What do you think of the new guidelines discouraging mammograms for women under 50?

A new government study has recommended that most women not get mammograms until they reach age 50. It also suggests that women stop doing breast self-exams. What do you think of the new guidelines discouraging mammograms for women under 50?

Responses texted to MPR:

I am a 16 year old girl, and if my mom had not had her routine mammogram when she was 41, she would be dead now. I don’t know how i could live without her. -Michelle, Minneapolis, MN

The age and frequency of mammograms should be decided by the patient and their doctor based on medical and family history. Also with higher rates of cancer every year it seems dangerous to recommend less screening when it has been proved early detection saves lives. -Sarah Fahey, Eagan, MN

Responses from the Public Insight Network:

Despite being low risk, I had a base mammogram at age 35 and yearly mammograms starting at age 40 as recommended by my doctor. This year my mammogram results appeared irregular and I went in for more tests. The end result was that at age 43 I was diagnosed with breast cancer. I underwent a mastectomy a short time later. Where would I be at age 50 without having had a mammogram? Quite likely six feet under. Is it not worth others to undergo a bit of discomfort and/or the possibility of a false positive so that lives like my own can be saved? -Jennifer Hartman, Los Angeles, CA

I was sent for one, but because I don’t have health insurance (I’m a part-time community college instructor), I couldn’t afford it. Frankly, I’m relieved the age limit has been moved upward. Now I can coast for 5 more years. -Jennifer Rueda, Hillsboro, OR

Recommendations for maintaining health are dubious at best–witness how Vitamin E, hormone replacement therapy, and calcium supplements were first vigorously recommended and now have been debunked by rigorous studies. It is always difficult to determine what to do as an individual. I recently read that colonoscopies, which are strongly recommended, miss about a third of colon and colorectal cancers. People must make the best decisions they can with the information they have–information that is almost always incomplete. -Carol Henderson, Minneapolis, MN

Agree totally. I am a physician. I have spent last few years discussing with friends the lack of data showing the benefit in women 40 to 50 with no family history, and ample evidence of harm in increased procedures. Ditto BSE. Because of official guidelines, none listened. Three of five required ultrasounds and one required biopsy, all normal. -Te Pazdral, Cambridge, MA

My sister-in-law discovered stage 1 Breast Cancer because of her yearly mammo – she was 45 and had no family history and none of the risk factors – she is thin and athletic and eats an extremely healthy, low fat diet and never smoked. The mammo saved her life. Even one life is worth saving. -Alice Potter, Westminster, CO

I understand the reasoning behind the new recommendations – that the benefit to a few is less than the harm of misdiagnosis of many. But I wouldn’t want to be that one in whatever that does develop cancer in her 40’s (like my sister). -Christine Hopkins, Oceanside, CA

If there is real evidence that mammograms in 40-year-olds don’t find that many tumors, then it makes sense. However, I know of 2 women who had breast cancer before they were 50, one of whom who died of the disease. -Lynn Hoenke, Grand Rapids, MI

I think it is irresponsible. One of the reasons they are giving for reduction in number of mammograms is that biopsies are stressful. I have had one and it was very stressful, although it turned out negative. But how much more stressful would it be if you found out you had cancer that had gone on for a long time undetected? -Nancy Snyder, Muskegon, MI

I concur with the guidelines. Some people forget that irradiation itself is a cancer risk & should be balanced against other factors. Sex-related organs have less protection against cancer because of their generative functions; breasts are primarily fatty tissue which tends to collect toxins from the body. Put all this together and x-ray it every year for several years & the process may very well be more risky than the prospect of cancer. Doctors don’t like to come right out & say that irradiation itself bears a certain risk because that would frighten women off, but it’s true. YMMV: testing depends on one’s personal profile. -Susan Williams, Lakewood, CO

I’m disgusted and outraged. It’s another strike against womens’ health care. Literally overnight, decades of teaching women the importance of breast care awareness was deemed irrelevant. It’s a huge disservice to women who may have been on the fence about having this exam, and for families who have a history with breast cancer. -Susan Sheridan Tucker, Edina, MN

