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: To Get the Mammogram or Not: 40th Birthday Prompts Important Health-related Questions

To Get the Mammogram or Not: 40th Birthday Prompts Important Health-related Questions

Director of Application Development

I turned 40 last month, and I had my annual visit with my doctor. After the routine blood pressure check and blood work, she added another health screening to my growing list of routine appointments. She told me I should get a mammogram. 

 

The American Cancer Society recommends annual mammograms starting at age 40. The U.S. Preventive Services Task Force (USPSTF), in its controversial 2009 guidelines, recommends biennial mammograms starting at age 50. There is growing evidence to support the idea that the benefits of early screening do not outweigh the harm caused by false positives and over diagnosis. But, many institutions and physicians continue to recommend annual mammograms beginning at age 40. Including my own.

 

This is a tough topic. It is emotionally fraught. It brings up things we don't like to think about, and it is particularly sensitive for women who have survived breast cancer or who are currently undergoing treatment. The real problem is that with our current scientific understanding, it is impossible to know if a cancer that was caught by early screening will ever cause noticeable symptoms during a woman's life. This means that all cancers found through screening must be aggressively treated. A study published in the New England Journal of Medicine in 2012 concluded that nearly one-third of women diagnosed with breast cancer would never have developed the full-blown disease if left untreated.

 

There are scientific studies that support both sides of the debate, of course. But, the USPSTF reviewed the best evidence available at the time and developed statistical models to determine if the benefits in terms of decreased mortality outweighed the negatives and found (for women 40 to 49 with no other risk factors) that they don't. 

 

I want to stand on the side of science. And math. MMG's work with the Division of Cancer Control and Population Sciences has taught me the importance of evidence-based approaches to medicine and has given me great respect for the researchers who are trying to understand the science and to give us the best health information possible. And yet, I don't want this to become a well-reasoned argument to avoid a procedure out of fear of the unknown, or discomfort, or embarrassment.

 

And so, I had the mammogram. And it wasn't that bad; uncomfortable, but very brief. I don't yet know the results. Will I get another next year? I would like to say no. But, I'll have to talk to my doctor about that. And you should too. Every woman is different, and thus every situation is different. What is right for me, at this time, might not be right for you, but the important thing is that you have the conversation.

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