Screening mammograms in the U.S. have reduced the death rates of women ages 50-74 from breast cancer by over 67%. Yet there is insufficient data to know if the same benefits occur in women less than 50 or over 75. In the U.S. most women begin their breast cancer screening at 40 but in England they don't start until 50 and then it is only every other year. So which is best, does it even matter?

Several recent reviews have been done and the US Preventative Health Task Force attempted to tackle this issue. What they found was that if we continue to screen women annually until they are 79 we get an additional 8% reduction in breast cancer deaths and if we lower the age of screening to 40 we get an additional 3% reduction. So this sounds good, right? Well, to save one life of a women in her 40's one thousand mammograms would need to be performed. At an average cost of $102/mammogram, it would cost $102,000 to save that one life (though the person whose life was saved thinks it was worth it). Also for every 1000 women screened annually at the ages of 40-69, 2250 false positives would occur (that's when you have something show up on mammogram, have additional testing and it turns out to be nothing). Because of these costs involved, the number of false positives and relatively little (though significant) gain in cancer detection, the recommendation changed to every other year screening starting at 50. That is when all the controversy began. How young is too young to screen and how old is too old?

A recent review article showed that the death rate of women aged 75 to 84 who didn't receive screening mammograms was two times higher than those who did. With our aging population, it will take years before we will know the true risks/benefits of screening in this age range. A similar delimma is encountered with younger women.

I've had two women this past year in whom breast cancer was found in their 40's, one at 42 and one at 45. I joked with them that saving their lives was not 'cost effective.' They chuckled but then realized that's exactly what the new recommendations were implying. Medicine is quickly becoming more of a business and less the practice of a healing art. National recommendations address population health not individual health. What about the woman who has smoked 20+ years, or who never breast fed, or who started her periods at an early age, who's mom had breast cancer? This is where a physician with years of training and experience can help each individual decide what is best for them and not apply the cookie cutter, one size fits all model of health care that is becoming the new norm. We create potential patient risks when we take general information and attempt to apply it to all women without taking into account their individual risks.

All of that is to say, Ask your doctor what's right for you. Only someone who knows your history, current health status, concerns, risk factors, ect. . . . can help you decide which screening regimen is right for you.