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Radiologists say mammograms should start at 40
November 29th, 2011
12:01 AM ET

Radiologists say mammograms should start at 40

When the U.S. Preventive Services Task Force recommended in 2009 that routine breast cancer screenings should begin at age 50 instead of 40, controversy ensued about the benefits of screening for breast cancer and the age a woman should have her first mammogram.

Now a new study, presented at the Radiological Society of North America's annual meeting in Chicago, found that women between the ages of 40 to 49 do have a high rate of developing breast cancer even if they don't have a family history of the illness.  

The study authors believe their results support the recommendation that annual screening mammograms begin at age 40, which other organizations like the American Cancer Society and American College of Obstetricians and Gynecologists also endorse.

The study looked at patient's records from the database at the Elizabeth Wende Breast Care clinic in Rochester, New York, over a 10-year period. (2000-2010) They found 1,071 of more than 6,000 patients were between the ages of 40-49. Of those, 373 patients were screened for breast cancer.

The researchers found 144, or 39 percent, of those women had a family history of breast cancer, while 228 (61 percent) did not, with one patient whose history was unknown.

"There's been a lot of talk about who should get mammograms, especially the 40 age group, and we found these women were indeed being diagnosed with breast cancer," said Dr. Stamatia Destounis, lead author of the paper and a doctor at the breast care clinic. "And even worse, many of the cases had spread to the lymph nodes, which means early detection is important."

The data showed invasive cancer was diagnosed in 64 percent of cases presenting without family history and 63 percent with family history. The lymph node metastatic rate was similar, at 29 percent without and 31 percent with family history.

"Family history does not seem to impact the rate of invasive disease in this particular patient group," Destounis said. "Which leads us to believe that women, even those who don't have a family history, could greatly benefit from a mammogram beginning in their early forties."


soundoff (36 Responses)
  1. woman6

    No. There is too much exposure to radiation. Don't do it.

    November 29, 2011 at 08:33 | Report abuse | Reply
    • noname

      No. There is not enough early detection. I am doing it.

      November 29, 2011 at 09:14 | Report abuse |
    • Jennifer

      My 42 year old sister was diagnosed last year with stage IV breast cancer. I have lost two aunts (each side of family) to breast cancer. I had my first mammogram Jan 2011 and I'm only 38. Six months after that I had my first MRI. By the grace of God I am free and clear. I will continue to have both done. If women don't become proactive with their health we will continue to lose our mother, aunts, cousins, nieces, daughters, sisters and even our men.

      November 29, 2011 at 11:06 | Report abuse |
    • wsc

      No. You go ahead and avoid it, but by the time mine was found, it had indeed spread to my lymph nodes. Had I waited, I'd be dead now. I'll take the radiation of a mammo over the 6 weeks of radiation treatments ANY TIME.

      November 29, 2011 at 12:48 | Report abuse |
    • No name

      My breast cancer was detected when I was 46 by a mammogram, and it was so far back in my breast, nobody could feel a lump. It was only picked up on film.

      November 29, 2011 at 17:36 | Report abuse |
    • angrynotmad7

      I am 55 and I have never had a mammogram. Why........its the radiation that causes cancer not the cancer itself. My advice to anyone who believes in a healthy life style. Its about going green. Anything green is alkaline and cancer does not thrive in this environment. Anything that is acid is where cancer thrives.........so you can be choosey what to eat. Eat smart and be smart. Has anyone noticed through the years the increase of breast cancer? Figure it out........Tell me.........what man would have his testicles radiated? Think again...........You would think after all these years they would of found a cure for cancer.....and the reason this country didnt , its because it brings in big money, its a money making business, nothing more. Also, there has been men who found cures for cancer.....look it up on the computer. The Gerson Therapy, Berzinski is another........and read what happen to the men who wanted to make people well without chemo, radiation . Its all because of our diets. CHECK IT OUT...........:)

      November 30, 2011 at 00:41 | Report abuse |
    • Justme

      You're "mad" all right. But not in the way you believe you are.....

      Not only that, you're ignorant.

      November 30, 2011 at 07:18 | Report abuse |
  2. Sister

    What about screenings for younger women? My sister died of Breast Cancer at age 40 if her screenings started earlier she may be alive. Because of her illness the rest of my family started screenings early. Now I have a 34 year old sister diagnosed with Breast Cancer. The only reason her screenings started so young was because of our family history. There was no family history when my older sister was diagnosed at age 37 and that is why she died.

    November 29, 2011 at 09:18 | Report abuse | Reply
    • Sarah

      i was diagnosed at 26 and my doctor told me I would have been dead by my baseline at age 40. If I ever have a daughter her screenings will start at age 16. There is a much lower risk of radiation exposure now compared to years ago so I don't see how earlier screenings could be bad. I also had no family history and no genetic mutation. I'm sorry to hear that your sister passed away from her breast cancer. There should be more focus on the younger women being diagnosed because it's this group that has the higher mortality rate because their cancers are more advanced by the time they are discovered.

