What is best for me and my family? 

Breast Cancer Risk and Mammography Screening in your 40s

 

A goal of The Patient Revolution is to support people in thinking, feeling and talking about how healthcare affects their lives. One way we do this is through facilitated discussion groups. We've attempted to recreate part of that experience here, sharing information that might be helpful as you consider the decision of whether or not to pursue mammography screening in your 40s.

Consider going through the material with a friend or two. Talking about it really does help. The conversation bubbles indicate moments where we encourage you to pause and give voice to your thoughts and reactions to the information we provide below.

When you think about breast cancer risk and mammography screening, what stories come to mind? How familiar are you with headlines like these below? What other factors do you think about in relation to mammography screening?

Amy Robach of ABC Says On-Air Mammogram Found Breast Cancer

For Women, a More Complicated Choice on Mammograms

American Cancer Society, in a Shift, Recommends Fewer Mammograms 

Doctors still divided on when women should start mammograms

 

The reason we start hearing more about breast cancer around the age of 40 is that the chance of developing breast cancer increases with age.

Out of 1000 women OF AVERAGE RISK over 80 years...

 
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What is your reaction to this information? How does it fit with your expectations?


 

What happens when women do or do not get mammograms to screen for breast cancer?

 

Out of 1000 women of average risk that DO NOT get regular mammograms in their 40s...

 
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Out of 1000 women of average risk that DO get regular mammograms in their 40s...

 
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What is your reaction to this information? What stands out to you? What fits with what you thought? What surprises you?

 

uncertainty and overdiagnosis

NCI Division of Cancer Prevention, on overdiagnosis

NCI Division of Cancer Prevention, on overdiagnosis

Cancers can grow fast, slow, very slow, or not grow at all. These differences contribute to the uncertainty about the benefits of screening. Ideally, we would like to be able to detect cancers early, before they become symptomatic or pose a threat to a women’s health and life. Overdiagnosis occurs when we detect cancers that grow very slowly, or not at all, and would never pose such a threat in a woman’s lifetime. We don't currently have a consistent, reliable way to identify the speed at which a cancer will grow when at the moment of diagnosis.

 

BReast cancer risk

The information you see here is based on average risk. The factors that might increase your risk include:

Older age (risk ticks up more significantly at 50)

Race/Ethnicity - Risk calculation has mostly been done with white women although as more data has become available, the risk models have been updated for African American and Asian and Pacific Islander women. The estimates for Hispanic women include data from white women and have more uncertainty. The data for American Indian and Alaskan Native women is entirely from white women and may not be accurate.

History of breast cancer in first-degree relatives - mother, sisters, and/or daughter

Personal history of cancer which might have been called (ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS)

Genetics mutations, such as BRCA1 or BRCA2

Higher estrogen levels - Researchers look at age of menstruation particularly before the age of 12 and age at first live birth.

You can estimate your own risk using this Breast Cancer Risk Calculator.

What is a mammogram?

A mammogram is an X-ray image of your breast used to screen for breast cancer. (see this video by Mayo Clinic)

During a mammogram, you stand in front of an X-ray machine designed for mammography. A technician places your breast on a platform that holds the X-ray film and positions the platform to match your height. The technician helps you position your head, arms and torso to allow an unobstructed view of your breast.

An X-ray captures black-and-white images of your breasts that are displayed on a computer screen and examined by a doctor who looks for signs of cancer.

A mammogram can be used either for screening or for diagnostic purposes. Screening refers to looking for breast cancer when a woman has no symptoms. In a woman with a breast lump, a mammogram can be used to look for the cause of her symptoms. 

SCREENING recommendations

Most guidelines recommend mammography screening for women in their 50s. For women younger than that, there is less certainty. Recommendations from groups like the US Preventative Task Force (USPTF) and American Cancer Society (ACS) have shifted in recent years creating possible confusion. 

Currently, for women in their 40s, the ACS recommends women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms (if they wish to do so) and women age 45 to 54 should get mammograms every year. 

The USPSTF recommends the decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.

The common thread in the recommendations is that all women should be familiar with the known benefits, limitations, and potential harms linked to breast cancer screening.

 

What do you see at the benefits of mammography screening? The limitations? The potential harms? Do you feel comfortable sharing these feelings with your clinician?