Doctors: Women Should Begin Mammograms at Age 40

Recent trends in breast cancer detection have wavered. To perform breast self-exams, or not? To get mammograms, or not?

The worry about breast self-exams is that they may skew results into too many false-positive tests. Some who recommend fewer mammograms have suggested that over-screening leads to unnecessary invasive tests and undue anxiety.

"What we recommend is that starting at age 25-26, woman begin physically examining themselves. It's very helpful [for them] to get to know their bodies," said Dr. Mehran Habibi, an assistant professor of surgery at
Johns Hopkins Bayview Center who specializes in breast cancer. "Seeing
any changes can be very helpful; some women do develop breast cancer
in their 30s and getting to know their bodies, that's No. 1."

"For the general population, not necessarily at an increased risk, at
age 40, it's recommended that woman start getting a mammogram every year," Habibi said.

"Now with digital mammograms, the quality of the picture is very good," he said.

Previously, with analog machines, mammograms were not as effective for women under 50, Habibi said, "because their breasts are much denser and [tumors were] harder to find."

Habibi stressed that breast self-examinations should continue even as women begin receiving regular mammograms.

"Many times, it is still a patient who shows the doctor where the
tumor is," Habibi said. "A lot of times it is benign. We take a biopsy
—because you can't tell the difference otherwise—and it's OK, but
you can't let years pass by."

Other doctors, as well as the 2011 Breast Cancer Symposium of the American Society of Clinical Oncology and The American Cancer Society, echo Habibi's opinion.

Dr. Jamie Caughran, medical director of the Comprehensive Breast Center at the Lacks Cancer Center in Grand Rapids, MI, helped lead the research team for a recent study on mammography. He found that women age 40 and up should receive mammograms and also self-examine. High-risk patients should seek advice from their doctors about the ideal age to start and frequency of tests.

The Michigan study, completed this year with data from nearly 6,000 women with breast cancer, counters guidelines by the U.S. Preventative Services Task Force, which recommends generally that women get mammograms every two years beginning at age 50. The USPSTF notes that screenings should be determined on an individual basis.

Among other findings in the Michigan study:

• Breast cancer in women younger than 50 was more likely to be detected first by feel than by mammography. Of the women whose tumors were found by feel, 40 percent were younger than 50.
• Overall, 65 percent of the breast cancer cases were detected by mammography, while 30 percent were detected by feel and the other 5 percent by other methods.
• For women diagnosed with breast cancer before age 50, 49 percent of the cases were detected by mammogram. Of those, 18 percent were Stage 2, and 4 percent were Stage 3.
• For women diagnosed with breast cancer before age 50, 46 percent of the cases were detected by feel. Of those, 50 percent were Stage 2, and 17 percent were Stage 3.
• For women over 50, 81 percent of breast cancers are detected through mammography.

In 2011, ASCO predicts 230,480 new cases of breast cancer for women, 2,140 for men, and 57,650 non-invasive cases across the United States. About one in eight women will develop breast cancer, according to ASCO.

In Baltimore County, breast cancer takes the lives of an average 25.3 per every 100,000. Between 2003 and 2007, a total of 132 people in Baltimore County died from the disease, according to the National Cancer Institute.