- With Mayo Clinic internist
Sandhya Pruthi, M.D.
read biographyclose windowBiography of
Sandhya Pruthi, M.D.
Sandhya Pruthi, M.D.
Dr. Sandhya Pruthi, certified by the American Board of Family Practice, has been practicing medicine at Mayo Clinic since 1995 with special interests in breast diseases and women's health.
Dr. Pruthi is a consultant in the Department of Medicine, the Division of General Internal Medicine and the Breast Diagnostic Clinic. She is an associate professor of medicine at Mayo Clinic College of Medicine in Rochester, Minn.
The Winnipeg, Manitoba, native is enthusiastic about promoting education and patient-related research and has been active in both areas since joining Mayo Clinic. Dr. Pruthi is the primary investigator at Mayo Clinic of a clinical trial evaluating new agents for the prevention of breast cancer and has research interests in the identification of biomarkers for early detection of breast cancer.
Her other research and clinical interests include managing the health of women who are at increased risk of breast cancer, breast pain and hot flashes, and developing patient education decision-making tools for breast-related concerns.
She is past director of the Breast Diagnostic Clinic and has been a member of the Women's Health Executive Committee. Dr. Pruthi has been newly elected as a secretary of the executive committee for the American Society of Breast Disease. She has assisted with a variety of website content.
"Having an opportunity to share information and empower my patients in the way that will help them to understand and be able to make educated decisions about their own health is very important to me," Dr. Pruthi says.
"The Internet is a tremendous resource and information site for people, and I want them to get up-to-date and accurate information to be able to make informed choices for themselves, their family members and friends."
Cancer (4)
- Mammogram: Can it find cancer in dense breasts?
- Breast implants: Do they interfere with mammograms?
- Mammogram guidelines: What are they?
- see all in Cancer
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Question
Mammogram guidelines: What are they?
Mammogram guidelines seem to differ about when to begin mammograms — at age 40 or at age 50. When should I start getting mammograms and how often should I have one?
Answer
from Sandhya Pruthi, M.D.
You're right that there are varying mammogram guidelines from different organizations about when to begin mammograms. Here's a brief summary.
Differing mammogram guidelines
In 2009, the U.S. Preventive Services Task Force (USPSTF) — a group of health experts that reviews published research and makes recommendations about preventive health care — issued revised mammogram guidelines. Those guidelines include the following:
- Screening mammograms should be done every two years beginning at age 50 for women at average risk of breast cancer.
- Screening mammograms before age 50 should not be done routinely and should be based on a woman's values regarding the risks and benefits of mammography.
- Doctors should not teach women to do breast self-exams.
- There is insufficient evidence that mammogram screening is effective for women age 75 and older, so specific recommendations for this age group were not included.
These guidelines differ from those of the American Cancer Society (ACS). The ACS mammogram guidelines call for yearly mammogram screening beginning at age 40 for women at average risk of breast cancer. Meantime, the ACS says the breast self-exam is optional in breast cancer screening.
According to the USPSTF, women who have screening mammograms die of breast cancer less frequently than do women who don't get mammograms. However, the USPSTF says the benefits of screening mammograms don't outweigh the harms for women ages 40 to 49. Potential harms may include false-positive results that lead to unneeded breast biopsies and accompanying anxiety and distress.
What Mayo Clinic recommends
At Mayo Clinic, the current practice is to continue to recommend an annual screening mammogram beginning at the age of 40, which aligns with the ACS recommendation.
At Mayo Clinic, a three-tiered approach is used:
- Breast health awareness, which includes a woman becoming familiar with her breasts in order to identify breast abnormalities or changes, and to inform her doctor of any changes that may need further evaluation
- Clinical breast exam performed by a health care provider and recommended annually beginning at age 40
- Screening mammography beginning at age 40
Screening mammograms can detect breast abnormalities early in women in their 40s. Findings from a large study in Sweden of more than 1 million women in their 40s who received screening mammograms showed a decrease in breast cancer deaths by 29 percent. And it's important to remember that most women who get breast cancer have no family history or other known risk factors for the disease.
Screening mammography is not a perfect exam. But it is the best available tool to detect cancer early, which can lead to better options and possibly less aggressive treatments.
If you're concerned about screening mammograms, talk to your doctor and learn what's right for you based on your individual risks. It's important that the two of you work together to develop a screening plan.
Next questionConflicting mammogram results: What can I do?
- U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine. 2009;151:716.
- Nelson HD, et al. Screening for breast cancer: An update for the U.S. Preventive Services Task Force. Annals of Internal Medicine. 2009;151:727.
- Mandelblatt JS, et al. Effects of mammography screening under different screening schedules: Model estimates of potential benefits and harms. Annals of Internal Medicine. 2009;151:738.
- Role of breast self-examination: Changes in guidelines. American Cancer Society. http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Role_Of_Breast_Self-Examination_Changes_In_Guidelines.asp. Accessed Nov. 17, 2010.
- Pruthi S (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 17, 2010.
- Hellquist BN, et al. Effectiveness of population-based service screening with mammography for women ages 40-49 years: Evaluation of the Swedish Mammography Screening in Young Women (SCRY) cohort. Cancer. In press. Accessed Oct. 29, 2010.
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