A year ago, the U.S. Preventive Services Task Force issued what they thought would be a relatively uncontroversial analysis of the evidence and recommended strongly that women get mammograms on a biannual basis between the ages of 50 and 74 which I discussed here.   The recommendation of delaying the start of mammograms by 10 years led to much debate among patients, advocacy groups, and physicians.  Unfortunately, it also resulted in confusion among patients.

The reason for the change is that we know that women who are at very high risk for breast cancer (more than one first degree relative such as a mother or a sister who had early breast cancer) should consider  being tested for the breast  cancer gene (BRCA-1 and BRCA-2) and should have very frequent, early testing for breast cancer directed by a specialist. We also know that women at average risk (no close relatives with breast cancer) do not live longer or otherwise benefit from mammograms before the age of 50. What we don’t know was when women at intermediate risk (several relatives with breast cancer) should begin getting mammograms.

Last week, a study by British researchers was published in the Lancet Oncology, titled “Mammographic surveillance in women younger than 50 years who have a family history of breast cancer.”  The study helps answer the question “when is the right time to start mammograms?”  The answer is – It depends on the patient’s family medical history.

This particular study was designed to determine if women who do not have the breast cancer gene (BRCA-1 or BRCA-2) but do have a strong family history (at least one first degree relatives such as a mother or  a sister with a very early cancer or multiple relatives such as sisters, aunts and cousins with cancer) benefit from annual mammograms starting at age 40. This study found that those women who are intermediate risk for breast cancer (strong family history  but negative for the cancer gene) and were offered mammograms were less likely to die of breast cancer than if they had not received a mammogram.

Because everyone participating in the study received screenings, there was no control group.  This makes the findings not as strong as one designed with control group, but still the results are relevant and important.

In case it’s not readily apparent, the reason not to just offer mammograms to everyone is that  women who are screened when it is not needed are placed at risk of unnecessary surgery and increased anxiety. If a patient would receive no benefit from the screening, then it should not be recommended. From this study we can deduce that in addition to all women over 50 benefitting from mammograms, women over 40 with a strong family history are better off if they get a mammogram  as well.

Based on this study, a woman younger than 50 should know her family medical history and be willing to discuss it with her primary care physician. Based on this study there are some women that clearly benefit from being enrolled in a screening program before the age of 50. If she has one or more close relatives who are  afflicted with breast cancer she should  discuss early screening with her physician.

The holiday season is a great time to talk with family members about health and learn more about one’s family history. A great tool to use for this is found here. After using this tool to determine a complete family history, the  primary care physician can help to ascertain risk status and lay out a plan for early detection and treatment or prevention of diseases. By using this tool a person could find a type of medical screening such as a mammogram that might be of benefit or maybe they’ll just find out interesting information about their family.

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