Study Recommends Mammograms Beginning at Age 40

Recent trends in breast cancer detection have wavered. To perform breast self-exams, or not? To get mammograms, or not?

The worry about breast self-exams is that they may skew results into too many false-positive tests. Some who recommend fewer mammograms have suggested that over-screening leads to unnecessary invasive tests and undue anxiety.

However, the 2011 Breast Cancer Symposium of the American Society of Clinical Oncology overwhelmingly supports these preventive measures. The American Cancer Society agrees.

“While there has been ongoing debate about when and how breast cancer screening should occur, this study validates that women who undergo regular mammography screening present at earlier stages and often require less aggressive treatment than those who do not,” said Dr. Jamie Caughran, medical director of the Comprehensive Breast Center at the Lacks Cancer Center in Grand Rapids, MI.

Caughran, who helped lead the research team for a recent study on mammography said women age 40 and up should use both methods for detection. High-risk patients should seek advice from their doctors about the age for and frequency of tests.

The Michigan study, completed this year with data from nearly 6,000 women with breast cancer, counters guidelines by the U.S. Preventative Services Task Force, which recommends generally that women get mammograms every two years beginning at age 50. The USPSTF notes that screenings should be determined on an individual basis.

Among other findings in the Michigan study:

• Breast cancer in women younger than 50 was more likely to be detected first by feel than by mammography. Of the women whose tumors were found by feel, 40 percent were younger than 50.
• Overall, 65 percent of the breast cancer cases were detected by mammography, while 30 percent were detected by feel and the other 5 percent by other methods.
• For women diagnosed with breast cancer before age 50, 49 percent of the cases were detected by mammogram. Of those, 18 percent were Stage 2, and 4 percent were Stage 3.
• For women diagnosed with breast cancer before age 50, 46 percent of the cases were detected by feel. Of those, 50 percent were Stage 2, and 17 percent were Stage 3.
• For women over 50, 81 percent of breast cancers are detected through mammography.

On a local level, earlier-rather-than-later mammograms are supported, too. Dr. Patricia Joseph, a breast surgeon at , recommends exams beginning at age 40, not age 50.

"The age of initiation has been debated for decades," she explained. "We feel strongly that screening should be done between ages 40 and 50."

Joseph noted that a baseline exam at 35-years-old, followed by annual exams beginning five years later, is an intelligent approach. "We do not start earlier than 35 unless there is an unusual, strong family history [of breast cancer]," she added. "Premenopausal breasts are dense, and mammograms are not helpful—we can’t see much."

Eloise Caggiano, the Program Director of the Avon Walk for Breast Cancer, was diagnosed with breast cancer in 2006 at the age of 33.

"The Avon Foundation and many other well-known cancer organizations stand by the original recommendation of women getting Mammograms at 40," Caggiano said. "That’s what I would personally recommend. As a foundation, we stand by that original recommendation of starting at 40."

In 2011, ASCO predicts 230,480 new cases of breast cancer for women, 2,140 for men, and 57,650 non-invasive cases. About one in eight women will develop breast cancer, according to ASCO.

In New York, experts predict 15,570 new cases of breast cancer to be diagnosed this year. According to the Centers for Disease Control, the female breast cancer incident rate in New York state was 122-124 per 1,000 in 2007, the most recent year available. New York's rates are higher than the average but not the highest in the country.