The American Cancer Society recently announced new guidelines for when women should get a screening mammography for breast cancer. The announcement has led to some confusion for women about what is best for them.
Wendie Berg, M.D., Ph.D., is a radiologist, specializing in breast imaging at Magee-Womens Hospital of UPMC and a professor of radiology at the University of Pittsburgh School of Medicine. She provides some information below about when and why women should get mammograms.
Q: Do I need a mammogram before I turn 45?
A: Yes. The entire reason we screen for breast cancer is to find it EARLY, when most treatable and survivable. Breast cancer is the number one cause of death in women aged 35 to 54 years. Mammography has been proven to reduce deaths due to breast cancer in women screened beginning at age 40. We know that 25 percent of all years of life lost to breast cancer occur in women diagnosed before the age of 45.
We also know that some women who are considered at a “high risk” for breast cancer due to known or suspected disease-causing mutation (such as BRCA1 or BRCA2) should begin screening at least by age 30, to include MRI.
Q: What about false alarms (known as “false positives”)?
A: About 10 percent of women having a screening mammogram will be called back (recalled) for extra testing or views. THIS IS NORMAL. Among women called back, 95 percent do not have cancer. If a needle biopsy is necessary, even that is a simple test not much different from a dental filling.
There are also newer techniques, such as 3D-mammograms, that are more able to see cancer and there is less need for recall for extra testing.
Q: What About Screening in Dense Breasts?
A: Younger women are more likely to have dense breast tissue, which can hide cancer on mammography. In women who have breasts categorized as “dense” (heterogeneously dense or extremely dense), adding screening ultrasound after a mammogram can help find more breast cancers. Because ultrasound detects more, there is more to check and ultrasound does also increase the chance of needing a needle biopsy to determine if something detected is cancerous. For more information on breast cancer screening, dense breasts and risk factors, please visit www.DenseBreast-info.org.
Q: Is mammography covered by insurance?
A: Insurance is required in nearly all states to cover the full cost of screening mammography. If requested by a health care provider, additional screening with ultrasound, or MRI is generally covered by insurance after a deductible/co-pay, though pre-authorization may be needed for MRI.
Diagnostic mammography is performed to evaluate abnormalities on screening or when a woman has signs or symptoms of breast cancer. A deductible/co-pay will typically apply for diagnostic mammography.