Should You Still Get Mammograms?

Nicole from New Jersey wrote to us about an issue that's on many women's minds this week. Her question: "I am a 44-year-old woman and am scheduled for my first mammogram in 2 weeks. Do the new recommendations mean I shouldn't get it or that my insurance won't pay?"

Our reply is: There's no easy answer to whether or not you should get one. Until last week, guidelines for screening were that women at average risk should get a mammogram every year starting at age 40; women at high risk due to family history or genetics were urged to start earlier and sometimes to get more frequent checks.

That changed when the U.S. Preventive Services Task Force (USPSTF) announced last week that mammograms should begin at age 50 for most women and should be repeated every 2 years. (If you're at high risk for breast cancer, guidelines haven't changed.) The USPSTF, composed of an independent panel of medical experts, makes recommendations to Department of Health and Human Services. Their advice influences doctors and insurance companies but doesn't, by itself, change the rules.

Why the shift? For starters, screening younger women hasn't dramatically increased the number of lives saved. While mammograms have reduced the risk of breast-cancer deaths overall by about 15%, that risk is so low in women under age 50 that the screenings don't save significantly more lives. Research cited by the task force estimates that to spare the life of one woman in her 40s, 1,904 women would need annual mammograms for a decade. In contrast, one life is saved for every 1,339 women age 50 to 59 who get 10 years' worth of checks and for every 377 women in their 60s. It's difficult to examine research like this because if the woman in her 40s with cancer is you, your sister, your wife, or your daughter, these statistics won't mean much to you. To delve deeper into the meaning of these statistics and address more about both sides of the controversy is more than we have room for here, so this Monday we are devoting a whole section of The Dr. Oz Show to this issue.

Mammograms are far from perfect for other reasons, too. They can miss aggressive, fast-growing cancers and have trouble spotting problems in dense breast tissue, and both challenges are more common in younger women. Younger women have a 1 in 10 chance of a false alarm -- suspicious findings that scare people and trigger expensive, time-consuming, and sometimes uncomfortable biopsies and other checks, yet turn out not to be cancer. About half of women in their 40s will have a false positive by the time they've had 10 mammograms. In addition, Danish researchers recently found that about 1 in 3 cancers detected by mammograms may be so slow growing that they'll never be a problem. (But 2 in 3 aren't, so you see why there's no easy answer here).

Does all of this mean you should skip your mammogram? Not necessarily. The American Cancer Society and other breast-health groups don't think so. More than 193,000 American women and 22,700 Canadian women will develop breast cancer, and more than 46,000 will die this year. Last week, many cancer groups came out in favor of continuing to recommend yearly mammograms starting at 40.

But before you throw your hands up in confusion, consider this: The change in recommendations may open the door to better breast-health checks that are tailored to you. See, these are just guidelines, they're not hard-and-fast rules that apply to every woman. The decision to start getting mammograms before 50 should be an individual one that a woman makes with her doctor -- even the task force agrees with this. So chat with your doc about your risk factors, which include anyone who's had breast cancer on your mother's and/or your father's side; immediate relatives who've had breast cancer before age 50 or ovarian, pancreatic, or prostate cancer; known genetic risks (a family member who's tested positive for a breast cancer gene); or lifestyle factors that could raise your risk, such as late childbearing. Talk with your doc about your own concerns. Would you prefer annual checks, understanding the risk for both false positives and missed cancers? Or are you comfortable with less frequent tests? Finally, get to know your breasts. While the task force also suggested that breast self-exams don't save lives, we think it's a good idea that you get to know what's normal and what's not. If you're going to do the monthly breast checks anyway, learn how to do them correctly.

Meanwhile, insurance coverage for annual mammograms won't change, at least not right away. In most states, regular screenings for women 40 and up are mandated by law and would have to be changed by state legislatures. And the good news for you is that most state legislatures move with the speed of a tricycle.