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When to Get a Screening Mammogram

How often and when to start routine mammograms is a matter of debate.
By
WebMD Feature
Reviewed by Laura J. Martin, MD

Every year? Every other year? Not until you're 50? Once you turn 40? Will the real mammography screening recommendation please stand up?

If you're a woman approaching the age of 40, you've likely been told to prepare for your first screening mammogram around the time of your big birthday and then to have one every year (in some cases, every other year) thereafter. (Of course, that's just for routine mammograms; breast lumps always require a mammogram and/or other tests to start diagnosing whether it might be breast cancer.)

But in November 2009, the U.S. Preventive Services Task Force (USPSTF) updated its screening recommendations and said that women of average risk for breast cancer could wait until age 50 to start getting mammograms and then follow up only every two years, rather than annually.

These new guidelines set off a heated debate within the medical community and don't match up with most other mammogram recommendations from major medical organizations.

The debate is still going on, leaving many women unclear about when they should schedule their mammograms.

 "We're having the scientific arguments back and forth and in the meantime, women, in a sense, get caught in the middle," says Len Lichtenfeld, MD, deputy chief medical officer of the American Cancer Society.

Your doctor can help you sort out the options. Here's the background you need.

Changing the Story

The revised USPTF mammography screening guidelines marked a sea change from the recommendations being made by nearly all major medical associations, including the American Cancer Society, the American Medical Association, and the American College of Obstetrics and Gynecology.

Although some organizations were more flexible with regard to the frequency of screening -- in some cases, every one to two years was acceptable -- women previously were advised to start mammography screening at age 40. That was also the Task Force's position in 2002, the last time it made a statement on the matter before 2009.

What fundamentally changed in 2009 was that the USPSTF came out against routine screening mammography in women age 40-49. Instead, it stated that the decision to get routine screening mammograms before age 50 should be "an individual one and take patient context into account, including the patient's values regarding specific benefits and harms."

It was widely reported, however, that the USPSTF was against screening entirely for women with an average risk of breast cancer between the ages of 40 to 49. That wasn't the case, says Diana Petitti, MD, professor of biomedical informatics at Arizona State University and vice chair of the 2009 USPSTF committee.

The actual recommendation was not communicated well, according to Petitti. "The decision about the age to start being screened at 40, 42, 44, 48, should be one that was more individualized," she says, rather than a woman's 40th birthday triggering an automatic authorization slip from her doctor to get a mammogram.

The USPSTF's other recommendations included biannual, rather than annual, mammograms for women ages 50-74. And there is insufficient evidence, the task force said at the time, to accurately assess the benefits and drawbacks of regular mammograms for women older than 75.

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