Nicole from New Jersey wrote to us about an issue that’s on many women’s minds this week. Her question: “I am a 44-year-old woman and am scheduled for my first mammogram in two weeks. Do the new recommendations mean I shouldn’t get it or that my insurance won’t pay?”
Our reply? There’s not an easy answer as to whether you should get one. Until last week, guidelines for screening were that women at average risk should get a mammogram every year starting at age 40; women at high risk due to family history or genetics were urged to start earlier and sometimes to get more frequent checks.
That changed when the U.S. Preventive Services Task Force announced last week that mammograms should begin at age 50 for most women and be repeated every two years. (If you’re at high risk for breast cancer, guidelines haven’t changed.) The task force, made up of an independent panel of medical experts, makes recommendations to the Department of Health and Human Services. Its advice influences doctors and insurance companies but doesn’t by itself change the rules.
Why the shift? For starters, screening younger women hasn’t dramatically increased the number of lives saved. While mammograms have reduced the risk of breast cancer deaths overall by about 15 percent, the risk is so low in women under age 50 that the screenings don’t save significantly more lives. Research cited by the task force estimates that to spare the life of one woman in her 40s, 1,904 women would need annual mammograms for a decade. In contrast, one life is saved for every 1,339 women age 50 to 59 who get 10 years’ worth of checks, and for every 377 women in their 60s. It’s difficult to examine research like this because if the woman in her 40s with cancer is your sister, your wife, your daughter, these statistics won’t mean much to you.
To delve deeper into the meaning of these statistics and address more about both sides of the controversy is more than we have room for here, so we are devoting a whole section of “The Dr. Oz Show” on Monday to this issue.
Mammograms are far from perfect for other reasons, too. They can miss aggressive, fast-growing cancers and have trouble spotting problems in dense breast tissue, and both challenges are more common in younger women. Younger women have a 1-in-10 chance of a false alarm — suspicious findings that scare people and trigger expensive, time-consuming and sometimes uncomfortable biopsies and other checks, yet turn out not to be cancer. About half of women in their 40s will have a false positive by the time they’ve had 10 mammograms. In addition, Danish researchers recently found that about one in three cancers detected by mammograms may be so slow-growing that they’ll never be a problem. (But two in three aren’t, so you see why there’s no easy answer here).
Does all of this mean you should skip your mammogram? Not necessarily. The American Cancer Society and other breast health groups don’t think so. More than 193,000 American women and 22,700 Canadian women will develop breast cancer, and more than 46,000 will die this year. Last week, many cancer groups came out in favor of continuing to recommend yearly mammograms starting at 40.
But before you throw your hands up in confusion, consider this: The change in recommendations may open the door to better breast health checks that are custom-tailored to you. See, these are just guidelines; they’re not hard-and-fast rules that apply to every woman. The decision about starting mammograms before 50 should be an individual one that a woman makes with her doctor — the task force itself agrees with this.
So chat with your doc about your risk factors, which include anyone who’s had breast cancer on your mother’s and father’s side or immediate relatives who’ve had breast, ovarian, pancreatic or prostate cancer before age 50; known genetic risks (a family member who’s tested positive for a breast cancer gene); or lifestyle factors that could raise your risk, such as late childbearing.
Talk with your doc about your own concerns: Would you prefer annual checks, understanding the risk for both false positives and missed cancers? Or are you comfortable with less-frequent tests? Finally, get to know your breasts. While the task force also suggested that breast self-exams don’t save lives, we think it’s a good idea that you get to know what’s normal there and what’s not. If you’re going to do a monthly breast check anyway, learn how to do it correctly.
Meanwhile, insurance coverage for annual mammograms won’t change, or at least not right away. In most states, regular screenings for women 40 and up are mandated by law and would have to be changed by state legislatures. And the good news for you is that most state legislatures move with the speed of a tricycle.
The YOU Docs, Mehmet Oz and Mike Roizen, are authors of “YOU: Having a Baby.” Want more? See “The Dr. Oz Show” on TV (check local listings). To submit questions, visit realage.com.
