Mammograms: Yes or No? The Government enters the debate.

By Jae Hong Lee, MD, MPH

Should I get a mammogram or not? This is the question many women are asking, as the debate rages on about whether mammograms save lives or are a painful waste of time and money. The U.S. Department of Health and Human Services (HHS) recommends that women over 40, and especially those over 50, should have routine mammograms. They issued guidelines on breast cancer screening based on the recommendations of the U.S. Preventive Services Task Force, an independent panel of experts that advises the HHS on preventive medicine. Our Q & A below uses their recommendations to answer several key questions that women are asking.

Why should I undergo mammograms?

The Task Force reviewed the eight major studies on mammograms and found that routine mammograms reduced the risk of dying from breast cancer by about 23% when all the data is pooled together.

This is a different conclusion from that reached by a Danish research team in late 2001. The Danish scientists had reviewed the same major studies and excluded all but two of them because they believed the other studies were flawed. On the basis of those two studies, they concluded that routine mammograms do not save lives from breast cancer.

The Task Force scientists agreed that many of the eight studies were flawed but did not believe the flaws were serious enough to exclude the studies from their analysis. The Task Force concluded that the flaws in these studies did not change the finding that mammograms save lives from breast cancer.

When should I start getting mammograms?

Although the Task Force recommended that women start getting mammograms at the age of 40, they acknowledged that the evidence supporting the benefits of mammograms for women under 50 was "weaker" than for older women. Women in their 40s tend to have denser breast tissue, making it more difficult for doctors to accurately interpret mammograms. In addition, women under 50 are less likely to get breast cancer than older women, so women under 50 are less likely to benefit from the procedure.

The panel of experts emphasized that patient preferences should be taken into account in calculating the balance of benefits and risks. They agreed that the recommendation for women to begin routine mammograms in their 40s was stronger for those with a family history of breast cancer diagnosed before menopause.

The Task Force made clear that the evidence for the life-saving benefits of mammograms was strongest for women aged 50 to 69 years. There is little question that women should begin routine mammograms no later than the age of 50.

How often should I get mammograms?

For women aged 40 to 49, the Task Force stated that there is not enough data to specify how often mammograms should be scheduled, but they suggested that women 40 or older get mammograms every 1 to 2 years.

For women 50 or older, the panel found little evidence that annual mammograms were better than mammograms performed every other year. Most doctors currently recommend annual mammograms for women older than 50, and patients should speak with their doctors before changing their mammogram schedule.

This is perhaps one question that is not asked frequently enough. Unfortunately, no clinical trial has ever enrolled women older than 74, so there are no data designed to answer this question.

The Task Force recommends informing women that the benefits of mammograms (early detection of cancer) increasingly outweigh the risks (inaccurate findings and overtreatment by physicians) as women age between 40 and 70. However, while older women are more likely to develop and die from breast cancer, they are also more likely to die from other causes (such as heart disease). The panel concludes that women who already have other conditions that threaten to shorten life are unlikely to benefit from routine mammograms.

What about other techniques for detecting breast cancer, such as breast self-exams?

The panel has concluded that there is not enough evidence to recommend for or against performing routine breast examinations, whether they are performed by a doctor or by the patient herself. Properly designed studies have not yet been done to determine whether routine breast exams save lives and whether the benefits outweigh the risks -- such as false-positive exams that create anxiety when they detect "lumps" that are not breast cancer.

Where should I get mammograms?

Assuming that mammograms are appropriate for you, the test should be performed at mammogram centers that are properly accredited with quality assurance standards in place.

A listing of accredited mammogram facilities is available here.

From the HHS- what you need to know about mammograms and breast cancer.

Of course, you'll also find many other articles on breast cancer and mammograms on the National Center for Policy Research for Women & Families website.