When does one start having mammograms?

[arivecchi]

Just wondering

[bubbaray]

Here, age 40. Free, no referral or requisition necessary from a dr. Just call the Screening Mammography program office nearest you (they also have mobile trucks that travel the more remote areas of the province).

ETA: I assume you mean screening mammograms, not diagnostic. Diagnostic is at any age -- I had my first in my 20's

[infomama]

40 here as well...

[JElaineB]

My gyn said between 35-40 to have the first one. I chose 40.

[arivecchi]

A friend was shocked I had not had one. I am 36 and I had always heard it was 40. Thanks ladies.

[MamaMolly]

I had always thought 40 but recently my doctor said she recommends getting a baseline one done at 35 or 36, then the next at 40. I was still nursing so I chose to wait :bag (not that I think it would hurt the milk, I just thought it would hurt the BOOB. ;)

[bubbaray]

I had always thought 40 but recently my doctor said she recommends getting a baseline one done at 35 or 36, then the next at 40. I was still nursing so I chose to wait :bag (not that I think it would hurt the milk, I just thought it would hurt the BOOB. ;)


My dr won't requisition a non-urgent mammogram, nor tell me to go for a screening mammogram, while nursing. SHe told me it not only hurts but nursing changes the structure of the breast. I waited until I had stopped BFg for nearly a year for my first screening mammogram. That said, I had had a number of diagnostic ones done in the past.

[JBaxter]

Baseline at 40 here but if there is a family history sometimes baseline at 35. My OB said 4 months after the last nursing before getting a mammogram

[ncat]

I had mine at 35ish - early due to family history.

[Twoboos]

Family history so baseline at 30 - thank you dr! I should have had my second at 35 but put it off until just after I turned 37.

[pinkmomagain]

Baseline at 35yo and then yearly at 40yo.

[rlu]

I had always thought 40 but recently my doctor said she recommends getting a baseline one done at 35 or 36, then the next at 40. I was still nursing so I chose to wait :bag (not that I think it would hurt the milk, I just thought it would hurt the BOOB. ;)

Ditto. Family history so 35 but I nursed DS for 2 years so first one was at 38. Going in for my next one next week.

[let73]

Baseline at 35yo and then yearly at 40yo.
:yeahthat:

[HIU8]

I believe it's 40. However, my obgyn wanted me to have my first one before 40 (and after DD was born). I was 37. My grandmother had breast cancer 2x and my mother has benign breast disease.

[ThreeofUs]

35 is the standard here, but we have major research hospitals back-to-back in NE Ohio, and they take a super aggressive stance toward spotting and addressing breast cancers.

[vonfirmath]

Strong family history, so I've had breast ultrasounds since 26 or so and a mammogram at 30 and again at 35.

[DietCokeLover]

A friend of mine just went to her yearly check up (she just turned 40) and her dr said first time with no fam history wait til 42. I always thought it was 40.

[arivecchi]

My grandma had breast cancer so I guess I will call my doc and discuss this with her next week.

[Fairy]

Doc sent me for my first at 36 for the baseline, then once a year starting at 40. I had one earlier than that for pain/lumps -- they were 100% fine. I call it the yearly squeeze. LOVE my place that I go, it's the radiology place in Northbrook Court. A bit of a schlep for you, but PM me if you want more info.

[Melbel]

Baseline at 35yo and then yearly at 40yo.

:yeahthat: My OB/GYN told me not to have a mammo while nursing (in addition to structural changes it could be messy :) ).

[stefani]

Baseline at 35yo and then yearly at 40yo.

:yeahthat:

[inmypjs]

I turned 35 this year, and my OB told me to have a baseline one this year, and if there are no concerns, to have them yearly at age 40.

[arivecchi]

Doc sent me for my first at 36 for the baseline, then once a year starting at 40. I had one earlier than that for pain/lumps -- they were 100% fine. I call it the yearly squeeze. LOVE my place that I go, it's the radiology place in Northbrook Court. A bit of a schlep for you, but PM me if you want more info. Thanks! :waving4:

[Tinkerbell313]

My practise recommends the 1st one between 35 and 40. Then yearly after that.

