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Another Voice: Cutting through the confusion over mammograms

By Ermelinda Bonaccio

Not a week goes by where someone doesn’t reach out to me to ask for guidance about when she should be screened for breast cancer. It might be a friend or relative who poses the question, the mom of one of my son’s friends or someone I just met on the sidelines of a soccer game, but my phone rings quite frequently with questions about how often to get a mammogram.

“My sister’s turning 40 next month. I told her she’s got to start getting her mammograms, but she said no, she heard she should wait. Did they change the age you’re supposed to start getting them?”
“So, I don’t need to go every year for my mammogram like I used to? Is it really OK to go every other year?”

“My mom’s 76, and she’s still getting her mammogram every year, like clockwork. Should she still be getting mammograms at her age?”

I understand why there’s confusion about mammography. There have been a lot of new studies in the last few years, a lot of high-profile media coverage and a lot of claims both ways about the benefits and risks of getting a regular mammogram.

Although at times the benefits of screening mammography have been overstated, some of these recent studies seriously distort the potential risks. I cannot help getting frustrated when these debates surface in the media, because there is consensus among the major organizations that establish guidelines for mammography – the National Comprehensive Cancer Network, American Cancer Society and American College of Radiology – that screening mammography decreases breast cancer mortality. If you look at the data closely, yearly mammography starting at age 40 saves the most lives. Although there are differences in these organizations’ recommendations, they all support women beginning routine mammography in their 40s.

Based on this evidence, this is what I tell my friends, members of my family, my patients and what I follow myself regarding whether and when to get a mammogram:

Women at average risk for breast cancer should get annual mammograms beginning at age 40.
Women at higher risk for breast cancer because of family history or other risk factors may need to begin breast cancer screening sooner, and should consult their primary-care provider or a breast cancer specialist to determine the most appropriate age to begin screening.

Women should continue routine mammography as long as their health is good and they have a life expectancy of greater than 10 years.

The core question that guides my practice is always: What approach saves the most lives? I stand behind the recommendation that annual mammography should begin at age 40. The evidence from multiple studies is that routine mammography reduces the risk of dying from breast cancer by at least 30 percent, perhaps even more. That is a striking statistic, and a tremendous opportunity the medical community has to save lives.

Good health begins with good information.

Ermelinda Bonaccio, M.D., of Amherst, is chief of breast imaging at Roswell Park Cancer Institute. She will mark 20 years of practice in the field of breast imaging next month.

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