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Mammography: Get It or Not?

Screening Mammography Best for Women Over 50
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WebMD Health News

April 23, 2003 -- Screening mammography -- women are confused about when to start having it. In their 40s? After age 50? A new report helps women sort through the data.

The report is published in this week's New England Journal of Medicine.

In it, two experts conclude that all earlier studies "do not negate the effectiveness of mammography, especially for women older than 50 years of age," writes study author Joann G. Elmore, MD, MPH, with the University of Washington in Seattle.

Women between age 50 and 69 stand to benefit most from a screening mammogram, she states in her paper.

Family history is still viewed as a woman's strongest risk factor. "All women, regardless of their age, should be asked whether they have a family history of breast cancer, ovarian cancer, or both," she tells WebMD.

At age 40, women should start talking with their doctors about breast cancer screening -- even if they have no strong family history of breast cancer, she says.

For younger women -- those in the 40-to-49 age group -- the benefit of screening mammography is smaller. Also, the risk of false-positive results is greater in younger women because they have denser breasts. This creates undue anxiety and leads to unnecessary biopsies, Elmore says.

Scheduling a mammogram right before her period starts -- the luteal phase of the menstrual cycle -- may decrease a woman's breast density, she suggests. Stopping HRT 10 to 30 days before a mammogram may also reduce the number of misleading abnormalities.

Women should take heart that a condition called ductal carcinoma in situ, which accounts for about 14% of all breast cancers diagnosed, is highly treatable, partly because of early detection through mammograms.

In fact, screening mammography often gets credit for saving lives when lives would be saved anyway, even if the cancer is detected later on, says Otis Brawley, MD, associate director of the Winship Cancer Institute at Emory University School of Medicine in Atlanta.

The big advantage: "Mammography allows doctors to find tumors when they are smaller -- and much more treatable with lumpectomy and radiation -- rather than later when mastectomy is necessary," he tells WebMD.

But he always advises women over age 50 to get mammograms, and to start earlier if she has family history.

"I really think it's a tragedy when women in their 50s, 60s, and 70s don't have mammograms at least every two years," Brawley tells WebMD.

Women need to understand their own risk of breast cancer and be ready to discuss mammography with their doctor.

"I'm a primary care doctor, and it's very challenging to adequately discuss the risks and benefits in an outpatient encounter," Elmore tells WebMD. "Women are becoming increasingly informed, and they need to be."

To determine her own risk of breast cancer, women should check the National Cancer Institute web site at http:\\bcra.nci.nih.gov\brc\.

"Women are often surprised when they find their risk is much, much lower than they realize," Elmore tells WebMD.

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