When I went for my 1st one two years ago...I wa expecting it to be uncomfortable (I am not BFing)...but, I found that it was not...it wasn't cold...it wasn't squeezing feeling (sorry for lack of terminology). I don't know...it wasn't at all what I had expected. And once I start every year...I will be OK with it. I find the bloodwork that I have done every 2 months to be more uncomfotable than a mammogram.

[o_mom]

Family history here, so waiting for BF to end wasn't an option. Started at 32 and roughly yearly after that (didn't do it while pg and waited until about 9-12 mos PP each time). Really was not painful at all, even with BF.

[hardysmom]

The Standard of Care is a baseline between 35-40, then yearly. Generally, most physicians won't push women to get mammos on the earlier side of that range. Tissue is dense, etc, etc...

Free screening clinics usually begin at 40.

I don't believe you can get mammos while BFing or pregnant. The machine squashes your breast to just a few cm thick in order to get pictures. That would be a mess. This is what they mean when they say young women's breasts are too "dense." I had no idea about the squashing thing when I had my first (and last) mammo.

Only 5% of breast cancer cased are diagnosed in women under 40. Mean age at dx is 64. Breast Cancer in young women, though it can happen, is extremely rare.

If you have a 1st degree relative who was diagnosed with breast cancer, particularly if they were premenopausal at diagnosis, you will be screened when you are 10 years younger than that relative's age at dx.

I was dx'd at 39, so my daughters will have mammograms (or whatever) when they are 29.

If you are known (or suspect) to have a BRCA genetic mutation, predisposing you to breast cancer, you may also receive early screening either by mammogram or (ideally) MRI.

MRI screening in younger high-risk women is the way to go. That is how Christina Applegate found her tumor so early. Sadly, getting MRI screening can be a battle so far as insurance is concerned. I believe Ms Applegate was starting a foundation to address this issue for BRCA+ young women.

I was either pregnant, nursing, or exhausted from 35-39. With no family history, getting a mammo wasn't high in the priority list. In retrospect, had I received one during a window between kids, maybe I would have been dx'd before I was node positive.

Stephanie.

[mypa]

I got my first mamogram done at 37, 4mo. into breastfeeding because my doc felt something suspecious. By that time my milk supply had leveled off so there was no "squirting" issue.

[ilfaith]

Figured I'd revive this topic, given the new guidelines announced today...

http://www.nytimes.com/2009/11/17/health/17cancer.html

For the record, I am 40 and have not yet had a baseline mammogram. I got the referral a year and a half ago when I was 39, then got pregnant and am now breastfeeding. I intend to nurse DS until sometime after I turn 41, and would plan to get my first mammogram then, assuming insurance would still cover it for someone as "young" as I am.

[JElaineB]

Figured I'd revive this topic, given the new guidelines announced today...

http://www.nytimes.com/2009/11/17/health/17cancer.html

For the record, I am 40 and have not yet had a baseline mammogram. I got the referral a year and a half ago when I was 39, then got pregnant and am now breastfeeding. I intend to nurse DS until sometime after I turn 41, and would plan to get my first mammogram then, assuming insurance would still cover it for someone as "young" as I am.

I just saw this as well. I am turning 40 at the end of the year and I have not yet had a baseline mammogram. I will definitely ask my gyn about this at my appointment next spring. Her practice is at an academic medical center and they are very much into evidence-based medicine. So if there is no evidence mammograms for women under 50 help I imagine her office will likely revise their recommendations to patients. I have been kind of wary of radiating my breasts yearly, so I can't say I would be unhappy if they changed their advice.

[jenny]

It is a hot topic right now b/c of the new guidelines. I think if you are a 40-year-old woman with no history of breast cancer, the docs will say that you not get a mammogram until age 50 and that you get it every 2 years instead of every year.

If you do have a history of breast cancer in your family or have had breast cancer, the new guidelines will not apply to you.

Women in Europe do not start screening for breast cancer until age 50.

[katydid1971]

I saw Dr. Love who wrote the Breast Book (kinda considered the expert on breast health) on NBC news tonight. She said that the mamagrams at 40 was based on politics not science and 50 is the right age to start mamagrams unless you have a family history of breast cancer.