      November 29, 2011 at 10:31 | Report abuse |
    • angrynotmad7

      Her life style and diet played a big role............my husbsand is living proof of living without cancer. He was diagnosed with a tumor on his kidney, increase of white blood count, having leukemia. Well, the tumor gone and his cell count came down from 32 thousand to 12 thousand and the tumor is gone all because he takes these suplements and eat a diet rich in greens. He did away with all meats.........this was 2 years ago, so consider what i said..........gerson therapy and Dr. Berzinski. Do hope your sister gets well..............SMILES

      November 30, 2011 at 00:48 | Report abuse |
    • Justme

      You don't know anything about her sister, you nut. Get an MD and maybe you'll have something to say about what causes cancer.

      November 30, 2011 at 07:19 | Report abuse |
    • consensus

      I read about burzinski and gerson. They're both quacks.

      November 30, 2011 at 21:22 | Report abuse |
    • Kuldip

      I did not play the game this year, but I was "invited" last year to play by a woman whose mom (a friend of mine) had braset cancer. My friend's daughters live with the threat of that due to heredity issues everyday. At the same time, another younger woman I know, 24, was diagnosed with braset cancer the same week the game hit facebook last year. She was angry about the game. (Obviously not 5-years-cured, but after a year of medical rigor, she's clear right now.)I don't know that there's an absolutely right or wrong side here.Any time one talks about an issue it raises awareness in ways we cannot measure. If one man saw that and encouraged his wife to do a self-examine or go for a mammogram, it might have changed one life, and right there it's worth it. Game or not.And you're right, we need to decide what to do with our dollars and look into how much money goes where. I irritated the first friend I mentioned above when I opted out of donating to a braset cancer walk she was in because the organizers where making big bucks off the walkers.My mom died of heart disease at 59, more women die of that than braset cancer, so I tend to send my dollars in that direction–but I don't wear red on given days. I guess I'm not a joiner...Truly though? This post doesn't sit well with me. I'm not sure why. Maybe it's the Tiny Prints mention. Maybe it's the preachy tone. Maybe it's the jumping on the bandwagon when you see it as a high horse that needed mounting.But it's raising awareness too, so I can't argue much even if I don't fully agree.

      March 5, 2012 at 22:26 | Report abuse |
  3. Sara

    No mention of breast thermography, interesting. Great test no exposure to radiation, uses infra red, detects cancer cells before a mammogram, okay for any age women, approved by FDA since 1986. Why no mention of this test? We know why. Cost without insurance is less than $300 inclusive of report. How much does a mammogram cost? Look it up for yourself http://www.breastthermography.com/. Always remember, you must take charge of your health. What they suggest isn't always best and their are usually safer options.

    November 29, 2011 at 10:51 | Report abuse | Reply
    • Justme

      Nope. The reason is because it is not nearly as effective as mammography.

      November 30, 2011 at 07:20 | Report abuse |
    • Sara

      Justme,

      You are 100% wrong, has nothing to do with that. Follow the money trial. Cancer is a MONEY MAKING business.

      November 30, 2011 at 11:09 | Report abuse |
    • consensus

      What's a money "trial"?

      You know, you'd don't have to have perfect grammar to post on some blog, but if you expect to escape ridicule when you make posts that are full of conspiracy theories and then can't write your way out of a paper bag, you're living in lala land.

      November 30, 2011 at 19:01 | Report abuse |
    • Cynthia

      I chose to have a thermography. It was $120 for a session. Fortunately, I came back low risk for cancer, but the test did catch my thyroiditis. I highly recommend thermography, even if you do get regular mammograms. It's a great way to have extra piece of mind at a low cost, with no radiation risk.

      December 1, 2011 at 12:02 | Report abuse |
    • consensus

      "Piece of mind"? Oh, brother. You and Sara are equally equipped.

      December 1, 2011 at 19:36 | Report abuse |
  4. Dr. Mike

    This is a VERY complex issue for a small discussion board. I have a few points to contribute:
    -The USPSTF reports that screening mammography in women 40-49 DOES save lives by detecting cancer. They changed their recommendation on the basis that much fewer women die from cancer during this age group and approximately 1904 mammograms would be needed to prevent one breast cancer death. Given the high number of false positive mammos (abnormal findings that turned out to NOT be cancer) due to dense breast tissue, unknown risk of breast radiation, and stress associated with abnormal screening, they changed the recommendation.
    -You can screen women who are 20-29 and 30-39 and find cancer, even in those without family history of breast cancer. The number of women needed to screen to find one cancer is tremendously high. The goal is to find the perfect time to screen that maximizes benefits to patients and minimizes harm.
    -Regardless of your threshold, there is BIAS from organizations like the Radiological Society of NA and the American Cancer Society who stand to gain from increased screening, testing, and treatment. Sad, but true. The USPSTF has no incentive to earlier testing.

