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  • With Mayo Clinic nurse educator

    Sheryl M. Ness, R.N.

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  • Living with cancer blog

  • Nov. 20, 2009

    Mammogram recommendations: What do changes mean for you?

    By Sheryl M. Ness, R.N.

23 comments posted

Living With Cancer

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You've likely heard about the U.S. Preventive Services Task Force this week revising its screening recommendations for breast cancer based upon an analysis of various mammography screening schedules. Experts suggest screening every two years for average risk women ages 50 to 74 achieves most of the benefits of annual screening, but with less harm. And although there was a decrease in deaths for women ages 40 to 49, screening resulted in additional mammograms and false positives, therefore isn't being recommended. These findings were published in the Nov. 17, 2009, Annals of Internal Medicine.

Photo of Sandhya Pruthi, M.D.
Sandhya Pruthi, M.D.

Sandhya Pruthi, M.D., director of Mayo Clinic Breast Clinic, Rochester, Minn., and medical editor at MayoClinic.com, shares what these guidelines mean for Mayo Clinic and its patients:

Like any guidelines, the recent U.S. Preventive Services Task Force's revised mammography screening guidelines for breast cancer are general suggestions for care for broad groups of people. Mayo Clinic physicians will evaluate the new evidence and ongoing studies regarding screening mammography, but for now we'll continue to offer annual screening mammography to women ages 40 and older, which align most closely with the American Cancer Society recommendations.

In the meantime, please keep all scheduled mammogram appointments. If you have concerns, contact your healthcare team.

I would be remiss if I didn't take this opportunity to discuss the importance of early detection of cancer. Just this week I cared for a young woman in her 30's diagnosed with breast cancer after she found a lump on her breast. Many young women have shared similar stories with me about how they found a breast lump on their breast self-examination, and with further evaluation were diagnosed with breast cancer. So, I still recommend that my patients be proactive and be familiar with their breasts. If there are changes they should bring this to the attention of their healthcare provider promptly.

I've also counseled many women in their 40's whose diagnosis of invasive breast cancer was the result of an abnormality found on a screening mammogram. The cancer was diagnosed at an early stage before the lump could even be felt on the clinical breast examination.

Breast cancer is an anxiety provoking diagnosis and can affect women of all ages. We've made significant strides in the past decade in decreasing death from breast cancer due to the combination of early detection and improved treatments in both young and older women.

Please take a moment to share how you've been proactive in seeking early detection of cancer.

23 comments posted

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  • February 3, 2011 3:37 p.m.

    I'm 77 and had mammograms since 40 is it still necessary at this age?

    - Bonita

  • November 22, 2010 8:21 a.m.

    Hi All, why is it necessary for women over 55yrs to have eight ex-rays on their breasts every two yrs, does this not subject their cells to a higher risk of getting breast cancer. Regards;Marie

    - Marie

  • October 6, 2010 9:55 a.m.

    I am 72 yrs old, but have a horrid fear of breast cancer I feel I would be remiss if I did not have my normal mammograms-what do you think? sincerely, Alli

    - No name given

  • September 8, 2010 6:06 p.m.

    Found a lump on my left breast after 6 months gave birth to my 1st child back in 2004. Diagnosed breast cancer at aged 30th in London. I was black out and feels like end of my journey. Living in UK with my husband and family thousand miles in malaysia. Have to sent my son back to malaysia due to my hectic appoinment treatment to attends. Undergone the process chemo, radiotheraphy, hormone(zoladex). Glad was in UK with no double standard between goverment and private hospital. Treatment was d best. Now i'm clear and had a 2nd child later in 2008. Never look back and still keep going for my kids future. I'm very cautious whn comes to health. Its fortunate if malaysia gov can provides treatment to early detection patient too

    - Ayu

  • September 4, 2010 9:13 a.m.

    I have LCIS with a family history of breast cancer. I am concerned about what to do, what route I should go, even after reading various statements on different sites about this. I have not ruled out prophylactic mastectomy and am unsure about taking tamoxifen. My doctor wants me to take tamoxifen. Before I go back to my doctor with more questions I need more info/input and to know where to look for reliable information. I welcome more input from the professionals and those who personally know from experience other than what is already posted here. I would also like to know why take Tamoxifen for only 5 yrs.? Also, why take it if it's unlikely, according to what I read, that in the first 5 yrs. I won't develop breast cancer? I have so many questions but can't seem to get an answer to some of them. I am also confused where to begin and how to phrase the question so as to be understandable about what I am asking and looking for an answer to. Are there any suggestions as to where to find more reliable information?

    - Debbie

  • April 14, 2010 9:52 a.m.