[hardysmom]

It is a hot topic right now b/c of the new guidelines. I think if you are a 40-year-old woman with no history of breast cancer, the docs will say that you not get a mammogram until age 50 and that you get it every 2 years instead of every year.

If you do have a history of breast cancer in your family or have had breast cancer, the new guidelines will not apply to you.

Women in Europe do not start screening for breast cancer until age 50.

I was a 39 year old woman with no family history of cancer. I'd never had a cyst, a lump, or anything. Breast Cancer was FAR from my list of concerns.

That said, I was diagnosed with Stage IIa Breast Cancer. I had bilateral mastectomy, started chemo on my twins' 3rd birthday, and then had radiation. I am on hormonal therapy to limit estrogen, daily Boniva to prevent bone mets, and will probably have to have my ovaries removed soon because there are not sufficient long-term therapies to treat BC in premenopausal women. Even after all this, I live with a 15% chance of it returning as metastatic disease in my organs.

These are the stakes. If your insurance will cover it, get a freaking mammogram.

At dx, my tumor was 1.9 cm and while I could feel it, it was way in there. By then, it had spread through my lymphatic vascular system and to my lymph nodes. I'm told that it probably took 3-5 yrs for it to grow to that size... breast cancer grows slowly. Had I had a mammo at 35 or 37 maybe I would have had less drastic treatment options.

The guidelines reflect 2 things-- First, that the number of BC diagnosis in young women, particularly young women without history, is VERY small.

Second, the cost-benefit analysis would say that screening young women isn't effective since, from an economic standpoint, you are spending a ton of money to screen a low-risk population.

That said, if you are one of the young women who discover that you have a lump, or "calcifications" who cares about the economics? Surviving breast cancer is all about early detection and young women have NO screening tools to diagnose us before we have palpable lumps, which means that (by definition) we can't "find it early."

"Early" in Breastcancerland means you find it BEFORE you have a tumor. You find it when you have "suspicious calcifications" or "DCIS" or "pre-cancer". Lots of pinked-out older lady survivors actually had Stage 0, DCIS, or precancer which is detectable by mammography... You don't see Stage 0 much with young women. We don't get mammograms. We find it late, after a tumor has not only developed, but grown to a size that you can feel it through our "dense breasts."

And while I am no Mammography Tech, I can guarantee you that while mammos may not be as effective on young, firm breasts as older squishy breasts, they can find a tumor before you can FEEL a tumor.

Because young women are not diagnosed as early, our mortality is much higher than our older counterparts.

The whole thing sucks. That is all I am sayin'. It bites.

So yeah, a mammogram can't find "pre-cancers" as effectively in young women as in older women which leads to chasing ghosts and biopsies of health breasts and a whole lot of stressful crap that drives up costs. Got it. However, a mammogram can find small tumors which are not yet palpable, before they spread to lymph nodes or distant organs.

I totally get why the Standards are changing, but, that said, if your insurance will cover it, get the screenings as soon as you qualify. The health risks associated with mammograms are SO insignificant relative to the potential benefit. They are a hassle and awkward, but oh-what-I-would-trade to get to be squished!

Point is, while it is imperfect, it is all we have.

MOST insurance will still cover mammos at 35-40 for a baseline. Even if your doctor doesn't recommend screenings until 50, if it is covered, get a referral. Just do it.

My (hard earned) .02.

Stephanie

[gatorsmom]

Stephanie, I'm so glad you chimed in. I saw the new guidelines today and it made me sick. As you said, the percentage of young women who get breast cancer before age 40 is small. It's like 3%. But if any of those docs recommending the new guidelines were in that 3%, I'm thinking their opinion of the guidelines might change. Exactly how high does the percentage have to be for mammograms to be important before age 50?

I went to a new OBGYN in the practice I usually go to because she had an open appointment at a convenient time for me. I told her I would really like a mammogram since I"m adopted and don't know my family history. She said I'm too young and the chances are small that I have BC or would get it any time soon unless I had a family history, which I don't. She refused. I reminded her that I don't know if I have a family history- there could be one. She said she doubted it and refused me. So, I went back to my regular OBGYN in the practice a few months later who listened to my concerns and felt a mammogram at age 38 wouldn't hurt. I had had some soreness in my breast that wouldn't go away and was also concerned about that (I had mentioned it to the first doc too who sort of brushed it off). He recommended I get it checked out. The mammogram came out clean and I felt relieved. I can understand that maybe this first doc had a good point, there really is a low risk but frankly I don't like feeling like just a number. I hate to think that 3% is an acceptable number of BC victims.

