Mammograms and Breast Health

October is Breast Cancer Awareness Month, and many women have questions or uncertainties about how to minimize their risk of breast cancer.  Most women recognize the importance of mammograms to evaluate their breasts.  However, mammograms are currently coming under a lot of scrutiny in the last few years and causing a lot of confusion for women since the U.S. Preventive Services Task Force (USPSTF) came out with it’s guidelines in 2009. Based on their interpretation of scientific data so far, in ‘average risk’ women, mammogram screening should begin at age 50, with repeat examinations every other year.  Other recommendations from this report include the elimination of self breast exam by women, the confirmation of the importance of clinical breast examination by a physician on a yearly basis, and the limitation of usage of digital mammography or MRI only for high risk patients that are younger and/or have dense breast tissue.  There has been much contentious debate on both sides between physicians of many different specialties, and it has even become a political football between Democrats and Republicans! Regardless, many physicians have reticence to change their practice because of the medical-legal environment in this country.

It’s important to stress that the USPSTF has made recommendations only, and they stress that these recommendations are for physicians to help guide their patients towards the most appropriate care they can receive.  The patient still has the ultimate decision regarding mammograms, and that with her physician’s guidance, she can make the most informed decision.

Woman contemplating surgery of the breasts should be properly informed about any surgical procedure and how to best prepare for it, including the possible utilization of mammograms. I work with my prospective patients and their primary care physicians to best inform them of risks, benefits, and alternatives to mammograms prior to a procedure. In general, however, my policy is that no mammogram is necessary in low breast cancer risk, premenopausal women, who are less than 50 years of age. This is especially true if she has very large and dense (non fatty) breasts. An alternative for women who have a family history that is significant for breast cancer, but are younger, or have dense breasts is MRI or a digital mammogram.

Once you have been properly informed of the risks, benefits and alternatives to getting a mammogram, you have a right to have a mammogram if you want or refuse.