Sunday, May 22, 2005

Why Not Earlier Mammograms?

I received a question about why doctors don't recommend that mammograms start earlier (they usually begin around age 40). Guidelines for early detection of cancer from the American Cancer Society give some reasons for the starting age:
-For most women, the risk of breast cancer is higher with age
-There seems to be little data on the value of mammography in younger women
-Risks include false positives, unnecessary biopsies, and over-treatment
-The risk of breast cancer as a result of radiation (from the testing) may increase if women begin screening at a younger age and have more mammograms over their lifetime
-The sensitivity of mammograms (ability to detect cancers) may be less in women under 40

However, some women are at a higher risk of breast cancer than others. For example, relatives with breast or ovarian cancer, or a relative who had breast cancer before age 50 indicates a higher risk. Some women may also have BRCA1 or 2 mutations (a genetic factor) that increase their risk. African American women may also have a higher risk of death from breast cancer, although they may get the disease less than Caucasian women. For these higher risk groups, the ACS guidelines suggest beginning mammography earlier (such as at age 30), screening more frequently, and/or using MRI or ultrasound screening. For younger women without these risks, having a breast exam done by a clinican is generally recommended. Your doctor can recommend the appropriate screening based on your own risk factors.

American Cancer Society Guidelines for Breast Cancer Screening: Update 2003
American Cancer Society Guidelines for the Early Detection of Cancer, 2005
Screening Mammograms: Questions and Answers
Understanding Breast Changes: A Health Guide for All Women
Improving Methods for Breast Cancer Detection and Diagnosis
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