[tylersmama]

Stephanie, I'm so glad that you posted. I saw those new recommendations today and just cringed. As many of you know, I lost a friend to BC two years ago, and have another fighting BC right now. The first was diagnosed at 30, the second at 32. Yes, the odds are extremely low of younger women having BC, but it also tends to be much more aggressive in younger women. I just can't stand the thought that "respected authorities" are saying that this doesn't do any good, it's not worth it to get mammograms or to do self-exams. So what if the number of lives saved by doing mammograms younger is low? Are those lives any less worthwhile?

Don't even get me started on the recommendation of not doing self-exams...I understand that they aren't that effective. But my friend Amy found her lump through a self-exam. And my best friend *just* found a lump a few days ago through a self-exam (which fortunately was diagnosed as benign just today). So don't tell me that self-exams aren't worth doing.

I feel like these new recommendations are like a big "sorry about your luck/screw you" to younger women who get BC. No self-exams, no doctor breast exams, no mammograms before 50. So how are these women supposed to get diagnosed? I guess they just have to wait until it's too late for them to effectively fight it. :(

[jenny]

I understand that breast cancer is very scary ... cancer in general is very scary. But when you said that a lot of the older pinked out ladies are stage 0, that really struck me.

Stage 0 is not cancer. And it also means that it may not ever turn into cancer. A large population of women are being over treated, having lumpectomies and radiation when they don't need it and living with the consequences of these procedures when they don't need to.

This is why the new recs came out. And this is why a lot of docs are in agreement with the USPTF and why Otis Brawley said a few weeks ago to Gina Kolata that the ACS is going to rethink its guidelines next year.

There is no scientific evidence that screening is beneficial. There is more scientific evidence that it is harmful.

If you are truly into learning more about the controversies of cancer screening, I would HIGHLY suggest you read Gilbert Welch's book: "Should I be Tested for Cancer? Maybe Not. Here's Why"

[hardysmom]

I understand that breast cancer is very scary ... cancer in general is very scary. But when you said that a lot of the older pinked out ladies are stage 0, that really struck me.

Stage 0 is not cancer. And it also means that it may not ever turn into cancer. A large population of women are being over treated, having lumpectomies and radiation when they don't need it and living with the consequences of these procedures when they don't need to.

If you are truly into learning more about the controversies of cancer screening, I would HIGHLY suggest you read Gilbert Welch's book: "Should I be Tested for Cancer? Maybe Not. Here's Why"

I don't even know where to start with this... it is not only controversial, but EXTREMELY complicated.

First, don't ever let a woman with Stage 0 disease hear you say she doesn't have cancer. You want a controversy! There are node-negative women with "just" DCIS who die of breast cancer. It is a small sub-set, but it does happen. Those pinked-out ladies are formidable.

A lot of the recommendations are about economics as much as anything else. That is not a BAD thing. Healthcare costs are out of control. So far as survivors are concerned I am on the wrong side of many issues including the federal mandate for insurance companies to cover expensive, ongoing reconstruction procedures without regard to costs.

Here is the crux of the problem for me... Cancer in young women is DIFFERENT than cancer in older women. Most oncologists in academic settings agree on this. Not only is it more aggressive, there may be unknown environmental causes. We don't know why some women (with no genetic history) get these aggressive tumors, why the tumors are so stubborn, etc. Furthermore, we don't know how to treat young women with breast cancer, particularly young women with hormonally driven cancers.

Furthermore, it is a WHOLE different thing to "wait and see" when DCIS is found in a 65 yr old than in a 35 yr old. As mentioned, these cancers are very slow growing, particularly in the older set who have low hormonal levels. I do not dispute the recommendations for this group. I think they are similar to the Standards used for older men with Prostrate Cancer.

