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When to Get a Mammogram?

I'm totally confused by recent medical reports providing conflicting information about when women should go for mammograms. In your opinion, at what age should women start getting them on a regular basis?

I don't blame you for your confusion. Public health authorities are at odds over this question, and the debate isn't over yet. Meanwhile, women are left in the dark on how best to take care of themselves.

The issue in question is whether women in their 40s should get routine mammograms to screen for breast cancer in its earliest stages. A National Institutes of Health (NIH) panel concluded after reviewing more than 130 studies that what benefits there were from screening women in their 40s did not justify a blanket recommendation to all women in that age group to get yearly mammograms. The panel felt that false positives requiring unnecessary biopsies, undue anxiety, and overtreatment were more likely than actual cancers.

Dissenting from that opinion is the director of the National Cancer Institute, Richard D. Klausner, MD, who said that routine mammography for women in their 40s could reduce breast cancer deaths. Officials of the American Cancer Society also disagreed, saying the panel did not go far enough in support of mammography in this age group and was further disappointed that more guidance couldn't be given to women in their 40s.

In my opinion, one of the most important things to keep in mind is that the effectiveness of a mammogram as a diagnostic technique depends entirely on the experience and skill of the person who reads it. Be sure to go to an expert. If you don't know who to call, contact the American Cancer Society at (800) ACS-2345 (227-2345). It's also my experience that mammograms do pick up tiny cancers that if left until palpable would be much more serious and life-threatening. I know several women whose lives were saved by early detection of breast cancer after a mammogram.

The downside, of course, is the amount of radiation involved. As readers of this column know, I am opposed to needless exposure to X-ray radiation. The ultimate conclusion of the NIH panel is that every woman needs to decide for herself whether to get a mammogram and at what age; this decision should be based on her family history and risk profile. I still believe that, unless you're at special risk, you can wait till you're 50, with perhaps a baseline film a little earlier.


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