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When to recommend mammography: NCI, ACS suggest screening at age 40 years
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The NCI recommends mammography for women aged at least 40 years.
Women in this age group should be screened with mammography every 1 to 2 years.
Breast cancer mortality can be reduced by screening mammography in women aged 40 to 70 years, according to the NCI, with the most benefit in women older than 50 years.
The NCI also recommends mammography for women who are at a higher than average risk for breast cancer. This includes women with a family history of the disease or those who are carriers of a mutation in the BRCA1 or BRCA2 gene. Clinicians are encouraged to discuss mammograms with women younger than 40 years who fall into one of these categories.
Recommendations from the American Cancer Society are similar to those from the NCI regarding age at which yearly or biennial mammography should begin.
The ACS recommends screening mammography for women aged at least 40 years.
The US Preventive Services Task Force recommends that screening begin at age 50 years and repeated every 2 years. The USPSTF also concludes that there is insufficient evidence to adequately determine the risks and benefits of mammography among women aged at least 75 years.
Risks and benefits of mammography
The NCI suggests that mammography can aid in early detection of breast cancer. Early detection means early treatment initiation, which can prevent the disease from spreading and reduce mortality associated with breast cancer.
Evidence suggests that mammography can reduce mortality among women aged 40 to 70 years, and especially among women aged at least 50 years, according to the NCI. However, the benefits of screening mammography among women younger than 40 years have not been sufficiently proved.
The NCI notes that mammography does not prevent all breast cancer-related mortality in women of any age group, and early detection of breast cancer does not prevent mortality from other health conditions.
Other potential concerns with mammography, according to the NCI, include false-negative or false-positive results. False-negatives can lead to the development of undetected malignancies, and false-positive results can lead to anxiety, overdiagnosis, overtreatment or treatment when no treatment is necessary.
The NCI makes specific note of the radiation exposure involved in mammography. Repeated radiation exposure may cause malignancy, and diagnosis of breast cancer or false-positive results may lead to further radiation exposure. Clinicians should be aware of patients who are pregnant or have other contraindications to radiation exposure.
Mammogram procedure
A mammogram is normally performed on an outpatient basis, however, the procedure may also be performed during a hospital stay.
For the mammogram procedure, a person stands in front of a mammography machine and one breast is placed on the X-ray plate. A separate, plastic flat plate is brought down on top of the breast and is gently compressed against the x-ray plate, which may cause discomfort.
The breath must be held while images are taken. There are normally two images taken of each breast, which requires breasts to be repositioned between photos.
Once the images are taken, a radiologist reviews the films. If there is a concern, additional films may be taken. In total, the mammogram procedure takes between 20 and 30 minutes.
Digital mammography
Digital mammography involves a system where x-ray film is replaced by solid-state detectors that are similar to those found in digital cameras. The solid-state detectors convert X-rays into electrical signals that produce images that can be viewed on a computer screen.
There are different types of digital mammography, including:
• direct radiography, which is most common and captures the image onto a flat-panel detector;
• computed radiography, which uses a cassette that contains an imaging plate; and
• digital breast tomosynthesis (DBT).
Mammography after malignancy
Follow-up for women who have had breast cancer should include mammography, according to ASCO. Women who have had breast cancer are encouraged to receive physical examinations every 3 to 6 months for the first 3 years, every 6 to 12 months for years 4 and 5, and every year thereafter, according to the ASCO guidelines.
Women who have undergone breast-conserving surgery should undergo a mammogram 1 year after the initial mammogram and 6 months after the completion of radiation therapy, according to ASCO. These women should undergo a yearly mammogram thereafter.
ASCO contraindicates the use of complete blood counts, chemistry panels, bone scans, chest radiographs, liver ultrasounds, pelvic ultrasounds, CT scans, 18F-fluorodeoxyglucose PET scans, MRI and/or tumor markers (cancer antigen [CA] 15-3 and CA 27.29) for routine follow-up in asymptomatic women who do not demonstrate specific risk factors during clinical examination.
For more information regarding the ASCO, NCI and USPSTF guidelines, visit:
US Preventive Services Task Force
Additional information can be found by searching the following websites:
www.cancer.gov/cancertopics/factsheet/detection/mammograms
www.hopkinsmedicine.org/healthlibrary/test_procedures/gynecology/mammogram_procedure_92,P07781/