Mammograms at 50: A Female Doctor Speaks Out

By Lissa Rankin, MD

What the Studies Say

Whew…Deep breath, Dr. Lissa. Okay, so mammography for women in their 40s has long been a controversial issue. Truth is, mammography just isn’t a great screening tool for women age 40-49. In our forties, our breasts are more dense, making it harder for X-rays to penetrate breast tissue to see early signs of cancer. Also, because breast cancer is less common in this population, you’re more likely to wind up with false positives, leading to follow up mammograms, breast biopsy surgeries, and enough anxiety to leave you quivering.  So medical societies have been mixed on their recommendations for women in their forties, but most agree that women in their forties should have mammograms no less than every other year.

While they’re not an ideal screening tool for breast cancer, studies estimate that mammograms detect about 75% of breast cancers in women in their 40s and 90% percent of breast cancers in women in their 50s and 60s.[i] Early detection can mean the difference between living and dying. If you’re over 40 and you get mammograms regularly, your risk of dying of breast cancer is reduced by 34%.[ii]

So why the push to nix it altogether when we already know that mammograms save lives? According to Dr. Otis Brawley, chief medical officer for the American Cancer Society, “With its new recommendations, the [task force] is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.” Say what? Actually, I do hear what they’re saying. The task force isn’t saying that nobody should get screened in their 40s. They’re saying they should talk to their doctor about risk, but they shouldn’t get screened routinely.  And I hear what they’re saying from an epidemiological standpoint. So maybe it’s not cost-effective. But price can you put on a mother of two young kids? I know we docs aren’t supposed to, but I can’t help getting emotional about this. I’ve lost too many people to breast cancer already…

Others Disagree

The American Society of Breast Surgeons just issued this statement. “We believe there is sufficient data to support annual mammography screening for women age 40 and older. We also believe the breast cancer survival rate of women between 40 and 50 will improve from the increased use of digital mammographic screening…The Society will continue to advocate for routine annual mammographic screening for all women beginning at age 40. Mammography screening reduces breast cancer mortality and saves lives.”  The American Cancer Society agrees.

On the flip side, Dr. Susan Love, author of Dr. Susan Love’s Breast Book agrees with the new task force recommendations. She says:

These recommendations are long overdue. Most countries do no support mammography screening under 50 and do it every other year after 50 in their government-sponsored screening programs.  I hope that the insurers will change reimbursement, because it is probably the only way that women will be spared the extra radiation exposure of too many mammograms. Since our system pays the radiologist, hospital, or mammography center and biopsying surgeon by the more they do, there is no incentive for this to come from the medical profession.

Strong words.  Yes. Mammograms have their risks. Applying radiation to a breast in order to reduce the risk of breast cancer may indeed seem counterintuitive. I work at a holistic health center, and many in the holistic health world recommend against mammography altogether, favoring breast thermography, which my patients often choose to use as an alternative to mammography.  And yes, it’s true that mammography is not a great screening tool for younger women.  But what’s a girl to do?