The recommendations had been that all women have an annual mammogram after age 40, and after age 35 if the patient had a significant family history of breast cancer. I had known, from conversations with friends who are radiologists, that not all in the radiology community agreed this was such a good thing, as evidently a screening mammogram involves a not insignificant dose of radiation to the breast tissue. Of course, all radiation can (over time) increase the risk of developing cancer, and so the risk of developing cancer as a result of the tool used to diagnose it early is highest in younger women. In other words, the younger you are, the less likely you are to actually have a cancer, and the greater the risk of the radiation the mammogram represents. Hence their other recommendation- that women without s significant family history of breast cancer and without a history of radiation to the chest wall not begin having mammograms until age 50. They further recommended that they only have them once every two years, in order to reduce this radiation exposure.
So are these sound recommendations??? What should an appropriately concerned person do? Breast cancer certainly is scary, and it takes too many mothers, sisters, grandmothers, wives, and daughters....
My initial reaction, having reconstructed many breast after mastectomy, and losing many friends to breast cancer over the years, was that they were making a big mistake... and possibly were making a big mistake in order to save money (the cost of annual screenings for all of America's women is not negligible)...
Bu after reading the reports and studying the numbers, I think I'm leaning towards agreeing with them. There can be no doubt that radiation can cause cancer, and that mammograms expose the breast tissue to a pretty good dose of radiation. There is also no doubt that the risk of this radiation causing a cancer is going to be highest in younger patients, and that the risk of breast cancer is lowest in these younger patients. So- younger patients (i.e., those in their 40's) who are not at otherwise elevated risk, are the ones with the least to gain from annual mammograms, and with the most at risk if we expose them to all that radiation.
Having said all of that, however, I'm asking myself the question that always represents the bottom line to me... What would I want my wife, sisters, and mother doing??
I believe in reducing the radiation exposure over a woman's lifetime; but don't think we should completely abandon mammograms in the 40s... Maybe the best thing to do is to have one at age 45, and then not again until 50 if the one at 40 was unremarkable...
Again, if there is any reason the patient is at higher risk, all bets are off and mammograms should start early and occur annually.
For my elective surgery patients, I would sat that because breast enhancement surgery does produce scar tissue within the breast, we should still obtain a baseline mammogram before surgery if you are over 40, and over 35 if you have a family history of breast cancer.
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