Some researchers recommend that women get mammograms annually after age 40. Others suggest the test is best if women receive it every other year starting at age 50.
Still others assert that if a woman has a family history of breast cancer, it’s really best to start 20 years before reaching the age at which the youngest woman in the family received a breast cancer diagnosis.
Now, the Swiss Medical Board suggests that mammograms don’t do much good at any age.
So what is the truth?
The truth is that women are people, not statistics. While the right time and frequency to undergo a mammogram appears to be a moving target, women need to keep in mind that what is right for the population in general might not be the right decision for them.
I realize that’s not very definitive, but relying on absolute, black-and-white recommendations based on the population at large is not necessarily the best way to practice medicine when dealing with something as personal and individualized as cancer.
I have a strong aversion to flouting immunization recommendations, because the decision an individual makes about vaccines has implications for others. When it comes to cancer screening, however, a woman really needs to evaluate her needs and risks and talk to a trusted physician to come up with a plan that makes the most sense for her.
I used to adhere to a more rigid view. I couldn’t understand why anyone would choose to ignore mammography recommendations. Mammograms save lives. Period.
But as I’ve gotten older, my view has changed. I now realize that we can’t legislate people’s compliance with recommendations. Not everybody wants to be or needs to be “saved” in the way physicians understand that term.
Years ago, I recommended a mammogram to a patient who said, “‘Even if I did have cancer, I wouldn’t be treated for it.'”
That stopped me. We ended up having a very different conversation, and I was reminded that these recommendations are just that: recommendations. If an individual doesn’t want to have a test or makes a lifestyle choice that doesn’t affect others, who am I to try to force something on them?
There is also the awkward flip side. Mammograms are not deemed necessary if a person’s remaining life expectancy is under 10 years. “Well, based on my opinion, I don’t think you need a mammogram because I don’t think you’ll be alive in 10 years.” How do I have that conversation?
That’s not to say that I believe we should stop covering and offering mammography. Far from it. Recent headlines suggest that mammograms don’t save as many lives as we once thought, but it is undisputed that mammograms do save lives.
Also, we now know that not all breast-imaging techniques are created equal. Technology has advanced to the point where we can offer 3D imaging through breast tomosynthesis (3D mammography), breast ultrasound and MRIs to women for whom traditional mammography might not be as effective because they have dense breast tissue.
I recommend that women ask about the technology most suitable to their individual bodies and choose a center that offers fellowship-trained dedicated breast radiologists to read and interpret their results.
Instead of ordering women to follow recommendations to the letter, I now view my job as giving people the best information available and helping them arrive at a plan based on their own needs, their own individual risks and what feels right to them.
For some, it will be an annual mammogram. For others, it will be something else entirely. What’s important is that these women make the decision that makes the most sense to them as individuals — not numbers.
ALLYSON BROOKS is a doctor who practices at Hoag Hospital. She lives in Newport Beach.
