Forty is Still the New 40

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Many breast cancer experts say it's the right age to begin mammograms

By Laura Shin

Dr. Dara Richardson-Heron was diagnosed with breast cancer at the age of 34. She said it was breast self-awareness and a mammogram that saved her life.

"My doctor initially said, 'You're too young to get a mammogram and you're too young to have breast cancer,' but I insisted on having a mammogram and it turned out that I had breast cancer," said Richardson-Heron, a 14-year cancer survivor and CEO of the Greater New York City Affiliate of Susan G. Komen for the Cure.

There is no universal set of guidelines when it comes to mammograms. In fact, changes to some mammogram guidelines in recent years have stirred debate, leaving many women confused about when and how often they should get mammograms.

"I think the confusion has led to a complacency among women," said Richardson-Heron. "Since they don't know what to do, many of them are just not doing anything. My concern is that these women will be diagnosed later, and a later diagnosis is far more difficult to treat."

Richardson-Heron recommends women begin receiving annual screening mammograms at age 40-earlier if the woman has higher risk factors such as a strong family history of the disease, like she did.

The American Cancer Society, The American College of Obstetricians and Gynecologists, The Mayo Clinic and Susan G. Komen for the Cure all currently support a set of guidelines that recommends routine mammograms beginning at age 40 for women at average risk.

But in 2009, the U.S. Preventive Services Task Force, a group of health experts that reviews research and makes recommendations on preventive health care, revised their guidelines to include a recommendation that screening mammograms should be done every two years beginning at age 50 for women at average risk.

The task force reported that the benefits of screening mammograms do not outweigh the harms for women ages 40 to 49. Potential harms include false positive results that could lead to unneeded biopsies along with anxiety and stress.

There are, however, some issues with the task force's findings, said Dr. Laurie Margolies, chief of breast imaging at Mount Sinai Medical Center.

"The studies they looked at were very old, and there are several problems with that. One is that they're all on analog mammography," Margolies said.

Analog mammography takes images on film, whereas most mammogram machines sold now are digital, she said. Digital mammography finds more cancers in younger women than analog.

Even the disputed report emphasized it was not suggesting that women ages 40 to 49 not have mammograms at all, but rather that they should not be done routinely and should be conducted based on a woman's values regarding the risks and benefits of mammography.

Margolies acknowledges that there are instances of false positives in screening mammograms and there are some associated harms, but she believes the risks do not outweigh the benefits.

"Anxiety is painful and having a benign biopsy is not great, but I would rather have a benign biopsy than die from breast cancer," she said.

While women in their forties have a lower overall incidence of breast cancer, younger women tend to have more aggressive types of breast cancer, said Richardson-Heron.

"If you wait to diagnose these women, you potentially decrease the chance of detecting the cancer before it is spread to different parts of the body," she said.

"The most compelling stories are the women who tell me that they were diagnosed on their first screening mammogram at age 40, so I shudder to think what would've happened to them if they had waited to age 50 to get a mammogram," she said.

In addition to beginning regular mammogram screenings at age 40, it is also important to get a mammogram every year as opposed to every other year, said Mary Gemignani, MD, a surgeon at Memorial Sloan-Kettering Cancer Center.

"Yearly screening may potentially decrease the risk of interval cancers, cancers that occur between screenings, which occur more commonly in younger women," Gemignani said.

Mammography has been proven to save lives, said Margolies.

"The death rate from breast cancer has decreased 30 percent since 1990, and that's predominantly due to mammography screening," she said.

Richardson-Heron encourages women to know their family history and to be able to identify changes in their breasts. As far as mammograms go, she hopes women can move toward one set of guidelines.

"I want to cut through the confusion altogether. Don't even think about it. Get a mammogram at age 40 or earlier if you have any risk factors that make you more likely to get diagnosed with breast cancer," she said.

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