I also do not dispute moving to mammograms every 2 years. That is reasonable. Problem is that you can't FIND Stage 0 cancer without mammography, period. Without having mammos, the whole debate about "wait and see" is moot. And, most experts agree that the decline in mortality is related to early detection... Yes, we are probably over screening and over-treating. I am not going to debate that, I just think that AGE has to be a factor.

Prognosis is affected by age at dx. Our young bodies provide our cancers with fabulous environments to grow, meanwhile we hope to be around for 40 more years. We expect a much greater life expectancy than our older counterparts.

We don't know how to effectively mitigate the role of hormones in the development of tumors, besides the elimination of hormones through inducing menopause. For me, at 40, that is annoying. At 25 or 30 it would have been tragic.

I'm on Tamoxifen, which limits estrogens ability to bind, but I have a common genetic mutation which limits its effectiveness...

The issue is discouraging self exams and eliminating access to mammograms for a population of women who are already under diagnosed. Yes, the numbers are small, but we are out there. Again, in this economic climate tough decisions must be made and I think it is a valid discussion, it just bites if you are in the tiny percentage of effected women.

Because our numbers ARE so small, there is not economic incentive for drug companies to develop targeted treatments, we are INCREDIBLY under represented in research/trials, etc. Even if an academic oncologist WANTS to study young women, there aren't enough of us to get a good sample-size.

I'm writing so much that we are going to be late to school... sorry so disorganized. No time to clean it up.

One of my oncologists once said that everyone wants "aggressive treatment" but that aggressive isn't always better. It is hard to step-back when you or a loved one is diagnosed. I totally support the idea that many older women are over-treated, but good luck convincing a family they should watch and wait. We've been too conditioned the other way.

Unfortunately, because of our small numbers, premenopausal women are not broken out in the data or specifically addressed when new Standards are debated. We are certainly not addressed in media campaigns, etc. It is sad and scary.

Again, bottom line is that while imperfect all we have are self exams and mammography.

No oncologist would recommend watching and waiting if DCIS was found in a premenopausal women. That is for the older ladies.

Stephanie

[hardysmom]

Don't even get me started on the recommendation of not doing self-exams...I understand that they aren't that effective. But my friend Amy found her lump through a self-exam. And my best friend *just* found a lump a few days ago through a self-exam (which fortunately was diagnosed as benign just today). So don't tell me that self-exams aren't worth doing.

(

I also found my lump. Almost all young women initially find tumors themselves through self-exam (or by accident) because we don't have any other routine screening.

[egoldber]

I don't believe you can get mammos while BFing or pregnant.

You can't while pregnant, but you can while nursing, at least if you extended nurse. I wouldn't want to get one in the early, messy days of nursing. But after a year or 18 months I would. In between, it would probably be a judgment call.

Our local LLL group has a list of local mammography clinics and specific techs who are proficient at doing screening of nursing women.

[jenny]

I don't even know where to start with this... it is not only controversial, but EXTREMELY complicated.

First, don't ever let a woman with Stage 0 disease hear you say she doesn't have cancer. You want a controversy! There are node-negative women with "just" DCIS who die of breast cancer. It is a small sub-set, but it does happen. Those pinked-out ladies are formidable.

A lot of the recommendations are about economics as much as anything else. That is not a BAD thing. Healthcare costs are out of control. So far as survivors are concerned I am on the wrong side of many issues including the federal mandate for insurance companies to cover expensive, ongoing reconstruction procedures without regard to costs.

Here is the crux of the problem for me... Cancer in young women is DIFFERENT than cancer in older women. Most oncologists in academic settings agree on this. Not only is it more aggressive, there may be unknown environmental causes. We don't know why some women (with no genetic history) get these aggressive tumors, why the tumors are so stubborn, etc. Furthermore, we don't know how to treat young women with breast cancer, particularly young women with hormonally driven cancers.

Furthermore, it is a WHOLE different thing to "wait and see" when DCIS is found in a 65 yr old than in a 35 yr old. As mentioned, these cancers are very slow growing, particularly in the older set who have low hormonal levels. I do not dispute the recommendations for this group. I think they are similar to the Standards used for older men with Prostrate Cancer.

