Breast Cancer Q & A of the Day: When should I start having mammograms, and how often should I have them?

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Everyone agrees that women age 50 and older should have mammograms. But there has been quite a controversy for a number of years now as to whether women between the ages of 40 and 49 should also have annual mammograms. The problem is that women between 40 and 49 typically still have dense breasts, and on a mammogram, this dense breast tissue shows up as white—which is the same color as a cancer appears on a mammogram. With menopause, which typically begins around age 50, the dense tissue in women's breasts is replaced with fatty tissue, which looks gray on a mammogram. It is much easier to see the white cancer against this gray background. That's why mammography works better on women aged 50 and older.

To date, eight randomized controlled trials have found that mammography screening for women between 40 and 49 had no effect on mortality. Even so, some health organizations continue to recommend annual mammography for women between the ages of 40 and 49. At first glance, there would seem to be little harm in this recommendation. But there is a downside. Many abnormalities seen on mammograms may not be cancer (these are called false positives), but they will prompt additional testing and anxiety. In fact, as many as three out of 10 women who begin annual screening at age 40 will have an abnormal mammogram during the next decade, and the majority of these will end up having biopsies—only to learn that the test was a false positive.

The bottom line: Even in older women, mammography is far from a perfect screening tool. It may help you find your cancer early, but finding a cancer "early" is not a guarantee that your life will be saved. New data suggests that there are different types of cancers and that how quickly a cancer progresses has more to do with the type of cancer it is than when it is found. Probably the best way to decide when you should begin having mammograms is to discuss your personal risk factors for breast cancer with your physician.

You can learn more about the risks and benefits of mammography for women between the ages of 40 and 49 on this UCSF website.

You can find information about Medicare coverage and how to find an FDA-approved mammography center, on the FDA's website.

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This post is courtesy of the Dr. Susan Love Research Foundation, dedicated to eradicating breast cancer and improving the quality of women's health through innovative research, education and advocacy.To support this important cause and donate, visit www.dslrf.org.