Mixed Messages: When Should I Get a Mammogram?

I’m 51 years old and have been having annual mammograms since 2004. My grandmother was diagnosed with breast cancer in her 40s, and as a result, every year since I turned 40, I hold my breath waiting to hear the outcome of my annual screening exam. So far, I’ve been lucky.

However, with the American Cancer Society’s [ACS] recent announcement of a change in the recommended guidelines for screening mammography, I wonder who will hold her breath and worry about a missed opportunity for early detection and who will suffer the consequences of a delay in diagnosis.

This is the third in a series of posts addressing concerns about the new mammography guidelines, which propose conducting breast screening exams later in life and with less frequency for women at an average risk for breast cancer. Following decades of preaching the benefits of using mammography to detect cancers early on, these new guidelines are sending a confusing, chilling message to women all over the country. How are we to respond when our physicians recommend yearly breast examinations and mammography screening beginning at age 40, but the new guidelines contradict these recommendations, stating that clinical breast examinations are unnecessary? How are we to respond when breast cancer advocacy groups recommend monthly self-breast exams and yearly mammograms, but the new guidelines contradict these recommendations? Who should we believe? How can we protect ourselves?

We can start by asking questions and arming ourselves with tools to support early detection. According to Kathy Schilling, M.D., medical director of the Lynn Womens Health & Wellness Institute at Boca Raton Regional Hospital in Florida, women benefit most when they are knowledgeable about their own risk for breast cancer. Working together in a team approach, Dr. Schilling’s patients undergo assessments of breast density and lifetime risk factors, and design a personalized care plan specific to each patient. Dr. Schilling believes that when it comes to mammography, “less is more.” However, in this context, “less” refers to radiation exposure, not the frequency of mammography exams. “Our facility is the first in Florida to offer GE’s 3D imaging to our patients. This latest technology provides mammograms with high resolution but low radiation, and is an outstanding tool for evaluating patients with all types of breast tissues. ‘Less is more’ means that less radiation benefits women more. However, since even digital mammography will miss nearly 30 percent of cancers, we take an additional step to support traditional screening methods with additional tools including ultrasound, MRI and Molecular Breast Imaging,” explains Dr. Schilling.

Further elaborating on the concerns around radiation exposure, Dr. Schilling explained that GE’s 3D mammography delivers the same dose of radiation as its 2D mammography. This information is important to women who need to be educated in order to make informed choices about their medical treatment. When asked whether the new guidelines will influence her practice, Dr. Schilling said that she remains committed to the need for clinical breast examinations and will continue to endorse the guidelines promoted by the American College of Radiology, which still recommends annual screening mammography for women beginning at age 40.

Next, follow the lead of breast cancer advocacy organizations such as Susan G. Komen (best known for its internationally-attended Race for the Cure events) which has publicly responded that “although guidelines may differ regarding the age at which routine screening should begin, there is agreement that mammography is the best available tool for detecting breast cancer and that women and their health care providers should decide when those screenings should begin for individuals.” With this in mind, women should look to their doctors for guidance as to when and how often mammography is appropriate for them.

Lastly, think about signing up for an online personal health record to store your important health information and records. Many health systems, insurers and private companies now offer these tools, which allow patients to view their medical history including laboratory results, radiology reports and other critical information.

How to Protect Yourself:

1. Ask questions. Determine whether you are an “average” or “high risk” patient, and ask what it means to fall into either category. Know whether your breasts are dense and what tools you should use to best screen for abnormalities in your breasts.

2. Arm Yourself with the Right Tools. Mammography is just one of many tools that should be in your arsenal. Clinical breast examination, self-breast examination, Ultrasound, MRI, Molecular Breast Imaging and Breast Density tests are among the other tools that you can use to design a surveillance program that fits your personal needs.

3. Follow the recommendations of your physician to design a breast well-health program to meet your individual needs.

4. Maintain a personal health record to provide on-demand access of your complete medical history for your physicians, anywhere, anytime. While many health systems offer online access to your medical records, the inter-connectivity of these systems is often limited to those facilities within the network. This is fine, until you find yourself in an out-of-network facility. Maintaining your own personal health records gives you peace of mind that your medical records will always be available to you and your physicians when you need them.

Coming Up Next: It’s Already Happening: Insurance Companies Refuse to Pay for Screening Mammograms for Women 40-45.

Please share your comments and shared experiences! I will continue to blog about this topic, and hope that you will join me in reinforcing the message that Womens’ Health Matters and early detection saves lives.

Prior Articles as seen in the Huffington Post:

•   She was Told That She Was Too Young For A Mammogram

•   Too Young For A Mammogram? Too Average? The Discussion Continues