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Are Mammogram Guidelines Confusing You?

Northwell's chief of breast imaging sets the record straight on why it's never too early to start screening for breast cancer.

A blonde woman, unhooks her bra as she faces another female in an orange work outfit. The female gives a comforting smile to the woman who is standing in front of a mammogram imaging machine.
Photo credit: Getty Images
We see the back of a doctor's head and back. She is wearing blue hospital scubs, a mask and a hair covering. She is looking at a mammogram image on a lightbox on the wall.

Mammograms are no walk in the park.

Nina S. Vincoff, MD, is chief of the Division of Breast Imaging at Northwell Health, as well as an assistant professor of radiology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. She has two decades of experience in radiology, specializing in women’s imaging.

Are you unclear about when you should get your first breast cancer screening mammogram and how often you should have them? You’re not alone. Over the past few years, I’ve met so many women who are confused about this important decision. They tell me they used to think they should begin annual screenings when they turned 40—what most experts recommended in the past—but now they are unsure due to conflicting recommendations.

You may recall that in 2015, the American Cancer Society changed their recommendation and suggested that women who are at average risk for breast cancer should begin annual screenings at age 45, and then cut back to every two years starting at age 55. Soon after, the United States Preventive Services Task Force suggested women get mammograms only every two years between the ages of 50 to 74. So not only did both organizations change their guidelines, but the new guidelines are not the same. I certainly understand why many people are confused.

Despite these changes, my colleagues and I at Northwell Cancer Institute continue to strongly recommend annual mammograms starting at age 40. Here’s why:

1. Early detection saves lives.

Studies have proven that annual mammography starting at age 40 saves the most lives. That’s because while breast cancer can occur at any age, the risk noticeably increases at age 40. One-sixth of all breast cancers occur in the 40 to 50 age group, and 40 percent of all years of life lost to breast cancer are in women diagnosed in their 40s. These are women in the prime of their lives and careers, and a lot of them are mothers—so we want to pay attention and not let anyone slip through the cracks.

2. Saving lives outweighs the risks of screening.

Disparities in guidelines arose because some people gave weight to the so-called risks of screening, namely the possibility of needing additional imaging and/or a biopsy for what turns out to be a false-positive finding. (A biopsy is a procedure to remove sample cells or tissue from your body to exam it and determine the presence or extent of a disease.)

While it’s true that one out of every 10 women who are screened will need additional images in order for the doctor to make a decision, and of these women, one in five will need a biopsy, I don’t readily accept the idea that women can’t handle this level of stress. I let my patients know that 80 percent of women who undergo a breast biopsy end up not having cancer. I believe that when explained upfront, it’s something that most women can accept—that the biopsy may show no indication of cancer. But that’s a good thing! And saving lives trumps everything else.

It’s also important to note that the updated guidelines were largely based on 2D technology; we’re now moving toward 3D mammograms, which reduce the need for extra images by up to 40 percent, while increasing the detection of invasive breast cancer by up to 40 percent.

3. Early detection means less aggressive treatment and better outcomes.

Catching any cancer in its earliest stage greatly reduces the amount of treatment needed. Early breast cancer detection often means less extensive surgery, fewer mastectomies, and less aggressive or possibly no chemotherapy at all. This results in an easier recovery with less chance of side effects and complications—and a quicker return to normal life.

“An annual mammogram is beneficial for all women 40 and over because every one of us is susceptible to the disease, regardless of genetics or family history.”
Nina S. Vincoff, MD, Diagnostic Radiologist

4. It’s hard to predict who may have breast cancer.

New guidelines suggest that women who fall outside of the suggested screening age talk to their doctor and decide for themselves whether to get screened or not. But an annual mammogram is beneficial for all women 40 and over, even those who believe they are low or average risk. That’s because every one of us is susceptible to the disease, regardless of genetics or family history. In fact, 75 percent of breast cancer patients don’t have family history of the illness. And a woman in the U.S. has a one in eight risk of being diagnosed with the disease over the course of her lifetime.

5. A national consensus will probably not be reached anytime soon.

I hope that all organizations can come to an agreement on this important topic, but I don’t think it’s going to happen in the near future.  Therefore, it’s up to each individual to take a proactive approach to fighting this disease—starting with getting annual mammograms at age 40.

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Published May 29th, 2018
We see the back of a doctor's head and back. She is wearing blue hospital scubs, a mask and a hair covering. She is looking at a mammogram image on a lightbox on the wall.

Mammograms are no walk in the park.