I also do not dispute moving to mammograms every 2 years. That is reasonable. Problem is that you can't FIND Stage 0 cancer without mammography, period. Without having mammos, the whole debate about "wait and see" is moot. And, most experts agree that the decline in mortality is related to early detection... Yes, we are probably over screening and over-treating. I am not going to debate that, I just think that AGE has to be a factor.

Prognosis is affected by age at dx. Our young bodies provide our cancers with fabulous environments to grow, meanwhile we hope to be around for 40 more years. We expect a much greater life expectancy than our older counterparts.

We don't know how to effectively mitigate the role of hormones in the development of tumors, besides the elimination of hormones through inducing menopause. For me, at 40, that is annoying. At 25 or 30 it would have been tragic.

I'm on Tamoxifen, which limits estrogens ability to bind, but I have a common genetic mutation which limits its effectiveness...

The issue is discouraging self exams and eliminating access to mammograms for a population of women who are already under diagnosed. Yes, the numbers are small, but we are out there. Again, in this economic climate tough decisions must be made and I think it is a valid discussion, it just bites if you are in the tiny percentage of effected women.

Because our numbers ARE so small, there is not economic incentive for drug companies to develop targeted treatments, we are INCREDIBLY under represented in research/trials, etc. Even if an academic oncologist WANTS to study young women, there aren't enough of us to get a good sample-size.

I'm writing so much that we are going to be late to school... sorry so disorganized. No time to clean it up.

One of my oncologists once said that everyone wants "aggressive treatment" but that aggressive isn't always better. It is hard to step-back when you or a loved one is diagnosed. I totally support the idea that many older women are over-treated, but good luck convincing a family they should watch and wait. We've been too conditioned the other way.

Unfortunately, because of our small numbers, premenopausal women are not broken out in the data or specifically addressed when new Standards are debated. We are certainly not addressed in media campaigns, etc. It is sad and scary.

Again, bottom line is that while imperfect all we have are self exams and mammography.

No oncologist would recommend watching and waiting if DCIS was found in a premenopausal women. That is for the older ladies.

Stephanie

Stephanie, you're extremely smart, and I love your insight.

That said, you said your post that DCIS in a 35 year old is different from DCIS in a 65 year old and mammography is the only way to find it. The current guidelines (as long as they don't change since yesterday's news) recommends that women start mammograms at age 40. So a 35-year-old wouldn't be screened for cancer, unless there was a valid reason.

And since you mentioned numbers, I think screening a wide population of non-symptomatic people has gotten us to where we are today; meaning over treatment.

Cancer in young women (under 40) is rare and deadly. Cancer in black women is even deadlier. We definitely need more research on how to best find these cancers and more importantly, how to give targeted therapies for these specific kinds of tumors.

Right now, we're treating every woman the same, and not every woman is the same and not every cancer is the same. This is a problem.

So instead of us all getting angry and backing tests that have no scientific evidence behind them of being beneficial, we should be demanding that research dollars be spent on clinical trials, better drugs and better tests.

I also think you should read this post by Dr. Susan Love on why mammograms for women 40-49 is not a good screening tool. http://www.dslrf.org/breastcancer/content.asp?L2=1&L3=6&SID=132&CID=650&PID=6&CATID=31

She also doesn't recommend screening women under 40 b/c she says they are at a higher risk for radiation-induced cancer.

[KBecks]

I really appreciate this discussion and was hearing this on the news last night also.

I think that when it comes to the cost-saving opportunity for insurance and government health care, I'm worried about what it means for many people.

I'm turning 40 this year and would have a mammogram, but who knows?

[alexsmommy]

Well, up until today I was told baseline at 40 - unless there is a family hx then sooner. I'll be curious to see who "wins" this battle because you know insurance companies will try to go with the less restrictive option because its cheaper and say it's "elective" at age 40 now unless you have a family hx.
Working with younger (under 40) women who have developed breast cancer - well, it scares me. It seems to be so much more aggressive at this age. So though more rare, it seems more deadly.

