How many of you are confused by the seemingly endless rounds of recommendations about breast cancer screenings? I know that I am, and so this post is designed to help answer the six essential questions that will help you decide what to do about breast cancer screening.
1. When Should Mammograms Be Started?
In general, for women without a family history of breast cancer, according to the American Cancer Society, mammograms should begin at age 40. If there's a strong family history of breast cancer, your health care provider may recommend earlier screening.
2. Are Mammograms Enough?
For many women with dense breasts, it's now thought that the addition of an ultrasound will help to detect breast cancers that can be missed by traditional mammography. Women who benefit from the addition of ultrasound are those with more breast density.
Breast density is reported as a BI-RADS classification. For women with a BI-RADS classification of 3 or higher, an ultrasound should also be offered. At the very least, women need to be informed about their breast density.
Some states have legislation in place that ensure that women are informed of their density. Right now in California, where I live, we're hoping Governor Brown signs this legislation. Here's a quick one-minute video and more information on breast density.
Some women with a family history of breast cancer or who have the BRCA-1 or 2 genetic mutations may also need to have MRI. It's best to talk to your own health care provider about your own unique situation.
3. How Often Should Mammograms Be Done?
Though many groups advocate for mammograms every two years, I agree with the American Cancer Society, which recommends that women have a mammogram every year starting at age 40.
4. When Should Women Stop Having Mammograms?
There are wide differences in opinion for this question also. Some groups only advocate screening until age 70, others until age 75. Since women are living longer now than ever before, I find myself agreeing with the American Cancer Society, which advocates annual screening as long as a woman is in good health. I have many patients in their 80s who are strong and vigorous and who plan to be around for another 20 years, and want their annual mammograms, which I'm happy to order for them.
5. Who Needs Genetic Testing for Breast Cancer?
Any woman who has a one or more family members with breast or ovarian cancer should consider genetic testing for the BRCA-1 and 2 mutations. These are associated with an increased risk of breast and ovarian cancer. Though only about 15 percent of breast cancers are hereditary, it's helpful to know if a person is at higher risk.
If possible, the person with breast or ovarian cancer should be tested to see if they carry the mutation. If that person is positive, then other family members can be tested. If the family members who had breast or ovarian cancer can't be tested, then other family members may decide to be tested.
6. Who Needs MRIs for Breast Cancer Screening?
Women with a family history of breast cancer, those with a personal history of breast cancer and those who are at higher risk from having had previous breast biopsies may benefit from the additional screening possible with MRI. Though there can be many false positives leading to biopsies and procedures, MRI can help detect early breast cancers.
For more, here's a video of an interview with Dr. Wendie Berg about breast cancer screening.
Disclosure: I have no financial or business relationships with the American Cancer Society, anyone working on breast density legislation, nor any companies working on breast imaging or genetic testing.
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