    Just yesterday i was given a diagnosis of ductal carcinoma in situ AND invasive ductal carcinoma. I have had yearly, clean mammograms since i was 35yrs old. I had a clear mammogram in february, 2 weeks later found a pea size lump during self examination. It still didnt come up on the mammogram, but it is visible with ultrasound. Keep checking yourself. Do not assume mammograms are fool proof. We will be doing mri next.

    - Patty

  • February 7, 2010 3:31 a.m.

    At age 50, after finding a worrying lump during self examination, I had a mammogram, ultrasound and needle biopsy. Cancer was only confirmed after a surgical biopsy. This was followed by a lumpectomy and axillary clearance (no lymph nodes affected). I decided on no further treatment, but have continued having annual mammograms and, for several years, ultrasounds. It's been 15 years with no recurrence and my specialist concurs that radiation was not necessary for me. (At the time of diagnosis, after a 2nd opinion, a professor wanted me to have "the works", which included radiotherapy, chemotherapy, ovarian oblation and Tamoxifen.) My suggestion is: get as much information as you can and make an informed decision about treatment and find a doctor who supports you in this. Of course, I was lucky to have had a low grade cancer, with reasonably early detection, and it isn't always so. I'm also fortunate that I live in Australia, because you get good health care here, especially with serious illnesses, whether you have private insurance or not.

    - Ellie

  • December 22, 2009 4:13 p.m.

    I am one of those, older in years, that had a small lump(Stage 2) in my breast but it was found in time for me to get a lumpectomy and stop the spreading. And now I follow up with more frequent mammograms. Women,keep on following up! 1

    - Eva

  • December 3, 2009 4:28 p.m.

    I was diagnosed this August with Stage 4 breast cancer, it had already spread to my liver. I was 39 years old at the time with no family history. I strongly encourage women to do self check and get mammos. If I would have waited until I was 50 I would be dead.

    - Deborah

  • December 2, 2009 5:56 p.m.

    I am writing concerning the Pap smear guidelines that say after 65 (Medicare), you only need a Pap every 2 years, or maybe don't need one at all if you had "normal" Pap tests in previous years. Wrong, wrong, wrong, at age 69 with a normal Pap test history, I was diagnosed with an aggressive uterine cancer discovered by a Pap test!! I have been told that, thankfully, it was found so early (Stage 1). I had NO symptoms so if I had waited for symptoms, I wouldn't be here to write this blog.

    - Janet

  • December 2, 2009 10:19 a.m.

    Welcome to the new government health care. Apparently men decided women don't need all these mammograms. Men can get breast cancer also. I am past the age that they consider mammograms are not necessary any longer. I am in a high risk area and have had one biopsy. I will continue to have mammograms. Preventative care is less expensive than treating the disease and save lives. Why is that so hard for this government group to figure out.

    - Ferne

  • December 2, 2009 5:25 a.m.

    In 1998, at 68 years of age, I was diagnosed with breast cancer. There had never been a case in my family's history to our knowledge. The caregivers at the facility that discovered it, told me that if they hadn't upgraded their mammography machine just prior to my exam, it wouldn't have been detected that soon as it was too small to be felt through a physical exam. A lumpectomy removed all the cancerous tissue. Four years later, same breast, but different location, same diagnosis! Another lumpectomy but this time followed by six weeks of radiation and Tamoxifen for five years. Now, seven years later, I am still cancer free! You have to know that I'm a firm believer in early detection! Don't let the government and insurance companies destroy all the progress that early detection has made! Just one life saved is worth more than all the money saved by waiting! I feel that early detection saved my life and I'll always be grateful for it.

    - Shirley

  • December 1, 2009 9:01 p.m.

    If the new guidelines are saying to elimate mamograms because they cause unnecessary anxiety, then why can't the mamograms be read the same day so that women don't have to suffer anxiety for 7 to 10 days waiting for the dreaded call or letter? We need to change this for all women's peace of mind!

    - Linda

  • November 28, 2009 12:14 a.m.

    As I am nearing my one year anniversary from my breast cancer diagnosis at age 46, I was shocked at the new guidelines for mamograms. I had a recent family history of breast cancer (two sisters diagnosed within the last 5 years). I saw a genetic counselor who suggested an MRI in addition to doing a yearly mamogram. My insurance, even though it is an excellent company, denied the additional testing. I went for yearly mamograms and within a one year time frame I had an invasive breast cancer tumor. I chose to have a double mastectomy, chemotherapy, and I now take Tamoxifen. I believe I would not have had "invasive" cancer with no chance of ever being "cured" if my cancer was detected earlier by having proactive additional screening. I knew had the potential for breast cancer (although not detected with a genetic test), but my insurance looked only at the statistics to determine my screening needs. I can only hope that I live to see my now 6 and 8 year old boys grow up. I think the standard should remain at a once a year mamogram for the general population and additional yearly testing for those with a family history of breast cancer.

