So, it was that time again. Actually it was past time, but better late than never. Mammogram time! Fortunately, getting scheduled for this procedure was very simple. My primary care doctor (who is perfectly capable of managing routine gyn stuff, as a good PCP should be!) writes the order, I call the breast center, and I’m scheduled within the week! Pretty awesome, since the last time I tried to get scheduled, in a different city and state, the wait list was 6 months out, which wasn’t exactly conducive to following anyone’s recommendations for routine screening. The breast center was right across the street from my office, so it was a quick lunch appointment, and done! And the results were normal, as both the breast center and my PCP informed me very quickly, so I’m good to go for awhile!
But how long is awhile? The recommendations are somewhat conflicting. The American Cancer Society recommends yearly screening mammograms, starting at age 40, earlier if there is a family history of early diagnosis of breast cancer. The National Cancer Institute recommends every 1-2 years, again sooner if there’s family history. The U.S. Preventative Services Task Force, however, recommends every 2-3 years, and not starting until age 50. The Mayo Clinic, the American Medical Association, and Kaiser Family Foundation, are “not impressed” (insert your favorite McKayla Maroney picture here) with the USPSTF recommendations, and recommend annual screening, again starting at age 40.
Why are they different? As I would expect, the organizations specific to cancer research , diagnosis, and treatment (i.e. the ACS and NCI), recommend the more frequent tests, while the organization specific to population consumption of limited health care resources recommends less frequent, more targeting screening. The USPSTF places a higher priority on the different costs of negative screening, costs of money, time, anxiety, risks of unnecessary procedures; while the ACS and NCI place a higher priority on the costs of missed cancer and delayed treatment. They are all actually looking at the same research, which quantitatively definitely supports the benefits of screening, but they’re interpreting the qualitative findings differently.
So, whose recommendations should I follow for myself, and whose recommendations should I use for my patients? Organizations like ACOG (American Congress of Obstetricians and Gynecologists) and AAFP (American Academy of Family Physicians) are all saying, “Talk to your doctor,” which is probably the absolute best recommendation. Screening start and frequency should take into account your age, ethnicity, family history, past medical history, and ideally should be done at regular intervals of no longer than 2 years, and at the same imaging location, because following breast tissue changes over time is important to diagnosis. As I tell my patients, our breasts are not vanilla pudding! We have lymph nodes, fat, structural tissue, ductal tissue, microcalcifications, benign cysts. Research is mixed on the effectiveness of breast self-examination, but getting to know our own lumps and grains and built-in-underwires is still a good idea.
I’m concerned that women (like myself, ahem!) would use the USPSTF recommendations as an excuse to further delay regular screening, where 2 years turns into 3, 4, 5 (okay, almost 7 in my case, bad health care provider, bad!).
Why do we make these excuses to skip a very simple procedure? Well, for one thing, it isn’t all that comfortable. In my case, it wasn’t at all actually painful, but for someone with tender fibrocystic breasts or larger breasts, it could be very painful. For another, it might be very inconvenient. In Fayetteville, NC, as I said before, it was a 6 month wait! Seriously, I could have scheduled and fully recovered from getting implants before I got the mammogram – that seems to be an inversion of appropriate priorities. Some women are anxious, and fear that something will actually be found. Finding a cancer earlier is definitely better, research overwhelmingly shows, but fear isn’t a logical thing. Insurance, or lack thereof, is definitely a problem for quite a few women, unfortunately more likely to be those women at highest risk. Free mammograms are offered through various services, but they can be hard to find and schedule.
At any rate, now that I’m approaching 50, I’ll be much more careful about getting my own appropriately-timed screenings. It helps that scheduling is so much easier and more convenient. And I’ll continue to discuss and recommend regular screening for my patients and female friends, starting at age 40, at intervals of no longer than every 2 years, and try to help them overcome the different barriers to their getting those screenings.