The Mammogram Frequency Debate: What It Means to You
The question of how often women should be screened for breast cancer seems to have no clear-cut answer. While some experts say that women should be screened once a year, not all experts agree with this recommendation.
In 2009, the U.S. Preventive Services Task Force (USPSTF) recommended that women between the ages of 50 and 74 receive a mammogram every two years (biennially). Results from a study presented in December 2013 at the Annual Meeting of the Radiological Society of North America suggested that this biennial screening would save the U.S. health care system over $4 billion a year. But experts are quick to point out that, when it comes to cancer, there is more to consider than just cost.
WHAT YOU CAN DO
To lower your risk of breast cancer:
➤ Lose weight if you are overweight or obese.
➤ Limit your alcohol consumption to one beverage a day or less.
➤ Get regular physical activity.
➤ Avoid taking hormone replacement therapy if possible.
“The official recommendation from the American Cancer Society (ACS) is annually after age 40 and continuing as long as a woman is in good health,” says Anne Moore, MD, medical director of the Weill Cornell Breast Center. “This recommendation does not change based on a woman’s age.”
Evidence for annual screening
A study published in the Feb. 4, 2014 issue of the Annals of Internal Medicine revealed that annual mammograms, rather than biennial mammograms, may improve breast cancer prognosis. For the study, researchers reviewed the records of women with breast cancer and divided them into three groups based on the length of time between screening mammograms: less than 1.5 years, 1.5 to three years, and greater than three years. They found that the presence of cancer in the lymph nodes, which indicates the cancer has spread, or metastasized, was significantly lower in the first group, leading to the conclusion that a shorter interval than the two years recommended by the USPSTF significantly improves patient prognosis.
What about age?
While the official recommendation for older women does not change, deciding how often to have a mammogram (or whether to have one at all) is up to a woman and her doctor. Two factors need to be considered. The first is life expectancy: If you are very ill due to a medical condition that will likely be fatal in the near future, there is no benefit to be gained from a mammogram. The second factor is whether you would want to undergo treatment if a tumor were found: Treatments include surgery, radiation, and/or chemotherapy and can cause significant side effects, and some older women refuse treatment in order to maintain their current quality of life.
IF YOU DON’T HAVE INSURANCE
For women without insurance, low-cost mammograms are available in most areas.
Call the American Cancer Society at 1-800-227-2345 for information about facilities in your area.
The National Breast and Cervical Cancer Early Detection Program also provides breast and cervical cancer testing, for free or at very little cost, to women without health insurance. To learn more, contact the Centers for Disease Control and Prevention (CDC) at 1-800-CDC-INFO (1-800-232-4636) or visit their website at www.cdc.gov/cancer.
The importance of early diagnosis
Regardless of where they stand in the debate, all experts agree that the key to breast cancer survival is early detection, and that recent advances in medical technology have made that easier.
“We can detect breast cancers today that never would have been detected 15 to 20 years ago,” says Dr. Moore. “The technology has evolved enormously due to the digital systems of mammography that have been developed. In the old days, you just took a picture and would look at it like you would look at any photograph. Now, we do it on the computer and we can enlarge certain areas, look at them with different contrasts, and really hone in and find very, very tiny breast cancers that we never would have seen previously; this is going to make a huge difference in the long run.”
Bottom line: Unless your doctor advises otherwise, have an annual mammogram from age 40 onward.
The factor of cost
The good news is that, no matter how often you choose to be screened, your mammogram will most likely be covered.
“Medicare, Medicaid, and all private health insurance policies cover annual screening mammograms for women age 40 and over,” says Dr. Moore. In addition, the Affordable Care Act requires that health insurance companies pay for screening mammograms.
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