This is a paternalistic attempt to save the insurance companies money. Regardless of the protestations of the committee you can bet that the insurance industry will site these recommendation as a reason to stop paying for mammograms. Also I don’t think GP physicians will recommend before 50 mammograms because they are not trained enough in the disease. -Janice Farringer, Chapel Hill, NC

Because I have “lumpy” breasts, i had my first ultrasound at 28 and my baseline mammogram at 36. I started annual screenings at 40, but am thinking about changing that schedule to every two years. I value my drs’ opinion so that decision will hinge a lot on what they recommend. There is no history of breast cancer in my family so I’m not too worried. This will also help me to be more faithful with monthly self exams. -Tracey Dissel, Durham, NC

This amazes me (in a bad way)! As I understood the news program I heard, the study found there weren’t enough cancers found to justify the mammograms starting at 40 and breast self-exams. Any woman in those categories who has been diagnosed early and treated isn’t going to think it wasn’t justified. I personally find it reassuring to have had the mammograms and to have done the self-exams. -Terry Wagner, Aloha, OR

My grandmother died of breast cancer at the age of 56. My best friend died of breast cancer at the age of 43, she was diagnosed at 36 and it was already too late. My major concern is not so much the mammogram recommendation as the recommendations regarding self exams. Apparently I will have too much anxiety if I do self exams. Given the history – I will have much more anxiety if I don’t. I think it is dangerous to suggest that self exams are not important. -Angela Speck, Columbia, MO

I think it is absolutely the worst idea I have heard in a long time. I have a 47 year old friend diagnosed with breast cancer a few months ago. When they found the cancer it was stage 4 and in the lymph nodes. Now it has spead to other organs with a dismal prognosis. Why in the world would these guidelines change now? …after finally educating women on breast health. The is not good news for women. There is a trust factor here. If what we were told for 15 years is not good advice, shouldn’t it have surfaced sooner or at least be questioned? -Brenda Vaughan, San Antonio, TX

I find this confusing and problematic. The new guidelines do not recommend mammograms or even self-exams. Are our ob/gyn doctors exams supposed to be the means of discovery for women under 40.? The doctor interviewed on All Things Considered discussion yesterday was speaking from statistics — collectively we’re all at lower risk between 40 and 50, collectively there are 2 times as many biopsies given after home exams. How is that aggregated picture balanced against individual histories of people who are at risk? -Sarah Herr, Tucson, AZ

I think that each woman should have a personal treatment plan based on her history. However I have come to believe that for women with fibrocystic disease annual mammograms cause repeated tissue damage that may actually aid in the development of cancer. So I would agree that reducing the frequency would be beneficial if and only if MRI is available in the off years. -Adelle Popolo, Orlando, FL

In the 1990s. a physician wrote an article in Atlantic Monthly in which he was highly critical of routine mammogram practices. Although not a physician, I am a scientist. His viewpoint was compelling to me. When I began taking HRT, however, a yearly mammogram was a price I was forced to pay in return for HRT prescriptions. The new guidelines liberate me by allowing me to do what I have wanted to do for years–treat routine mammograms as a “less is more” procedure. -Jennifer Clark, Washington, D.C.

I am 38 years old, and I went for my annual check-up yesterday. While there my doctor brought up this report, and suggested that I go ahead and get my first mammogram now because she is worried that by the time I am 40 insurance companies may not be willing to pay for them. -Leigh Robbins, Charlotte, NC

I think you have to use your head. If you have a history of cancer in your family or engage in risk-taking behaviors like too much caffeine and smoking, then you should get a mammogram once a year. If you do a self-examination once a month or so and have no hereditary risks or behavioral risks, you should decide for yourself. People don’t take enough responsibility for their health; they blame it on the other guy–or McDonalds. I decide for myself what’s right for me and you should, too. -Susan Kirkland, Burnsville, NC

I’ve been fine so far. In fact, I asked my Dr. last year if I could start getting them every other year and she said that at my age, it’s more important than ever to get them every year. I’m 67. But I’m wondering about the insurance aspects for those women under 50 who wish to get a mammogram regardless of the guidelines. -Ann Swaney, Traverse City, MI