    That said, I can see both sides of the coin. Ultimately, we are talking about recommendations. Each patient and physician should use the available evidence, risks and benefits of testing, and make an individual plan.

    November 29, 2011 at 13:32 | Report abuse | Reply
    • Rick DeBay

      This is rare, a cogent well-informed posting. Keep it up.

      November 29, 2011 at 14:37 | Report abuse |
    • A scientist

      Thanks for the intelligent, balanced post. The reality is that this is a complex issue, and that (despite the conspiracy theories that tend to pop up on these boards), the vast majority of the doctors and scientists on both sides of this issue are well-intentioned, although everyone is going to have their biases.

      Every diagnostic test involves a cost-benefit analysis - what are the risks of the test versus the likely benefits? Daily mammograms starting at puberty would increase detection, but with huge costs (financial costs, invasive follow-ups, unnecessary radiation exposure, etc). At the other extreme, eliminating mammograms completely would cause many unnecessary deaths. The question is where in between these two extremes is the optimal balance.

      The problem is that there still are so many unknowns - we don't know the exact risks of mammogram radiation (which are likely low, but not non-existent), we don't know what fraction of breast cancers caught by early mammograms would have been lethal, etc. Until we have a better understanding of these variables, it will be difficult to decide the exact optimum mammogram timing, and reasonable people will look at the data and come to different conclusions. The biggest problem now is that this has become such a heated issue that those who try to analyze the data are often shouted down. We do not benefit women by pretending that we have all of the answers.

      November 29, 2011 at 14:57 | Report abuse |
  5. Susanne

    A scientist,

    Thanks for the well-balanced post. As a non-medical lay person, I am curious to know about the true risks of radiation exposure as far as these tests are concerned. There doesn't seem to be any good, solid information or any published study out there to explain it.

    I am especially curious because most dentists require their patients to undergo dental x-rays once a year. A lead-lined apron is provided to cover the patient from the neck down, thus protecting the breasts and reproductive organs from unnecessary radiation exposure. Yet, women, starting at age 40, are instructed by their doctors - more like demanded of, in some cases - to have their breasts irradiated (mammogrammed) on an annual basis. A health article I read several months ago listed the radiation dosage for various medical tests and the mammogram was shown to be of several orders of magnitude greater than an annual set of dental x-rays. If that is true, then why are we required to wear protective aprons for the dental but then told to have two of the most radiologically sensitive parts of our bodies x-rayed year after year? It just doesn't make sense.

    Also, I've often wondered if breast cancer is really as big of a threat as the testing folks and activists say, then why isn't every woman instructed to have a prophylactic mastectomy by a certain age? Wouldn't it make more sense to take preventive measures rather than to wait for something to possibly show up?

    November 29, 2011 at 15:25 | Report abuse | Reply
    • A scientist

      You are right that there are not great studies out there about the effects of medical radiation. The problem is that when a test may potentially both causes and detects cancer, it is very difficult to separate these two variables. Therefore, the simpler (and more relevant) question is whether getting mammograms increases or decreases life expectancy. The data are very clear that over age 50, mammograms increase life expectancy. From ages 40-50, it is less clear. Based on the research, most doctors believe that mammograms in one's 40s result in a very small net increase in life expectancy, but this isn't certain. The challenge it that, as with all human medicine, it is hard to do a well controlled study to definitively answer this question.

      As for prophylactic mastectomy, the problem is that any surgery carries risks of complications, so in the absence of a strong family history, the benefits of prophylactic mastectomy are generally outweighed by the risks. (This is the same reason we don't remove everyone's appendix at birth.) Additionally, mastectomy does not completely eliminate breast cancer risk.

      And it is certainly true that dental X-rays have far lower radiation doses. My gut feeling is that the lead vest is more for our peace of mind than necessity (the scattered radiation to the chest is likely quite low). The test that scares me is CT scans, which are being used with increasing frequency, despite very strong evidence that they increase cancer risk.

      November 29, 2011 at 16:52 | Report abuse |
  6. moni

    How about once a year? Why does 40 are they trying to get rid of some population so they can afford to pay for obama care

    November 29, 2011 at 17:43 | Report abuse | Reply
  7. harpo429

    21 years cancer free after finding a lump in 1990 . Thanks to the generosity of a stranger, I was given a mammogram at 40 years old and in Feb 1990 had surgery, radiation and chemo. Had I listened to the doctors at Johns Hopkins, I would be dead. they pshawed me and said it was probably a cyst. The community hospital used me as a test case since I had no insurance. think about having one if there is ANY history of breast cancer in your family.

