Screening Mammograms: When Should You Begin?

In a recent article on breast cancer screening, I noted recent changes in the recommendations of the Canadian Task Force on Preventive Health Care. The national organization did not recommend regular screening mammograms for women under the age of 50. Though mammograms detect breast cancers better than any other screening test in women between the ages of 40 and 50 – and save lives, the Task Force argued that this benefit was outweighed by the risk of false positives (abnormal screening mammograms later shown not to be cancer). The “harm” of the false alarms consisted of further diagnostic procedures, including biopsies and the resultant fear, anxiety and distress this causes.

In our province, the Screening Mammography Program continues to screen women annually beginning at age 40 and every 2 years from age 50 to 79. It remains a cost effective program that saves women’s lives.

On October 24th, Dr. Ian Gardiner, a radiologist with expertise in breast imaging – and my medical school classmate – presented a review of the evidence at the UBC Radiology Grand Rounds. He showed that annual screening mammography beginning at age 40 conferred a definite survival advantage.

If women did not start screening until age 50, a significant number of women would die with the late detection of cancer. With any breast cancer, the earlier the diagnosis, the better the survival rate.

He noted that 24.7% of breast cancer cases were women in the 40 to 49 age group.

If you are a woman considering when you should start your regular screening mammograms – as with any other medical procedure or treatment, consider the relative risks versus the benefits.

For most of my patients, the risks of emotional distress caused by false positives are outweighed by the benefits of early detection and improved survival. The risks of not starting regular screening mammograms at age 40 are life-limiting and devastating: missing cancers, discovering them at a later stage and increasing the risk of death.

The mammogram remains the single best screening test for breast cancer.

Women between the ages of 40 and 79 may book the test themselves through the Screening Mammography Program of B.C. (www.smpbc.ca, 1-800-663-9203 or 604-877-6187).

If you have breast symptoms – including a lump, tenderness, skin changes, palpable lymph nodes or nipple discharge, you should see your physician as soon as possible. Don’t wait for a screening mammogram. You would need a careful examination by a physician and other appropriate diagnostic tests.

All women should talk to their family physician about breast health and the timing of the most appropriate screening tests for breast cancer. A new free service is available to any woman in Greater Vancouver who is concerned about her personal risk for breast cancer and would like to attend workshops to reduce the modifiable risk factors through healthy lifestyle changes, including maintaining a healthy weight, increasing physical activity, eating a healthy diet and limiting alcohol consumption. The Breast Cancer Prevention & Risk Assessment Clinic is funded by the Canadian Breast Cancer Foundation – BC/Yukon Region. There is no cost to attend. For more information on this empowering resource for women, contact the clinic at (604) 603-5140 or breastcancerprevention.med.ubc.ca.

When one of my patients is diagnosed with any cancer – including breast cancer, in addition to appropriate standard medical therapies, I recommend they attend Inspire Health, where they will have a choice of a variety of evidence-based medically supervised complementary therapies, including nutrition, herbs, yoga, acupuncture and meditation. Inspire Health (inspirehealth.ca) – a non-profit clinic founded by pioneering physicians, Dr. Hal Gunn and Dr. Roger Rogers – treats the whole person in a positive and empowering atmosphere.

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About Davidicus Wong

I am a family physician. I write a weekly newspaper column, Healthwise for the Vancouver Courier, Burnaby Now, Royal City Record and Richmond News.
This entry was posted in Empowering Healthcare, Healthy Living, Preventive Health, Screening Tests and tagged , , . Bookmark the permalink.

2 Responses to Screening Mammograms: When Should You Begin?

  1. Tracy says:

    Dear Dr Davidicus, thank you for this article. In the uk screening doesn’t begin until 50. I developed breast cancer at 42, as did a number of my relatives. From my research, I understand that as well as making up almost a quarter of all breast cancer cases, age acts against women in the survival statistics i.e. the younger a woman is at diagnosis the less optimistic the long term survival stats prove to be. I think this is because cancers in younger women tend to be more aggressive and fast growing. I would urge women to go for screening if available. A biopsy is a small price to pay for a long life and as we don’t currently know which cancers will become killers (I know women who were node negative with “common” tumour types who’ve gone on to develop mets) I believe all cancers should be investigated and treated.

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