Age to Begin Breast Cancer Screening…Which is Right For You?
October is breast cancer awareness month. A fine time to discuss breast cancer screening. Of course, it is important to mention how lifestyle can really impact your risk for cancer of any type in addition to medical and mental health and well being: regular exercise, a healthy diet loaded with colorful vegetables and fruits, anti oxidants, self care and stress relief and avoiding smoking/secondary smoke.
General awareness of breast tissue is something that we all can do on a regular basis starting at any age. But let’s talk about formal screening. Mammogram is the standard of care for breast imaging as, compared to all other modalities (ultrasound, thermogram, MRI, etc), it has the most consistency in detection and is most affordable and least time consuming. It has become so confusing about when to initiate mammography as part of the routine screen as there are a variety of professional recommendations available: as early as age 40 or as late as age 50. Which is right for YOU?
Earlier screening at age 40 is recommended by ACOG (The American College of Obstetrics and Gynecology) and the NCCN (National Comprehensive Cancer Network) for both low and high risk women. The rationale being the earlier the detection, the sooner the treatment, the better the prognosis.
A mammogram has the potential to detect a tiny lesion or precursor that cannot be felt on self or clinical exam.
On the other hand, the younger you are, the more dense your breast tissue is likely to be. This can make detection difficult, and a lesion could be missed. Because of this density limitation to mammogram interpretation, as well as other epidemiologic factors, initiating mammography at age 50 has been recommended by the USPSTF (US Preventative Services Task Force). The ACS (American Cancer Society) takes the middle approach, and recommends age 45.
There are pros and cons to imaging which is why there are so many opinions about when to start. Some of the controversial issues are:
Amount of radiation over time
Stress of a false positive and the need to return for more imaging
Whether or not early detection leads to over treating
Effect on disease outcome
The breast density is another factor that can determine screening frequency and breast cancer risk. 50% of women will have either “extremely” or “heterogeneously” dense breast tissue. This is a radiologic interpretation and not something someone would know prior to their first mammogram. It is associated with the amount of glandular and structural components relative to the amount of fat in the tissue. More dense and glandular tissue will be harder to see through on the X-ray.
This density is concerning as it is felt to increase the overall risk of breast cancer (though it is unclear if this is due to biological activity vs limitations in detection). If you do have dense tissue, then having “tomosynthesis” or 3D imaging and/or adding ultrasound to the screen may be beneficial and can be considered.
Other factors that may encourage earlier screening:
Early age of your first period
A first pregnancy over age 30
No pregnancies/lactation
If you have a family history (especially if mother or sister)
A known genetic risk
Once mammogram is initiated, it is recommended every 1-2 years depending on the initial results, risk factors, age and individual preference.
Of course, as mentioned above, regular awareness (as opposed to a formal type or style of self exam) is best, and if you ever find anything of concern that does not seem to resolve, contact your provider, even if you recently had a normal mammogram!
Happy October, and let us know if you are due for, or interested in a conversation about your mammogram!
