Should Mammograms Start at 40?

Mammograms© John Foxx/Stockbyte/Thinkstock
What You’ve Always Heard
Mammograms save lives. But after that simple statement comes a lot of arguing. The big question: Should women start getting mammograms at age 40 or wait until they turn 50? The National Cancer Institute and the American Cancer Society recommend starting at 40; the U.S. Preventive Services Task Force says the evidence isn’t strong enough for a blanket recommendation.

The Headlines Now
Mammography saves even more lives than we thought, according to the longest study ever (it followed more than 100,000 Swedish women for nearly 30 years). Its conclusion? Women whose doctors offered regular mammograms cut their risk of dying of breast cancer by 30 percent. “That’s a really big deal,” Loretta Lawrence, MD, chief of breast imaging at North Shore University Hospital in Manhasset, New York, told the Los Angeles Times. “It translates to 15,000 to 20,000 lives saved each year.”

But Wait
The study didn’t attempt to determine whether mammograms between 40 and 50 are useful; data from that age group were simply combined with the rest. Some researchers even believe that a mammogram is more likely to harm a woman in this age group than help her.That can happen if the exam leads to aggressive treatment (including mastectomy) for something that wasn’t really dangerous, says Joann Elmore, MD, at the University of Washington School of Medicine. “In a great many cases, mammograms find slowly growing tumors that were never going to kill anyone,” says biostatistician Donald Berry, PhD, at MD Anderson Cancer Center in Houston. “But women who have had breast cancer often say that their mammogram saved their life. I’ve given up telling them that, judging from the statistics, that’s most unlikely.”

So What Should a Woman Do?
If she’s over 50, most experts recommend yearly or biannual mammograms. But if a woman is in her 40s, it’s reasonable to get a mammogram — or to skip it, says Barnett Kramer, MD, editor in chief of the Journal of the National Cancer Institute. “It’s a close call, which explains why the experts are tearing at each other.”

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