I am 61 years old. When I was in my 40’s, one “baseline” mammogram was recommended; annual screenings were not recommended until 50. I started getting regular mammograms at 50, every year at first, then every other year. My doctor has been OK with every other year. I have not had any issues after my screenings, however, last time I was called back to have a sonogram. -Mary Sanada, Carson City, NV

My mother died at 62 of breast cancer which had metastasized. One sister had breast cancer in each breast and had removal and reconstruction. Her daughter had cancer in one breast and had a mastectomy and elected to have the other breast removed. A second sister does not have breast cancer issues but her daughter just had a mastectomy and also elected to have the second breast removed. All of us had breast cancer before fifty. It seems to me that the recommendations of the federal health panel do not have those women with the breast cancer gene in mind. Those with the gene, typically develop breast cancer well before fifty years of age. -Clara Alexander, Denver, NC

While I understand the reasoning at a macro level, individual women will die as a result. Are the lives of those women less important than the overall cost? I know how I’d feel if I or my loved ones were one of the women who’d die. -Barbara Skoglund, North St. Paul, MN

Share your reply in the comments: What do you think of the new guidelines discouraging mammograms for women under 50?

  • Linda Snouffer

    Had I waited until my fifties to have a mamagram, I probably wouldn’t be able to comment on this question. I had a routine mammagram at age 42 and discovered that I had breast cancer. I chose mastectomy, needed no chemo or radiation, and NEVER have to worry about breast cancer again. I consider myself very lucky. Perhaps I was the statistic quoted by the CDC: the 1:1000 lives saved by early mammography.

  • Reggie

    I think it’s unconscionable of the medical profession to try to save money on the backs, or rather the breasts, of women. Sure, mammograms cost money, but they’re a heck of a lot cheaper than the treatment for breast cancer, let alone the cost of the lost work days while the woman is recovering.

    If this was a common cancer for men you can bet there would be no recommendation to cease and desist in this war. My mother and grandmother suffered greatly from breast cancer and you can bet I will continue to get an annual mammogram, even if I have to someday pay for it myself. Oh wait, I bet that’s what they want…saves them more money!

  • http://www.ovalgon.com/gh Gabriel

    I wonder how much of the risks of mammograms are because of our particular health-care system rather than inherent to mammograms. If there are risks to biopsy and surgical procedures to remove benign tumors then apparently doctors have been using these procedures more than their risks would indicate appropriate, most likely in order to make more money. Another argument for health care reform. However, once the reform comes, might not the risk pendulum swing back in favor of yearly mammograms? What do medical bodies in other countries recommend? Were any of these studies done in other countries?

    This result is also not encouraging for the relationship between women and scientists. Women tend to be stereotyped as unable to take advantage of many of the benefits of science because of an inability to deal emotionally with the unfamiliar risks involved, whereas scientists tend to be stereotyped as emotionally stunted and unable to offer the benefits of science to women in an emotionally satisfying package. Does this outcome mean we have scientifically proven both these stereotypes to be true (at least on average)? If so, that’s pretty sad.

  • Jo Anne Murphy

    I too was saved by a routine annual mammogram that detected a very agressive form of Invasive Ductal Carcinoma at age 46; my sister was saved as well at age 48 in the same year. We had no history of breast cancer in our family. What do I think of t his recommendation? Re-read my previous statement.

  • Lisa Payne

    I am shocked that the medical community would even entertain the idea of advising that mammograms are not necessary until age 50. This of course will be followed shortly by the insurance industry changing their coverage of such a vital early-diagnostic tool. (Oh wait, maybe that’s the whole point!) At a time when health care reform is trying to push a heavy cart uphill toward preventative medicine that could save society and government money in the long term, this move is incredibly short-sighted. My sister was saved from an aggressive form of breast cancer at age 36, just after insurance companies offered coverage for first mams at age 35. She is now 45 and cancer-free, and her children, husband, and I are blessed and grateful!

  • Doug

    My daughter did a self exam and found a lump. She went to her doctor who said it was nothing BUT if she really wanted a mammogram he would refer her on. She insisted on a mammogram and began treatment for breast cancer in January of this year. She went through 5 months of chemo, radical surgery followed by radiation, and now after care with treatments to hopefully minimize a recurrence. MY DAUGHTER IS 36 AND THERE IS NO FAMILY HISTORY OF BREAST C ANCER IN OUR FAMILY. I challenge “these experts” to convince my daughter that OVERALL their recommendations are the best approach.