    November 29, 2011 at 18:08 | Report abuse | Reply
    • Katie

      You don't need to have a family history to get breast cancer. I know three women who were diagnosed in their forties – none of them had any kind of family history. Mammograms can save lives. And so can self breast exams. My sister found her lump that way – two weeks after a clean mammogram.

      November 29, 2011 at 21:37 | Report abuse |
    • Eucharia

      Breast Cancer researchCommon Breast Cancer MythsThe first myth pnitarnieg to this disease is that it only affects women.Second myth that is associated with this disease is that if one has found a lump during an examination, it is cancer.Third is that it is solely hereditaryThe next myth associated with breast cancer is downright ridiculous. Would you believe, that in this day and age, some individuals still think that breast cancer is contagious?Conversely, some individuals foolishly believe that breast size determines whether or not one gets cancer.Finally, another myth that is associated with this disease is that it only affects older people. This is not so. Although the chance of getting breast cancer increases with age, women as young as 18 have been diagnosed with the disease.You can find a number of helpful informative articles on Breast Cancer research at Breast Cancer research

      March 5, 2012 at 21:21 | Report abuse |
  8. Justme

    It makes me laugh when I read posts like those of 'angry' and Sara. They spout nonsense in posts chock-full of misspellings and errors in grammar.

    Yeah, they're qualified to dispense medical opinions.

    November 30, 2011 at 07:22 | Report abuse | Reply
    • Sara

      Since when do you have to have perfect grammar to post on a blog? Also, their are no spelling errors in my post and I do know what I am talking about 100%. As for you, not so sure. You offer nothing of substance. Sorry, your time is coming to an end; people are becoming aware of the money making schemes in our healthcare system. What they suggest isn't always best!

      November 30, 2011 at 11:19 | Report abuse |
    • Sara

      Also you probably want to do your research BEFORE you give incorrect information such as above with saying thermography is not as accurate as mammography. It is obvious YOU haven't done your research.

      November 30, 2011 at 11:32 | Report abuse |
    • Justme

      No, darling, it's obvious you haven't done yours. And yes, there are errors in your post. If you don't know the difference between "their", "they're", and "there", you're hardly the sort of careful, thoughtful person whose advice I'd consider seriously.

      November 30, 2011 at 18:32 | Report abuse |
    • Justme

      From the American Cancer Society:Thermography (thermal imaging)

      Thermography is a way to measure and map the heat on the surface of the breast using a special heat-sensing camera. It is based on the idea that the temperature rises in areas with increased blood flow and metabolism, which could be a sign of a tumor.

      Thermography has been around for many years, and some scientists are still trying to improve the technology to use it in breast imaging. But no study has ever shown that it is an effective screening tool for finding breast cancer early. It should not be used as a substi tute for mammograms.

      Newer versions of this test are better able to find very small temperature differences. They may prove to be more accurate than older versions, and are now being studied to find out if they might be useful in finding cancer.

      -------–

      Not proven effective. The fact that Dr. Mercola the quack endorses its use is the first clue that it isn't proven to be effective or a substi tute for mammograms.

      November 30, 2011 at 18:37 | Report abuse |
  9. Susanne

    Another thing that I've found to be interesting is that there are about as many men diagnosed with prostate cancer as women with breast cancer. Prostate cancer also kills about as many men as breast cancer does women. The difference is the PSA test is only "offered" to men, along with a healthy amount of discussion about the risks vs. benefits and the fact that the test is imperfect and may lead to false positives, undue stress, unnecessary/debilitating treatment and so forth. There is also a good amount of discussion about how many of the prostate cancer diagnoses are indolent forms of the disease, meaning that they are slow-growing and may never harm the person in his lifetime. In short, he will die with it, not from it.

    The same can be said for breast cancer and mammograms, so why aren't women given more of a choice in the matter? Why aren't we given ALL of the facts? Speaking from personal experience and that of other women acquiantances, I can say that those in the medical community don't treat women with the same respect as far as personal choice and risk vs. benefit information goes. It seems we women are expected to just go along with things and do as we're told, like obedient little girls. Anyone who dares question anything is met with disapproval, shaming, pressure and scare tactics to submit to screenings that they may not want and may not benefit from. Those on the pink-ribbon bandwagon also are quick to jump in and try to shame or scare other women into complying. It's frustrating, to say the least.

    November 30, 2011 at 15:10 | Report abuse | Reply
  10. Truth hurts

    Leave those American lemmings to screw themselves. They sure love having their rectums probed, boobs squashed and the widest speculum rammed inside their private holes. It's disgusting, shameless and repugnant how much they seem to like it.

    December 2, 2011 at 11:27 | Report abuse | Reply
    • consensus

      Another ass brays its ignorance for all to see.

      December 2, 2011 at 18:46 | Report abuse |

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