Mammogram at 45? American Cancer Society says wait, but it’s personal

Costanza Cocilovo, MD is a board-certified, fellowship trained breast surgeon. She served as Associate Director of Breast Surgery and an Assistant Professor of Surgery at Georgetown before becoming the new medical director of the Inova Breast Care Center. Read Dr. Cocilovo’s profile. 

The debate around women’s mammogram recommendations is back. This week, the American Cancer Society published new guidelines, suggesting that women with an average risk of breast cancer can wait until they’re 45 to have their first mammogram. This is five years after their previous recommendation.

The current recommendations of the American College of Radiology (ACR),**, the National Comprehensive Cancer Network (NCCN) and the American College of Obstetricians and Gynecologists (ACOG) still state that mammograms should begin at 40.

As a breast cancer surgeon and a woman, I am often asked what I think – what I would tell a friend, daughter or sister to do.  My answer: it’s personal – way personal.

When it comes to breast cancer, there’s a lot we don’t know, but far more that we do know. For the most part, we don’t know who will get breast cancer – or why. Sixty-five percent of women diagnosed with breast cancer don’t have a family history or other obvious risk factor, and by far, most women with breast cancer do not carry the BRCA1 or BRCA2 genetic mutation.

Breast cancer is just a cruel trick of the cells that is hard to predict – but not hard to detect.

 We do know that early mammograms detect breast cancer when the tumor is still too small to be detected by touch. We know that the earlier the cancer is found, the better our chances to treat it successfully. And we know that, according to a cancer surveillance report published in 2012 by the National Cancer Institute*, a 40 year-old woman has a 1.47% chance of being diagnosed with breast cancer within the next ten years – that’s one in 68.

So if we delay testing, who gets left behind? Whose early tumors will be missed in that five-to-ten year window comprised of differences of medical opinion?

Among the arguments to delay the first test are radiation exposure and the emotional distress caused by false positive results and call-backs from screening mammograms. The ACP, NCCN and ACOG believe that much of the data that is used in the analysis is outdated. The amount of radiation in a mammogram is less than one gets from an airplane ride, and newer forms of mammogram are more accurate. Since the advent of digital 3D mammography (breast tomosynthesis), false positives and unnecessary callbacks have markedly decreased.

Still, at the end of the day, the risk of missing an early tumor versus a small dose of radiation, discomfort from the compression of the test, or the stress of a callback is something women need to weigh carefully when deciding whether to have their first mammogram at 40, 45 or 50.

Again, it’s way personal.