  • Steven

    Recommendations about prostate cancer screening have been moving in the same direction. The results of the research may be counter-intuitive, but ignoring science tends to get us into more trouble than otherwise.

  • Christine

    The Minnesota Breast Cancer Coalition supports the USPSTF recommendations. We need to keep in mind that the Task Force makes recommendations for public policy and therefore they must see the big picture & examine the evidence provided by studies of thousands of women. I urge the media to focus on the content of the article published in the Annals of Internal Medicine rather than focusing on anecdotal stories. As we all know, the plural of anecdote is NOT evidence. In the paper, the Task Force states “The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.” Women are urged to discuss their own situation based on their family history & personal concerns.

  • http://www.idealpolicy.com Rose

    How much of the this change is driven by the influence of insurance companies? Consider, as the insurance companies are pushed to reduce the procedures they will be reimbursing why wouldn’t they have a “list” of those procedures which provide them with a lesser return on their spending dollars.

    I’ve lived through many flip flops in advice by public agencies where one year it is a must the no longer needed. I’ve been skeptical that these course corrections are not politically or profit driven.

  • Joanna

    I have a terrific doctor (now) with whom I have a relationship of trust. However, this was not always the case, and I have often had to struggle to get the care I needed, especially when I was much younger and uninsured due to poverty. The recommendations of this panel may make some kind of scientific sense in a world in which EVERY woman had access to affordable, caring attention from a trusted physician regardless of economic situation. Given that this is not the case for millions of citizens, the people who will be least likely to have access to the referral before age 50 will be the poor, the uninsured, and those who are already not routine users of the health care system. The benefit of the recommendation for screening to begin at age 40 is that is takes the burden of responsibility off the woman and puts it on the doctor/clinic, thus making it more likely that women with no history of breast cancer in the family will get early screening. It allows clinics who serve the poor to recommend screening without having to fight on a a case-by-case basis with insurance providers. The same kind of confusing recommendations exist around the issue of routine pap smears,by the way, a procedure that entails NO risks to women, and that can save many lives from cervical cancer if done yearly.

  • Stephanie Wilkes

    As a young woman with a history of breast cancer on both sides of my family, I find these guidelines not only misleading, but downright appalling.

    Each of my aunts learned of their cancer from a mammogram; one was 35, one was 46. Both have gone through treatment, and are at the moment healthy and grateful that they were able to learn of their cancer in time to successfully treat it.

    With knowledge of my family history, I planned to get my first mammogram at age 35. To learn that insurances companies may stop covering mammograms before age 40 (or eventually 50) is worrisome, to say the least.

    I would like to think I would still be able to afford them myself, but what if I can’t? And what about those who know they can’t?

  • Linda

    Appalling! What kind of logic is it to reduce screening for breast cancer to spare women the chance of false positives and possible biopsies, when regular screening is proven to save many lives! I think most women would prefer having a false positive rather than finding out too late they have breast cancer. It makes one suspicious as to this group’s motivations!

  • Mary

    If they don’t want to make mammograms compulsory until after the age of 49, fine. However, I am not going to stop doing self-exams and I think it’s foolish for people not to check themselves and talk to their doctors about what they’re feeling or seeing. To me, that’s common sense.

  • Lynn Freeland

    I believe these recommendations are driven by everything but medical factors. Insurance companies will love this and ‘take it to the bank’ while young women die.

  • Nancy Harold

    These “guidelines” are crazy! Many women have found their own breast cancers through self-exam (including me.) Why would anyone suggest not doing them? The new “standard” of no mamogram untll age 50 seems to be a way to avoid paying rather than a way to save lives. My personal story is that I had breast cancer at age 34 and then at 43. There was no known family history. By the time I had a mastectomy, the cancer had progressed to the lymph nodes. With breast cancer being so pervasive and still so deadly if not caught early, why would anyone suggest this ridiculous new plan?

