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To Mammogram or Not?

October 25th, 2016

A Breast Surgery Expert at University Surgical Weighs In 


The importance of mammograms for detecting breast cancer in its early stages is well known. In the past, the wider medical community followed the American Cancer Society’s screening guidelines recommending yearly mammograms for women beginning at age 40 and earlier for women with additional risk factors. It was straightforward and simple to remember. 

But in 2009, the US Preventative Services Task Force made recommendations that were quite different from the easy-to-remember rule. They recommended that women start mammograms at age 50 and only needed to be screened every other year. They also said women could stop mammograms at age 75. 

“Last year, the American Cancer Society released updated mammogram recommendations based on extensive research that found middle ground with the two previous sets of recommendations,” says Laura Witherspoon, M.D., breast surgeon at University Surgical Associates. “Their recommendations also caused quite a stir by allowing for later initial mammograms (age 45) and moving screening to every two years at age 55.” 

The recommendations by the ACS also said an older woman should continue screening as long as she is in good health and is expected to live at least ten more years.

A Focused Approach to Screening 

Dr. Witherspoon worked with a team of experts at Erlanger that included specialists in radiology, radiation oncology and breast surgery to analyze the literature on screening effectiveness. Together they pored over the research and recommendations made by national organizations and major medical centers across the country to develop focused and comprehensive mammography guidelines for Erlanger. 

The team recommended women have an annual mammogram starting at age 40 and continue past age 55. However, if prior mammograms have been normal, and you don’t have an elevated risk for breast cancer, then you may consider getting a mammogram every two years. 


“All studies about the usefulness of mammograms show there’s a decrease in death rates for women who are screened versus those who aren’t. The research shows that when something abnormal is found on a mammogram in a younger woman, it’s less likely to be cancerous,” Dr. Witherspoon says. “The problem is that we don’t have other ways to find these potentially dangerous abnormalities. We were unwilling to write off a mammogram at age 40 completely.” 

Dr. Witherspoon noted that women who have regular mammograms starting at age 40 have a lower overall death rate than women who don’t. She also acknowledges that their group isn’t an impartial party when it comes to treating breast cancer. 

“I admit my bias toward trying to save women’s lives because that’s my job,” Dr. Witherspoon says. “Eighty percent of women who develop breast cancer don’t have any other risk factors, and we don’t know why. That’s why screening is so important.” 

Understanding Your Risk 

For women who are at high risk for breast cancer, starting mammograms at 40 may not be enough. There are two main things that cause increased risk – having a biopsy where atypical cells were present and a family history of breast cancer. Obesity is also a documented risk fact for cancer in general – including breast, pancreatic, colon and endometrial cancer. 

“When we talk about family history, we’re looking for first degree relatives – a mother, sister, daughter – who has had breast cancer. Women who also have numerous family members with breast or ovarian cancer are at increased risk, and that’s why we need to more closely evaluate and calculate their individual risk,” Dr. Witherspoon says. “For these women, I recommend breast MRI in addition to mammograms, and there are even medications that can reduce a woman’s risk.”

Genetic testing is another component available for women with a strong family history of breast or ovarian cancer to identify genetic abnormalities. Genetic counseling and testing wasn’t an option 15 years ago and is now commonly used by patients to make the most informed decisions about their health. 

The Highest Level of Care 

The breast surgeons at University Surgical are your advocates. Because of the work they do, they see many women who fall into the high risk category for breast and other cancers. And they have the skills and expertise to provide the most effective surgical treatment for breast cancer.

“I see women regularly who come in for consultations because they have an extensive family history or their family doctor is concerned, and we begin to build a relationship even before cancer is present,” Dr. Witherspoon says. “We know that finding cancer early is critical. But I also want women to have confidence in me so that if something happens, they know I’m here and ready to provide the best care every step of the way.” 


The bottom line: talk openly with your doctor about your risk for breast cancer, and get a mammogram every year beginning at age 40.   

Posted by University Surgical | Topic: News  | Category: breast health

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