I have been thinking lately about practice patterns and interventions lately. I went for my annual female exam recently, and was chastised by the family medicine resident because I haven’t had a mammogram yet. Gizabeth wrote about a similar discussion with her physician at Mothers in Medicine. She opted to get the mammogram. I argued with the resident. I left with a prescription to get breast ultrasound, which I am unlikely to fill.
I have seen doctors recommend mammograms to patients starting at 35 or 40. I have never personally seen anyone go by the USPSTF recommendations for low risk women to wait until 50.
I told the resident I was going by the USPSTF recommendations, and I thought mammography would be a poor screening tool for me and my particular set of circumstances. I breastfed for a combined three and a half years. I don’t smoke or drink excessive alcohol. I have no relatives with breast or ovarian cancer. I had my first kid in my twenties. Never used hormonal birth control. I’m white. And, my breasts are quite large. There’s not particularly fibrous, I don’t think, but that’s a lot of tissue to try to squish and see through. A lot of tissue to be repeatedly irradiated.
I am not a complete Luddite. I think mammography is an imperfect tool, but obviously saves lives. A recent study called The Swedish Two-County Study showed a life saving benefit to mammography, but according to this Time magazine article (disclosure: I haven’t read the full study yet), “In the study, women aged 40 to 49 in the screening group received a mammogram every two years; those aged 50 to 74 were screened about every three years.”
ACOG recommends ” that women in their 40s continue mammography screening every one to two years and women age 50 or older continue annual screening.”
I am not sure which group recommends screening at 35. but there probably is some medical association representing a specialty that has guidelines starting that young. For myself, I am planning on doing a baseline at 40, then probably not getting many more until I turn fifty, unless something comes up. For my patients, I will start discussing their particular risks and priorities, and we will work from there.