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Studies Point to Reasons for Mammograms in 40s

Women With Dense Breasts or a Family History of Breast Cancer May Want to Consider Screening in Their 40s

Understanding Personal Risk

Researchers were also careful to stress that the pair of studies was meant for policy makers, not for individual women to use to try to discern their own risk.

"These data do not present recommendations on what women should or shouldn't do," says Diana Buist, PhD, a senior investigator at Group Health Center for Health Studies in Portland, Ore.

"This should not be used for adding your risk as an individual person," Buist says, adding that it's better to talk through issues of risk with your doctor before deciding on whether to get a mammogram.

"Mammography is not a perfect tool," Buist says. "It just doesn't work as well in younger women. Because it doesn't work as well, it means that there are harms and benefits that are important for women to understand."

Other experts found the studies frustrating because they stopped short of offering any new advice.

"I'm not sure where that leaves women in their 40s who aren't sure what to do," says Kathryn Evers, MD, director of mammography at Fox Chase Cancer Center in Philadelphia. "I think the people who know they have bad family histories know they want mammograms, and it's not a discussion. I think for everybody else it's a very difficult problem."

"Most women who get breast cancer don't have these risk factors. What do you do if you're a 45-year-old woman with kids and you're scared?" Evers says. "It is ivory tower research in a lot of ways, and it's very hard to get a good practical message out of it, for me."

Advice to Women Considering Mammograms

Until there are better screening tools to replace mammography, Evers say there are two things women can do to better use the test.

The first is to find a good doctor who will carefully discuss the benefits and risks.

Drawbacks of mammography include false-positive results, radiation exposure, false reassurance, pain, over-diagnosis -- meaning the diagnosis of a tumor that isn't necessarily dangerous -- and overtreatment.

Studies show that about half of women who get an annual mammogram for 10 years starting at age 40 will have at least one false-positive result that leads to a cancer scare.

The benefits of mammography include early detection. One review suggests that mammograms have reduced breast cancer deaths by 15%.

If you do decide to get tested, Evers says it's smart to seek out a radiologist who is a dedicated mammographer, which means that they only read mammograms.

Mammographers are specialists, and studies show they are more likely to catch cancer when it's there and correctly rule it out if it's not. They're also less likely to order unnecessarily follow-up tests.


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