Kokomo Tribune; Kokomo, Indiana

April 18, 2013

Studies causing mammogram confusion

Doctors support screening at 40.

By Ken de la Bastide
Tribune enterprise editor

Tipton — A number of recent studies are causing confusion among women about when they should beginning getting an annual mammogram.

Studies over the past few years have indicated women should wait until they pass the age of 50 or begin at a younger age if they have dense breast tissue.

Local physicians are still following the recommendation by the American College of Obstetrics and Gynecology which says the time to start is age 40, or earlier if there are recognized risk factors.

“Some of the confusion is being caused by different organizations putting out opinions,” Dr. Cecelia Powless, with the Community OB/GYN Group, said. “You have to determine which you will align to.”

Powless said the American College of Obstetrics and Gynecology has no financial interest in what it reports.

“There is a big difference between a government sponsored and private group doing the study,” she said. “Our goal is to educate people.”

Powless said her patients are not raising the issue of the recent recommendations. She said the 2009 furor over not getting a mammogram until after the age of 50 quickly died down.

Dr. Maryann Chimhanda with St. Joseph Hospital, agreed that several organizations are making recommendations, but the American College of Obstetrics and Gynecology has not changed its recommendation.

“I usually recommend a mammogram starting at the age of 40,” she said.

“Most of my patients haven’t asked me,” Chimhanda said of the various studies. “We try to educate patients a few years ahead of time.”

Powell said 10 percent of mammogram x-rays may show something abnormal and require an additional view. She said 10 percent of the findings may be cancerous.

One study done by the private U.S. Preventive Service Task Force said exposure to radiation presents a risk to women who receive mammograms. That group recommends women start getting mammograms at age 50 and questions the benefits for women over the age of 75.

“A mammogram is a low-risk procedure,” Powless said. “We want to cast our net out wide. We don’t want to miss anyone.”

Powless said the fear is studies mentioning a potential health risk from the procedure will create anxiety in some women, who will stop getting the scan.

“The risk of breast cancer increases with age,” she said. “A woman aged 40 has a 1 to 80 chance of breast cancer. A woman aged 70 the risk increases to 1 in 40.”

Powless encouraged women to get a mammogram every year or two beginning at age 40. She said after age 50, an annual screening is recommended.

“There is a false sense that breast cancer is not happening to younger women,” she said. “Although breast cancer in women in their 40s is less common, they tend to be a more aggressive form of cancer.”

A woman who starts getting annual mammograms at age 40 can add 30 or 40 years to her lifespan, Powless said.

She said dense breast tissue is considered to be more glandular tissue and less fatty tissue. Powless said women with dense tissue tend to be pre-menopausal or undergoing hormone therapy. As women age the glandular tissue is replaced by fatty tissue.

Chimhanda said younger women tend to have more dense breast tissue.

“Patients are aware of what their breast tissue feels like,” she said.

Chimhanda said the recommendation she follows is based on age, since it’s the determining factor.

Powless said reports can impact when a women seeks advice from a physician.

She said the more dense the breast tissue, the less clear the mammogram image. Powless said there is a slightly higher risk of developing breast cancer for those with dense tissue.

Powless said there has been an increased interest in breast thermology as a means to detect breast cancer, but it’s not recommended by any organization.

“The Food and Drug Administration and American Cancer Society have both stated it is not a replacement for a mammogram,” she said. “It can give a false reading 60 percent of the time.”

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