  • Deborah

    Who’s in charge? The Medical community or the Insurance co’s? To suggest that mammograms are unnecessary until age 50 or above is already deplorable, but to also suggest that breast self examination is also unnecessary and may be to stressful is despicable!! HAVE WE GONE BACK IN TIME? At one time in America’s past it was deemed “To stressful” for women to vote.

    Hats off to Mayo clinic which is putting the welfare of their female patients before their lust and desire for insurance lobby dollars.

  • Andrea

    The reports I have heard say that the self exams and mammograms don’t save lives before 50. What about those cancers that were caught before they spread to lymph nodes and other areas. What about finding cancers that only require a lumpectomy and not radical mastectomies? Do mammograms find those? Do self exams find those? I think they probably do.

  • Amy

    My mother found a lump on her own in her breast at age 42 and after a biopsy, was diagnosed with breast cancer. By the time she found it, the cancer had already gone into her lymph nodes, which for a breast cancer diagnosis means there really was no curing it, just treating it. She passed away 3 years ago, at the age of 48. We have NO history of breast cancer in our family. If she had followed the original guidelines for mammograms (age 40), she may still be alive right now.

    I am saddened and discouraged by this recommendation–to me this recommendation is saying that my mother’s life (and any woman’s life) is not worth as much as the financial savings of those ten years of mammograms.

  • Karen

    I was 44 when my breast cancer was diagnosed. I was low-risk on all factors; I began menstration at the right age, I had my children at the right age, I was a non-smoker and didn’t engage in any other high risk behavior. There is no cancer – of any kind – in my family (we tend to die of heart disease). I would be dead by now under these new “guidelines,” and my children orphans. Somehow, I can’t quite believe that not getting mammograms would “save” money. They say there’s one case like mine for every 2000 women or so. Fine. Do the math. Add up the life insurance payouts, the social security payouts for my children, the health insurance payments of trying to “preserve” my life (subtracting the cost of the 7 weeks of radiation I had to have, since they caught the cancer so early), and the income taxes I have paid in the years between diagnosis and age 50 (and beyond!). What’s the total?? It’s certainly a bigger number than the actual cost than mammograms for 2000 women over 10 years. Just add up the numbers!!!! And then account for the fact that these are the hard costs only, not the social costs or the moral value of a life.

  • Liz Quam

    This is all about the money: the good of the group rather than valuing the individual. Who cares if a few mothers with young children die — its only a few!! To use as “evidence” that the screening should be eliminated because 40 year old women may have some anxiety about a false positive is sexist, condesending and misses the reality that we agonize through those false positives with our girlfriends and it has been the impetus for many of us to continue to be screened. Liz in Maple Grove

  • Heather Koshiol

    As a 38-year-old woman, I feel fortunate to have already had a baseline mammogram. While I think it’s fine for women to discuss with their physicians whether or not to have mammograms prior to age 50, my concern is that insurance companies will no longer cover costs for those under 50 who do choose mammograms.

  • Sharon in St. Paul

    I think the pullback from the total hysteria about breast cancer is good, but the new guidelines are just confusing and don’t convey the ambiguity of the situation. They are trying to say the suffering isn’t worth it, but the guidelines as stated are very ham-handed. I had the exact same experience as the woman on NPR who had the 3 needle biopsies and the disfiguring biopsy. Cost was over $1500. While I can appreciate the women at risk, who want people like me to go through this for their sake, bless them, but I feel the doctors don’t really know what they are doing. The oncologist couldn’t read the mammogram or sonogram, and so did the biopsy, and only the pathologist said something definitive: that I have fibrocystic tissue, the least prone to cancer. My GP still doesn’t get that and worries every time I see him. When have you heard the media discussing fine points such as this? The lump recurred within 3 weeks of removal during the biopsy, and so I figured it was plumbing, not something that could be excised. I turned to traditional Chinese medicine. They are familiar with my type of breast tissue and have treatments for it. Here I am 15 years later. I will never get another mammogram but do recommend thermography. Safer and not such a misogynistic procedure. Those issuing the guidelines are right that there is much suffering (I know I suffered needlessly and still do, due to the disfigurement) but they don’t explain it well, perhaps because the whole issue is very nuanced. I think women should get informed and not react to medical hysteria, but also should insist on diagnosis and treatment when their intuition dictates.

