puget Sound has devised a simple way for women to assess their risk and decide when to get screening mammograms. Women who are 40 or older and check any of the risk factors below should have mammograms every year:
Personal History:
- Breast biopsy
- Radiation therapy to chest before age 30
- Ovarian cancer
Family history (blood relatives):
Mother, sister, or daughter with one or more of the following:- Breast cancer before age 50
- Breast cancer in both breasts
- Breast and ovarian cancer
- Three or more family members with breast cancer
- Two or more members from the same side of the family with ovarian cancer
- One family member with breast cancer and another with ovarian cancer on the same side of the family
- Two or more family members on the same side with breast cancer before age 50
- One or more family member of Ashkenazi heritage with breast or ovarian cancer
A male family member with breast cancer.
While there is still some controversy about screening mammograms for “average risk” women younger than 50 and if all “average risk” women should be screened annually or every two years, there is strong evidence to support annual mammograms for all women age 40 and older. For elderly women the decision to stop screening should be based on health status and life expectancy in the context of a discussion with their healthcare provider. Another resource for women who still have questions is the Swedish Cancer Institute High Risk Program at 206-215-6400.