    - Ann

  • November 26, 2009 4:17 p.m.

    This sounds like the beginning of government health care. They don't want to spend the money on mammograms but think what it will cost to treat breast cancer that could have been found in early stages with a mammogram. With the history of breast cancer in my family and all died from it but 1, I will not stop getting mammograms.

    - Ferne

  • November 26, 2009 3:24 p.m.

    A Ouote from this weeks New England Journal of Medicine. "Screening mammography for women in their 40s is clearly effective. The problem is that the benefit is tiny and expensive. A recent cost–benefit analysis showed that adherence to the current guidelines from the American Cancer Society costs more than $680,000 per quality-adjusted life-year (QALY) gained, as compared with a proposed alternative costing only $35,000 per QALY.4 Statistician Donald Berry has calculated that for a woman in her 40s, a decade’s worth of mammograms would increase her lifespan by an average of 5 days — and this survival advantage would be lost if she rode a bicycle for 15 hours without a helmet (or 50 hours with a helmet).5 The key issue here, however, is that these figures represent population averages. For the small number of women whose lives are saved, the difference is literally as large as that between life and death." I'm sure COST is a factor$680 K vs $35 K

    - Andy

  • November 26, 2009 11:57 a.m.

    Many "modifications" to the breast care recommendations suggest the importance of the one-on-one relationship of a woman and her physician. BUT...please let us remember that there are manymanymany women....working women....older women....young women under forty who are unemployed....who do NOT have primary care physicians nor have they health care. WHAT ARE THE RECOMMENDATIONS FOR THEM? They seem to be among the forgotten....by the recommending panel and by many health-care oncologists and physicians. Please....let's talk about what they can and should do.

    - Paula

  • November 24, 2009 6:15 p.m.

    I have been told and also have read that even if you have mammograms and nothing shows up, that the pressure used on the breast from the mammograms can cause inactive cancer cells to become active. Is there any truth to this? I have read many reputive articles this theory. j4hkue

    - Jean

  • November 24, 2009 4:26 p.m.

    These new guidelines are very upsetting! I was 43 when I was diagnosed last year. The cancer was in the very early stages and was not detected by monthly breast exams. They caught it on my annual mammogram. I'm the first one in my family to have breast cancer, so with these new guidelines I probably would have had to wait until I felt a lump because a doctor most likely wouldn't have recommended a mammogram without a family history of breast cancer. I'm praying my sister will still be able to get regular mammograms now that there is a history of breast cancer in our family.

    - Tammy

  • November 23, 2009 1:42 p.m.

    Since my Mother had breast cancer, I was originally screened (mammo) at age 35. At the time I had a nipple that was pulling in and it was concerning me. I was told each year from 35 - 39 that I was fine. Nothing showed up on the mammogram. At age 39 I finally pushed the issue because I found two lumps. My breast had changed quickly over 6 months in that year. I went for my second mammo that same year and when they still couldn't find anything they did an ultrasound. They still said they didn't see anything that looked like cancer but they said there was something very small they couldn't classify. They did a biopsy but said 99.9% it was nothing. Well, all four biopsy samples were cancerous -- and fast-growing. Even though I was lucky and they did a biopsy, the cancer NEVER showed until they did an MRI. If mammos provide too much radiation, why aren't we talking about alternatives such as ultrasounds or MRIs rather than just advocating for less screening. I was aged 39 at diagnosis and under the current recommendations I would never have been screened. DON'T GIVE UP. Listen to your body and be your own advocate. It's your life.

    - Marybeth

  • November 22, 2009 10:53 p.m.

    I have had mamms since 30 after suspicious lump and biopsy. I will not stop having them annually. I will not be a statistic - I am being proactive and doing the best I can to make sure I am not missing breast cancer. That includes self-exam, mamms and regular check-up w/doctor. Until there's something more or better out there, why would they discourage or say to a woman a mammogram may not be worth it? When you are one of the 1000 saved in the 40-49 age range out of 20,000 mamms- it is TOTALLY worth it. We will not take step back in women's health. We need a unified message to make a difference! Fight for your life - get your mammogram, do your breast self-exam and pay attention to your health!

    - cami

  • November 22, 2009 8:02 a.m.

    I am 56 years old and I found a benign tumor by self examination in the early 80's. Since then, I have taken a mammogram every year. Without even addressing the new guidelines for when a woman should take their mammogram, I find it very upsetting that they are telling us we should not examine our breasts. Kudos to you for supporting our vision for taking charge of our bodies and our health.

    - Mary

  • November 21, 2009 9:56 p.m.

    I am taking a premenopause therapy based with estrgen and progestin since three years. I am fifthy year old.I take a digital mammogram every year. I think I will continue same routine.

    - may

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