  • Meg Kosowski

    One of the main reasons stated for deterring women from receiving mammograms is that frequently, false-positive results cause undue stress. If the volume of false results is so high that women are advised to avoid the test, logic would dictate that the test method should be re-evaluated, NOT that women should avoid seeking care.

  • E in Mpls

    1) Assuming that every woman has the ability to have a “personal discussion with her physician” is like assuming pigs will fly.

    Maybe all the money the insurance companies will save, by not paying for mammograms, can be spent to actually provide women with access to physicians?

    2) the idea of not doing self-exams (cost: $0) is ridiculous. I don’t, because of what someone above called “lumpy breasts”. There’s no much point in my case. But to recommend *no one* bother to do something that will help, that has no risk to performing it? What led them to think this was a good idea? (which I do not mean as rhetorical, but quite serious – why? Or does someone know *where* that information is?)

  • Vicky

    A Mamogram saved my life! I went in for a routine mamogram 2 years ago at the age of 44. They did a biopsy the next week and surgery soon after that. My radiologist and surgeon both said that by the time I would have been able to feel anything with a self-exam, my cancer would have progressed well beyond stage 1. I am apalled that anyone would suggest that the cost of mamograms is not worth the small number of lives it saves, and then to discount self-exams. The best thing to do is take charge of your health, get that mamogram, do self-exams and a live a healthy lifestyle.

    A friend who is a surgeon told me I was more likely to be hit by a bus than develop the cancer that I did. As long as the odds are not zero, I will do everything possible to protect my health.

  • Blaise Vitale MD

    I am a family physician who agrees with the new recommendations. While everyone agrees that breast cancer is a bad disease, and that mammograms done after the change of life save lives, these recommendations clearly show that many mammograms are needless.

    I am aware of much of the data related to mammograms in the 40’s. Most studies show absolutely no benefit – meaning that people are just as likely to die of breast cancer if they get a mammogram compared to not getting one. The few studies which do show a benefit suggest that I would have to screen every single women in my practice every single year during their 40’s and I MIGHT save one life over my entire career. This contrasts with the 3-4 new breast cancers I find every year after the change of life by routine mammography (and practically none of these women die). The American College of Physicians (the society of internal medicine specialists) has already come out against routine mammograms in the 40’s.

    I also think that the news media’s reaction has been inappropriate. This is a recommendation related to primary care medicine. Why in the world is the media only asking for opinions about these recommendations from specialists (and particularly breast center specialists who have financial incentives to keep the system the way it is)?

    If a test doesn’t save lives, is frequently wrong (causing needless additional ultrasounds and biopsies), is painful, and expensive, we should NOT be doing them as a ROUTINE. These guidelines certainly do not prevent a woman’s personal physician from ordering a mammogram for women who have breast complaints or a family history of breast cancer. I worry about the women who have bad experiences in their 40’s who then don’t have mammograms in their 50’s or 60’s when the tests are valuable.

    While we want to do everything possible to prevent breast cancer deaths, routine mammograms for women in their 40’s are NOT the answer.

  • Gerald L. Myking

    Sounding like a broken record and a conspiracy theory fruitcake, I could not help but notice that most all of the response’s from cancer survivors were from women in their 40’s, the last of the baby boomers. In my family breast cancer has struck 4 times. The youngest in her forties now had it in her thirties. I always get suspiscious when the government flip flops. What I do know is that DDT has not been used for over 30 years and the baby boomers were the last generation to be exposed to above ground nuclear testing. The air, land, and water in every county in the U.S. was contaminated with radioactive fallout which has since dissipated. The government claimed it did not know the risk of long term low level radiation. In a nutshell I think the government knows the risk has decreased considerably. Call me crazy 20 years from now.

  • Jerri Johnson

    Mammograms are in themselves inherently dangerous because they expose sensitive breast tissue to radiation, which over a lifetime can contribute to causing cancer. A better approach is to use thermography, which is a non-invasive, safe way to detect breast cancer by measuring heat patterns in the breast. A tumor has a rich supply of blood vessels and thus more heat is detected.