Ask Dr. Marie: Mammograms Not Always a Good Idea

These two new studies serve to remind us that screening mammograms for young women, especially very young women at increased risk for breast cancer, for example, either because of childhood radiation or genetic inheritance of a breast cancer gene, may not be a good idea. At the very least, screening any young woman before age 35 to 40 without worrisome breast signs or symptoms with a mammogram should not be routinely done.

Preventive Care Still Crucial

Although mammograms for early breast cancer detection have become a major part of women's health care (just as the Pap test is for diagnosing cervical cancer), it is always good to be reminded of the risks and the benefits of preventive health care and to question whether there are newer and smarter steps to an earlier diagnosis.

For cervical cancer, which we now know is caused by one of 15 high-risk strains of the HPV virus, doing the HPV test, which checks for the high risk strains of the virus along with the Pap test for women 30 and older, is thought to provide almost complete assurance that cancer or pre-cancer is not present. Yet many doctors today are still hesitant to add the HPV test because of fear women will be confused or frightened to learn they may carry a high-risk strain of the virus (only 5 percent of women screened will test positive for the virus, and many of these women have an active infection that will go away on its own within a year to two). They also worry that this HPV screening could lead to unnecessary follow-up testing.

Looking for Peace of Mind

Most women I talk to, however, welcome the greater peace of mind that a negative test result brings.

An MRI scan of the breast for breast cancer screening is thought to be more sensitive than mammograms and, therefore, more likely to pick up subtle breast changes or early breast cancer and it is not associated with ionizing radiation. But we still do not have enough research on screening MRIs in young high-risk women to know if they are safe, effective and worth the greatly added cost (both dollar cost and cost to women of needless biopsies, scares, missed work, etc.).

I suggest that until we learn more about the benefits and risks of MRIs in young high-risk women, every woman at high risk should talk with her doctor about the pros and cons of all available tests, including routine mammogram, breast ultrasound and periodic breast MRI. Every woman's medical history and breast exam will be different and only when all aspects of a woman's history are taken into account can the best decision for screening be made.

In addition to a detailed conversation with your practitioner about the best way to be protected, all women should:

Be familiar with how their breasts feel and what is normal for them, and not hesitate to report any change or concerns to their practitioner;

Have a regular breast examination by their practitioner, regardless of their risk factors;

Discuss the benefits and risks of mammograms with their practitioner and consider a yearly or biannual mammogram between the ages of 40 and 50 and have a yearly mammogram starting at age 50; and

Ask about getting a more sensitive digital mammogram if your breasts are very lumpy or dense.

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