You gotta know when to hold ’em

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.


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10 responses to “You gotta know when to hold ’em

  1. Great title. Now I’ve got that song stuck in my head.

  2. You’ve summed up my dilemma well. It’s hard to know what’s best to do.

    I actually have gotten harassing calls from my doctor’s office about it. When I pointed out the new guidelines, they’d never heard of it. Acted like I was majorly deluded. I told them to go look it up. And this was not long after a major publicity campaign debating the various guidelines!

    • MomTFH

      The resident actually left the room and consulted with “a colleague” about the USPSTF recommendations before coming back to talk to me about them. (I have suspicions the colleague may have been Google).

  3. Jay

    The American Cancer Society recommended the baseline at 35 years ago, with no data to support it. Whatever society it is that represents radiologists used to recommend it but no longer does. And yet it persists like a bad smell.

    I have large, cystic breasts. I’m at average risk – no pregnancies, also no excess EtOH intake, no family history, short-term hormonal birth control use. I knew I’d have an abnormal mammo and decided to wait until age 50 to start. Then I found a lump in my breast when I was 45. I had a diagnostic mammo which, indeed, was abnormal on the OTHER side. Lump turned out to be benign and I am scheduled for my next mammogram this year (I am now 50).

    • MomTFH

      I thought it was the American Cancer Society, but my Google power failed me when I tried to find it.

      It wouldn’t be as frustrating to me if it was a completely benign procedure.

  4. Val

    Think I got y’all all beat 😉 – had my first mammogram @ age 25 when [clinic which shall remain unnamed] was going on their wild tumor-hunt!
    But I didn’t have my next one until age 45:
    I know I’m prone to the same fibrocystic lesions as my mom, so after the biopsy I haven’t rushed back for my next one… It can wait until age 50!

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