Should Women Under Age 50 Get Yearly Mammograms?
Oct. 10, 2000 -- After years of disagreements, organizations that make recommendations about who should get mammograms and how often they should get them are still bickering, leaving doctors and patients on their own in deciding what to do.
All the guidelines agree that mammograms should be performed yearly beginning at age 50, but several organizations think the breast X-rays should start earlier.
The American Cancer Society and several other organizations currently recommend that women get yearly mammograms starting at age 40. The National Cancer Institute is in slight disagreement, recommending that women in their 40s have a mammogram every one to two years. Then there is the U.S. Preventive Services Task Force, which does not recommend mammograms before age 50.
The disagreement about when to start mammograms has stemmed from lack of scientific evidence showing a significant benefit from getting a 10-year head-start on screening, as well as the possibility of harm from screening errors that indicate tumors when really there are none. However, surveys suggest that most women are willing to risk the possibility of getting a false positive result -- a test that indicates a tumor even though one is not present -- if there is a possibility that lives will be saved.
Despite all the squabbling, most women in the U.S. think their yearly mammograms should start at or before age 40, according to one survey.
And according to the director of screening for the American Cancer Society, recent studies and experience with performing mammograms in younger women appear to support starting at age 40.
In a review article in the September/October issue of CA -- A Cancer Journal for Clinicians, Robert A. Smith, PhD, says tumors found in women younger than 50 tend to progress at a faster rate and change from less dangerous tumors to more deadly tumors faster than tumors found in older women.
Smith says until there are better methods of predicting which younger women will and will not get breast cancer, the best strategy is annual mammography starting at age 40.
But others, like Karla Kerlikowske, MD, say they do not offer mammograms to women in their 40s unless they have a family history of breast cancer or request to be screened early.
She says she tells women that they should have a total of 10 mammograms in their lifetime -- from age 50 to 59 -- to maximize the chance of benefit and minimize the risk of harm.
"I think what all this really says is that if there is this much argument and confusion and it's not that clear-cut [that mammograms are a good idea for women in their 40s], then it's not that great a test," saysKerlikowske, an assistant professor of medicine, epidemiology, and biostatistics at the University of California, San Francisco. "It just shows that it is a toss up and that there shouldn't be mass screening for everyone [under age 50]."
In addition, she says, another reason many experts disagree with the American Cancer Society and other advocates of early mammograms is because along with the early tests, they also want women to keep getting the breast X-rays for the rest of their lives. Kerlikowske says that suggestion is "ludicrous" because other health concerns, namely heart disease, become more of a risk to a woman's life than breast cancer as a woman ages.