[hardysmom]

Stephanie, you're extremely smart, and I love your insight.
That said, you said your post that DCIS in a 35 year old is different from DCIS in a 65 year old and mammography is the only way to find it. The current guidelines (as long as they don't change since yesterday's news) recommends that women start mammograms at age 40. So a 35-year-old wouldn't be screened for cancer, unless there was a valid reason..

Right now, most insurance will cover a baseline at 35. I didn't get one because my OB said I was low risk, I was nursing, I was busy, etc... It is a tough call. Again. I don't dispute getting mammos every 2 years, I just think they should be allowed at 40.

If my insurance wouldn't cover a premenopausal baseline, it isn't a hill I would die on or even spand much time fretting over, but if it was covered, I think it is useful.

I don't know the economics, but mammograms are pretty cheap relative to the cost of treating metastaic disrease. Still, over-treatment isn't much of an issue for younger women since, because of our age, we will usally get aggressive treatments one way or another. No one is going to say "Watch and Wait" with a 35 yr old. We get the full arsenal.

Dr Love is the bomb. I don't agree with everything she says, but her book is still the Holy Grail of Breast Cancer. I don't think mammos are fantastically effective, nor are self-exams. That said, MRIs are much more expensive, difficult to access, and still not perfect. A decent sized tumor on one of my lymph nodes wasn't observed in a pre-op MRI. We just don't have many tools for early dx.

Over-treatment is a tough thing. Who is high risk? Should hormone positive women have chemo? Who should have radiation? When is a mastectomy a better choice over lumpectomy... It is hard to answer these questions based on data since data is about groups and treatment is about individuals. In a litigous society, it is hard NOT to treat. What if you lose your practice when a "watch and wait" patient is dx'd with liver mets?

I can speak best from my experience, but I am just one women with a rare condition. There aren't enough of me to extrapolate much of anything concrete.

And yes, minority women are also very under-studied. That is actually my Mass General oncologist's particular area of interest.

It will be interesting to see how it plays out.

Stephanie

[lovin2shop]

Only have a second here, but I'm with Stephanie, get a mammo as early as you can get it covered! No family history or concerns, then you can wait a long time before doing another one, but get that baseline, it can be very valuable information later!

And, for the record, you can get a mammo while nursing. I did one 6 weeks post partum and it honestly wasn't that big of a deal! I was freaked out by it, but it was just a matter of pumping right before in the car and it really didn't hurt any more than the regular squish of a routine mammo. It is more difficult to read a mammo of a nursing mom, so it is not as beneficial for baseline or screening. But, it is definitely important and not huge ordeal for diagnostic testing.

I'm very high risk, so I have yearly mammos, MRI's, and ultrasound as necessary. They know me pretty well at the diagnostic center by now! It is honestly a relief in a way, I feel that if I were to get BC, it will be most likely be detected very early and will be treatable.

I cannot say the same for my friend who is my same age, 37, and has boys the same age as mine. She had her first mammo last year after detecting a lump. They thought they caught it early enough, but the cancer has now come back and has spread to her brain, liver and bones. She was not high risk and was not screened before finding the lump. I know that statistics say this is rare in young women, but I've seen the devasting effects enough in my life enough to feel like it is more than anecdotal and worth going through a pretty basic screening test.

[nofeea]

Not sure if this will help anyone's decisions "to mammo or not to mammo"...but just to add another voice to Stephanie's and throw some more info out there... I am another premenopausal woman (with no family history) who suddenly found herself with a Stage 3 Breast Cancer (with 7 positive lymph nodes) that needed chemo, radiation and all the other anti-hormone stuff that followed (I won't go into details now but I think you already got the idea from Stephanie).

Now for the scary part... My tumors (yes, more than one) were NOT detected in a mammo which I coincidentally got at 38 several weeks before my husband felt the lumps and realized what they were. My mammo was done about 6 months after I finished breast feeding and my breasts were too dense too see the lumps. My husband happens to be a radiologist and he looked at films himself-before and after we found out about the cancer- and in dense breasts you really can't see cancers well. You need Ultrasounds to see them. Even knowing where my cancer was it couldn't be seen on my mammo. Yet insuranse does not standardly pay for ultrasounds...

[Melanie]

Thank you for this discussion. I hadn't thought about a baseline but I will try to get my MD to recommend one next year.