Why Is Mammogram Advice Still Such A Tangle? Ask Your Doctor : Shots - Health News Leading physicians' groups don't agree about when and how often women with an average risk for breast cancer should get a screening mammogram. But your history can help guide you and your doctor.
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Why Is Mammogram Advice Still Such A Tangle? Ask Your Doctor

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Why Is Mammogram Advice Still Such A Tangle? Ask Your Doctor

Why Is Mammogram Advice Still Such A Tangle? Ask Your Doctor

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STEVE INSKEEP, HOST:

Let's sort through the confusion over mammograms. The latest recommendations involve a vital decision for some women over 40. The American Cancer Society says the average woman should not start breast cancer screenings until age 45. That's different from some other recommendations. For example, one group says women should start getting mammograms at age 40, another says age 50. NPR's Patti Neighmond reports on the conflicting advice.

PATTI NEIGHMOND, BYLINE: Stephanie Nichols is a stay-at-home mom who lives in Boston. She's 44 now. But when she turned 40, the buzz about mammograms was everywhere.

STEPHANIE NICHOLS: I had heard from a number of friends that are all around the same age and getting mammograms, so it wasn't a surprise. I anticipated that was going to come up.

NEIGHMOND: And the topic did come up the next time Nichols visited her primary care doctor.

NICHOLS: We talked about my family history relating to breast cancer and cancer in general, my health in general.

NEIGHMOND: And together, they decided to postpone mammograms until Nichols turned 45, which is exactly the age the American Cancer Society now recommends women of average risk, like Nichols, start screening for breast cancer.

NICHOLS: I was comfortable taking a risk knowing that my risk for breast cancer was low compared to the risks for having to have more invasive procedures, such as biopsies or lumpectomies.

NEIGHMOND: In fact, researchers say over a 10-year period of getting yearly mammograms, women have a 50-50 chance of being called back at least once for further testing that in the end turns up nothing. And that's one reason why the Cancer Society changed its advice and now says women should start screening at 45 not 40. But the advice is at odds with federal health advisers who say women should wait till they're 50 and with the American Congress of Obstetricians and Gynecologists, which says women should start at 40. As a result, it's no wonder women may be confused.

LYDIA PACE: There's a really wide range in the way that women approach this question.

NEIGHMOND: Dr. Lydia Pace is a primary care doctor at Brigham and Women's Hospital in Boston.

PACE: Some women come in already knowing that they want to start screening at 40. Some women ask about it before age 40. And then some women come in really wanting to have a more nuanced conversation with the doctor about whether they should start or not.

NEIGHMOND: Pace says some women at higher risk - those with a family history of breast cancer, for example - may choose to start screening at 40. Others who are super worried about breast cancer may do the same.

PACE: If they have had strong personal experiences with family or friends who had breast cancer, that may be a much more powerful influence for them than any conversation we can have. And so for those women, starting at 40 is totally the right decision.

NEIGHMOND: And it's not just patients who are unsure. Lots of doctors are frustrated, too. Laura Esserman is director of the UCSF Breast Cancer Center in San Francisco.

LAURA ESSERMAN: Let's put our energy into doing better instead of arguing about it.

NEIGHMOND: Esserman says part of the problem is that the evidence from clinical trials everyone's arguing about is 30 to 40 years old.

ESSERMAN: These trials were done before we had modern treatments for breast cancer, before we knew about the different kinds of breast cancer and before we really understood a lot about breast cancer risks. So it's high time that we do a modern trial where we put some new ideas to the test.

NEIGHMOND: Esserman recently received a grant to see whether a personalized approach, like the one Stephanie Nichols worked out with her doctor, is as safe and effective as yearly mammograms starting at age 40. As for when you can stop annual mammograms, the new guidelines from the American Cancer Society say you can switch to every other year starting at age 55. Patty Neighmond, NPR News.

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