Mammograms have greatly improved our ability to diagnose and treat breast cancer by detecting tumors up to three years before they can be felt by hand.

When breast cancers are first detected through screening mammography, the tumors are generally smaller, require less intensive treatment and are treated more successfully.

Screening mammography have been shown to save lives in women ages 50 to 70 and increasing evidence shows a similar benefit in women 40 to 49 years of age.

Mammography continues to be unsurpassed by other imaging studies as the mainstay of breast cancer screening.

This handout provides you with information to help you decide how frequently and at what age you should have a mammogram.

• What is a screening mammogram?
• How do breast cancer and screening mammography differ for younger and older women?
• How often should I get a mammogram if I am under age 50?
• How often should I get a mammogram if I am age 50 to 70?
• How often should I get a mammogram if I am age 70 or older?
• What should I do?
• Where can I find out more about screening for breast cancer?
• How do I arrange to have a mammogram through PAMF?

What is a screening mammogram?

A screening mammogram is a low dose X-ray study of the breast performed on a woman without breast symptoms and with a normal physical examination of the breast. It can show changes in the breast tissue, such as clustering of calcium, which may suggest cancer. The actual diagnosis is made by performing a biopsy and examining the tissue under a microscope.

While screening mammograms are performed at regular intervals on women without symptoms, please consult your primary care provider before having a mammogram if you notice the following:

• A breast lump that persists for more than two weeks, persists after a menstrual cycle or increases in size
  
• Pain that is localized to a small area of one breast
  
• Bloody nipple discharge
  
• Changes in the skin or new asymmetry of the breasts
  
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  How do breast cancer and screening mammography differ for younger and older women?

  Before menopause, breast tissue is generally denser, making it more difficult to detect cancer. Breast cancers in premenopausal women occur less frequently but are more aggressive than in postmenopausal women. The average time between detecting breast cancer on a mammogram and feeling the cancer on a physical examination is 1.25 years for women in their 40s and 3 years for women in their 50s. One in nine women in the United States will develop breast cancer in her lifetime. Increasing age is the greatest risk factor for breast cancer, even more important than a family history of breast cancer.
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  How often should I get a mammogram if I am under age 50?

  There is no evidence that screening mammography in women younger than age 40 saves lives, and routine screening in women under age 40 is not recommended. Recommendations for women ages 40 to 49 remain somewhat controversial. The American Cancer Society and National Cancer Institute, which focus on preventing cancer deaths, recommend yearly screening mammograms for women 40 to 49 years of age. The U.S. Preventive Services Task Force and the American College of Physicians, which more broadly analyze the risks and benefits to the population being screened, do not recommend screening for this age group.
  
  The reason for different recommendations from different professional organizations stems largely from how each group weighs the importance of false positive and false negative screening results. A false negative mammogram is one that misses a breast cancer discovered by some other means, usually breast physical examination. A small number of missed breast cancers is unavoidable, which is why all women should also have careful breast exams and serial mammograms. A false positive mammogram is one that initially is reported as suspicious for cancer, but no breast cancer is confirmed. With mammograms, false results are more common before menopause. Among women ages 40 to 49 being screened annually, up to one-third will have a false positive result at some point, requiring additional mammograms and/or a biopsy that does not confirm breast cancer. This can cause anxiety, loss of work time and discomfort. Women planning to have screening mammography should be aware of the risks of false positive and false negative results and be prepared for further tests if indicated.
  
  The Palo Alto Medical Foundation (PAMF) reviews the guidelines for screening mammography each year, and our own recommendations have evolved. We currently recommend that women ages 40 to 49 have an annual screening mammogram performed.
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  How often should I get a mammogram if I am age 50 to 70?

  The strongest evidence for the benefit of screening mammography is among women 50 to 70 years of age. Because breast cancers generally grow more slowly and are easier to detect in this age group, mammography may be performed at less frequent intervals, every one or two years. We currently recommend that women ages 50 to 70 undergo a screening mammogram every one to two years. Women in the following two categories will generally choose yearly mammograms:

  • Those with more concern about lowering the risk of breast cancer death and less concern about the effects of false negative and false positive tests
    
  • Those at greater than average risk for breast cancer (discussed below)
  
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  How often should I get a mammogram if I am age 70 or older?

  The incidence of breast cancer increases with age, until about age 79, and then declines. There is conflicting evidence about the benefits of screening mammography for women 70 and older. Decisions to screen women age 70 and older depend on women’s personal preference and general health.
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  What should I do?

  In addition to your personal preference, you should also take into account your own personal risk of breast cancer. Be aware that your risk of breast cancer is increased by the following factors:

  • breast cancer in your mother, sister or daughter
    
  • ovarian cancer in yourself or in your mother, sister or daughter
    
  • radiation treatment to the chest area, as with Hodgkin's disease
    
  • breast biopsy revealing precancerous or high-risk tissue
    
  • A mild increased risk occurs with first menstrual period before age 13, menopause after age 52, no full-term pregnancies before age 35, DES use by your mother when she was pregnant with you or being greater than 30 pounds overweight
  Talk to your primary care provider about screening more frequently if you are at higher than average risk for breast cancer.
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  Where can I find out more about screening for breast cancer?

  • A conversation with your primary care provider
    
  • Community Health Resource Center at PAMF
    
  • Community Breast Health Project in Palo Alto
    
  • http://mammography.ucsf.edu/inform/index.cfm
  
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  How do I arrange to have a mammogram through PAMF?

  
  Call our Radiology Departments at the following locations:
  
  Palo Alto Clinic Health Center
  650-853-2955
  
  Los Altos Center
  650-254-5259
  
  Fremont Center
  510-490-1222
  
  Redwood Shores
  650-598-3160
  
  The mammogram appointment should take 1/2 hour. Mammogram results are forwarded to your physician within one week. Your physician will contact you with results.
  
  Special instructions: Please do not wear any deodorant, spray, oil, cream or powders on your chest or underarms the day of your appointment. Wash your breasts and underarms thoroughly the day of your appointment.
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