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Ask the Medical Expert Archives 2000-2004

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February 2000

Q. Should I get a mammogram?

A. There is little debate about the value of mammogram after age 50 years. Women who get a mammogram decrease their risk of dying from breast cancer by 25%. This has been shown in multiple studies around the world.

The big question is whether mammography is a good idea for women between 40 and 50 years of age. (The recommendation for a "baseline" mammogram at age 35 has been dropped.) In most of the world, women are NOT encouraged to get a mammogram until they are 50 years old. In the United States, this topic is the center of intense controversy. This controversy is fueled by the lack of sufficient evidence to make a definitive recommendation. Without evidence, we are left with our best guess about what to do.

Currently, the American College of Obstetricians and Gynecologists (http://www.acog.com/) and the American Cancer Society suggest women in this age range get a mammogram. For the woman who fears the cancer and is willing to accept the risks of mammography (primarily a false positive test leading to unnecessary concern and biopsies), this seems a prudent course.

On the other hand, the American Academy of Family Physicians (http://www.aafp.org ) and the American College of Physicians believe that women should be told of the known risks and benefits and decide for themselves. For example, a woman who has less fear of breast cancer, hates the mammogram procedure, and doesn't what to do anything that might cause harm (see preceding paragraph) without having documented benefit, might choose to wait until she is fifty.

While there is even less evidence in favor a mammography in high risk women, such as those with a family history of breast cancer, most doctors recommend a more aggressive screening approach for these women.

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