Ideal age to start mammograms

Bertie, 47, went for a regular checkup. Her gynecologist, who’d known her for 18 years and delivered her two kids, walked her to the mammography suite after the visit.

“No appointments. Took me in right away. Such personal care,” she said cheerfully.

I had questions for my good friend. But first, does Bertie get a say in this?

To most of us, breast cancer has a face – friends, family, colleagues, ourselves. An estimated 41,400 people (40,920 women and 480 men) will die from breast cancer this year. Every pink ribbon renders a wrenching story.

While 1 in 8 women (12 percent) will develop breast cancer in their lifetime – with screening and better cancer treatment – only 1 in 38 women (2.6 percent) will die from it. Ninety percent survive past 5 years compared to 75 percent in 1975.   

Mammograms save lives. The U.S. Preventive Service Task Force (USPSTF) recommends screening every two years starting at age 50 for average-risk women. Other expert groups like the American College of Obstetricians and Gynecologists (ACOG) recommend starting at age 40.

Why the age difference? The controversy surrounding screening young women is an old one. In a nutshell, breasts change after menopause. Mammograms work better for older women.

Studies show that if doctors do mammograms on 10,000 40-year-old women for 10 years, they’ll save 3 lives from breast cancer.

Do the same for 10,000 60-year-olds? They’ll save 43 lives. Significantly better.  

What’s the tradeoff?

For both groups of women, hundreds will be subjected to unnecessary biopsies, thousands to callbacks for false positive results. Consider the burdens of cost, anxiety, discomfort, procedural risks.

Today most experts would say if a woman values early cancer detection, understands and can stomach the uncertainty surrounding early screening, then start mammograms at 40. And I want to add, whatever choice she makes, it’s the right one.

What about BRCA genes?

BRCA 1 and 2 are two genes, each coding a protein that repairs damaged DNA, our genetic blueprint. Damaged DNA, if left unchecked, can develop into cancer.

These BRCA proteins are effectively cancer fixers. Like a spellchecker for our genetic codes.

There are thousands of BRCA gene mutations. Some worse than others. Many predispose men and women to an increased risk of cancer – not just breast, but ovary, prostate, colon, pancreas, etc. A familial cluster of these cancers might raise a red flag.

But BRCA mutations contribute to a small percentage of breast cancer (5 percent). They’re not routinely screened. Most women who develop breast cancer have no risk factors. That is scary.

“So Bertie, you’re telling me your gynecologist took time from her busy morning to walk you to your mammogram.” I asked, “Just how many scheduled mammogram appointments have you missed?”

Chuckling, Bertie said sheepishly, “Maybe two. Three. Who’s counting?”

“The electronic medical record, for one,” I said, “flagged you as a ‘flight risk.’”

But one thing for sure, taking the time to make sure Bertie got her mammogram done, her gynecologist cares about her. A lot.