Mammogram Confusion - When Should I Do My Mammogram?

When do I start getting mammograms and how often should I get them?

When should I start getting mammograms? 

While many doctors say that 40 should be the starting age for mammograms, not everyone is on the same page. The American Cancer Society recommends that women should have their first mammogram at age 40 and then every year following. The U.S. Preventive Services Task Force (USPSTF) recommends starting at age 50 and then every two years. "The problem is that the younger you are, the more dense your breasts," says Sara Gottfried, MD, an obgyn in San Francisco and author of The Hormone Reset Diet. When you start screening at a younger age, you are balancing the risk of the procedure—radiation and false positives, as well as false negatives due to dense breasts—versus the benefits of earlier detection." 

Breast anatomy

Can I figure out what my breast cancer risk is?

Yes, kind of. Risk is most commonly calculated using the Gail Model, which will tell you your 5-year risk of developing breast cancer and your lifetime risk. But it won't tell you when to start getting a mammo or how often to get it. There's currently no clear-cut way to do that. But research being done right now might lead to a future paradigm for weighing the relevant risk factors:

• Carriers of the BRCA1/BRCA2 genes 
• Having a mother or sister with breast cancer 
• Having your first period before 12 
• Older than 30 for first baby 
• Over 55 when starting menopause 
• Past or current use or oral contraceptives 
• Those who drink 2 to 5 alcoholic beverages a day 
• Dense breasts on mammogram 
• Greater bone density 
• History of a benign breast biopsy 

Angelina Jolie done two mastectomy due to discovery of BRCA gene carrier

Can I lower my risk for breast cancer? 

Yes. The following "protective factors" are associated with a lower risk of having breast cancer, says Jan R. Penvose-Yi, MD, from Tri-City Medical Center in San Diego, CA:

• Regular exercise
• Breastfeeding 
• Having several children 
• Keeping a healthy BMI 
• Having ovaries removed before age 35 

Breast feeding reduces the risk for breast cancer

What's this about dense breasts and mammograms? 

"Having dense breasts means that on a mammogram at least 50% of the breast tissue appears white," says Maggie DiNome, MD, director of the Margie Petersen Breast Center at John Wayne Cancer Institute at Providence Saint John's Health Center in Santa Monica, CA. 

"That means a small breast cancer, which would also be white, might hide in those dense areas of tissue. It's like trying to find a polar bear in a snowstorm." Adding a second type of screening can overcome the limitations of a mammogram. 

"In addition to mammograms, there are further screening tools for dense breast tissue such as Tomography and the Automated Breast Ultrasound (ABUS). These are designed specifically for women with dense breast tissue," says Sonja L. Cerra-Gilch, MD, section chief of breast imaging and intervention at Aria Health.

Do dense breasts get less dense over time?

Yes, according to Claudia Mason, MD, a board member of Susan G. Komen South Florida. Thus, it's sometimes easier to detect cancer on mammograms as you age. This is one of the reasons some doctors believe in starting mammograms at age 50. If your breasts continue to be dense after menopause, you should be monitored closely by your doctor, says Wulf H Utian, MD, medical director of The North American Menopause Society.

Sp if I do have cancer, how likely is a mammogram to actually detect it?

The older you are, the more likely it is to successfully find cancer. "Randomized trials have shown that the sensitivity of mammography and clinical breast examination is higher in older women," says Penvose-Yi. "It has been estimated that mammography detects about 73% of breast cancers in women in their early 40s and 85% of breast cancers in women in their early 60s."

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