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Ask the Medical Expert Archives 2000-2004

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Early Breast Cancer Screening

Q. It seems that younger and younger patients are getting cancer. Is it advisable to request a mammogram for patients in their early 20s who have a family history of breast cancer? Would you recommend this for all patients or just those with a family history?

A. Mammograms are an effective way to try to catch breast cancer at earlier stages (and hence more likely to obtain a cure). For a female patient with a family history of breast cancer in a first-degree relative (mother or sister), I begin screening the patient either 10 years before the youngest age of the relative, who has had breast cancer, or by the age or 35.

For example, if the mother has had breast cancer at age 35, I would begin yearly mammogram screening at age 25 with a physical exam of the breasts each year beginning at the same time.

Up to 10-15% of breast cancer may only be detected on palpation of the breasts and may not be seen on mammogram. A self-breast exam may or may not be helpful. Studies are inconclusive. For routine mammogram screening for patients without family history, the American Cancer Society guidelines recommend a baseline mammogram between ages 35 and 40. At age 40, women should be treated annually.

There is no specific upper age for terminating screening, but it depends on the overall health and life expectancy of the patient. Also, for those patients at increase risk of developing breast cancer, there is now a FDA approved drug, Tamoxifen, that may help to reduce the risk of developing cancer. Also, one-day genetic screening may be more clinically useful to help determine future risk of developing various cancers and help guide treatment options.

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