Radiologists Still Recommend Mammograms for Women in their Forties

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Family history is often considered the greatest risk factor for breast cancer and doctors usually refer these women earlier for screening mammograms. It has recently been suggested by the US Preventive Services Task Force to increase the age of a woman’s first mammogram from forty to fifty in the case of low risk, ie – no family history of disease. However, a radiologist group sticks by their recommendations that all women, regardless of family history, should maintain the current practice of going for a baseline mammogram to screen for breast cancer at age 40.

Dr. Stamatia V. Destounis, a radiologist and managing partner at the Elizabeth Wende Breast Care facility in Rochester NY, evaluated cancer patients who were seen between 2000 and 2010. During the study period, 373 women between the ages of 40 and 49 were diagnosed with breast cancer after a screening mammogram. Only about 39% of those women had a family history of the disease, meaning a primary female relative such as a mother, sister or daughter.

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For the women with a family history, just over 63% were ultimately diagnosed with invasive breast cancer (cancer that had spread to the lymph nodes) compared with 64% of the women without a family history – indicating that women in their 40’s with no family history of disease are just as likely to develop invasive breast cancer as women with a cancer family history.

Dr. Destounis, who presented her findings today at the annual meeting of the Radiological Society of North America (RSNA) in Chicago, concludes that all women beginning at age 40 receive annual mammograms, not just those considered high risk because of a family history of disease.

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"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,” she says. "And even worse, many of the cases had spread to the lymph nodes, which means early detection is important."

The Susan G. Komen for the Cure website notes that most women with breast cancer indeed do not have a family history of the disease. Only about 13% of women diagnosed have an immediate female relative with breast cancer. Having a family history, though, does raise the risk even higher by about three or four times.

But age of diagnosis is also a factor in deciding risk, notes Dr. Michael LeFevre, co-vice-chair of the US Preventive Services Task Force. “Having an aunt die of breast cancer at age 85 is not the same as having a mother or sister with breast cancer at 42,” he says. Susan G. Komen for the Cure notes that a woman whose mother was diagnosed with breast cancer before age 50 has about twice the risk of a woman without family history, but for a woman whose mother was diagnosed after 50, the increase in risk isn’t as great.

Factors that also affect breast cancer risk include age, inherited genetic mutations, breast density on mammogram, benign breast conditions such as hyperplasia, and reproductive factors such as age at first birth and number of children.

Conclusion – Women should begin the discussion early with their doctors on the timing for their first baseline mammogram based on the totality of risk factors and not a single study or group recommendation.

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