To wonder whether we should get yearly mammograms over 40?

[Cortina]

Following on from the thread about American women and health screening etc, I've been wondering about mammograms.

Friends in Asia and the US have these yearly over 40. If you are working abroad a medical check up is often part of the package and you'll be booked in for a yearly mammogram.

These sort of mammograms have picked up breast cancer for two friends - aged 41 and 43. For one they detected the cancer before it had become apparent - they didn't need chemo just radiotherapy and have now made a complete recovery.

They tell me the reason we don't do mammograms here in UK for 40 plus is due to cost. I've been reading up and it seems its not that simple, there can be false positives etc. However, I wonder whether it's something we should be doing too even if we don't have a family history of breast cancer?

I'm a medical physicist and the real reason we don't do routine mammograms to women under 50 is that every mammogram increases the risk of a breast cancer forming. For women over 50 the benefit of the number of cancers detected outweighs the risk but for women under 50 it doesn't.

For women at high risk of breast cancer there is a benefit to mammography before the age of 50 and these women are invited to attend.

Breast screening may cause more harm than good in any population and age. An independent review is happening at the moment:

info.cancerresearchuk.org/news/archive/cancernews/2011-10-25-UKs-breast-cancer-screening-programme-reviewed

I think there's a danger in assuming that just because it's done elsewhere.. It should be done here.
A screening programme is only worth having if it saves lives. The PSA test is routinely used in the US to test for prostate cancer in men. Does it pick up the disease? Yes, often. Does it saves lives? Questionable.
Breast screening is very controversial. There are studies (mainly from Northern Europe) that question it's role.
Which is why they are currently reviewing the screening programme in the UK. Until then, I believe that women are encouraged to attend their screening appointment.

Interesting. So cost is a complete red herring?

I read something somewhere about a mammogram 'machine' that used 'less radiation' or something like that.

Also what about a yearly chest X ray? Is that a bad idea?

What would the yearly chest xray be for?

Part of routine, annual medical check ups in other countries.

Its more radiation though, more cost.
Do you have the figures of what proportion of those x rays pick up previously unsymptomatic, unsuspected problems?

I would say it wasn't a good idea unless it was looking for something specific that someone was considered to be at risk of or suffering from. All radiation exposures in this country have to be justified by a trained professional and so this shouldn't happen. I say shouldn't but there are companies (Life something?) that do offer CT scans etc for people not suffering from symptoms. The irony is that by exposing people to radiation you may then cause them to suffer the problem you are looking for.

Regular chest x-rays used to be common up to about 40 years ago. It was to pick up early signs of TB, I think. They then found that since the incidence of TB had declined there was more risk from the X-rays. That plus a greater understanding of the dangers of radiation.

I'm only 27 and I have breast cancer and I don't think it's a good idea, even though my cancer was identified through ultrasound, mammograms, fine needle aspiration, etc, after I found the lump.

I agree with the poster that said we should think carefully about doing it just because it's done elsewhere. As far as I understand, the risks outweigh the benefits for that age group and I can see screening causing unnecessary panic. Much better to educate people about breast awareness. Plus, there is very little knowledge about the causes of breast cancer in the under 50's.

Remember that the way doctors make their money in the States is by ordering lots of (dare I say it - unnecessary) tests and appointments. It does make things skewed - more isn't necessarily better.

DOI: NHS doctor. I order what I think is clinically indicated, ignoring the cost when deciding what is or isn't needed.

Investigations when a breast lump has been found are, of course, completely appropriate.

We are lucky to have the Health Service we all enjoy. We should think ourselves lucky to have a three-yearly mammogram for which we do not pay at the point of delivery.

Bubblebobble - sorry to hear that. Hope all is gong well for you.

Should we all be going for breast ultrasound before 50 - that doesn't have risks attached and may show something problematic which could then be followed up with a mammogram if it was deemed necessary? An examination from a breast specialist might also flag potential problems?

Why do we decide 50 is the key age for mammograms? Why not 47 or 48 or 49?

How much exposure to radiation do you get from a mammogram and CT scan?

My mum was diagnosed with breast cancer at 44 - she died at 51. I recently had an appointment with a gynaecologist (am not in UK) and when I told her about my mum's history, she said I should have a mammogram every 2 years from the age of 34 (ie. 10 years before mum's diagnosis). When I asked whether this could actually be harmful to have my breasts exposed to radiation every 2 years from a young age, she just said 'no'. Not sure if was the language barrier or what, but I didn't feel particularly reassured. Especially when I googled when I got home and it says that mammograms on younger women often give false positives/negatives because the breast tissue is denser than in older women. Don't know what I should do as I know this isn't offered in the UK, but is that due to cost, or because it isn't necessary? I asked if ultrasound was an alternative and again the answer was 'no'. Don't know why not.

VOMIT Victim of Medical Imaging Technology is an acronym for our times. First coined by Richard Hayward in 2003 in the BMJ, VOMIT is a term for the patients who suffer unnecessary interventions for abnormalities observed by imaging or other investigational technology, but not found during surgery.(Richard Hayward. VOMIT (victims of modern imaging technology)?an acronym for our time BMJ 2003;326:1273 (7 June), doi:10.1136/bmj.326.7401.1273)[1]

It is well recognised that lots of harm is done by uneccessary investigation. You find loads of variations of normal - consequent investigation causes lots of patient anxiety (which can sometimes never be assuaged) and surgery with poor outcomes

USA orders so many tests because tests = business

If you were selling vitamins you'd insist they were essential. over dosing certain vits causes ill health. People are a bit blind to facts and let anxiety convince them that all tests are a) safe and b) beneficial

I have been diagnosed with one of the breast cancer genes (BRACA2). As such, I have a mammogram, MRI and a ultrasound yearly- I am 30. I was told that it is only with a strong family history, diagnosis of a breast cancer gene etc that suchbscans etc would be carried out, due to being particularly high risk.

Like much in medicine it's risk vs benefit

No one is saying medical imaging is wrong and vic is giving a good example of someone who benefits from it

Out of interest, vic, would you mind saying what your family history of breast cancer is? My mum was the only person in the family - her mother is 90 this year and she had 2 aunts who died in their late 80s, and not of cancer. I was told by the gynaecologist that because she was diagnosed before 50, there is a stronger chance of it being genetic.

Dippy, yearly ultrasound is much more accurate, with none of the X-ry risks.

It's interesting how many have said it's not a good idea because of health risks, yet I read a link on here a couple of days ago, which siad after trials in some areas, they were now rolling out earlier screening to all women in the UK. It said by 2016 (I think) everyone will be invited to have a mammogram from the age of 47.
I agree with BubbleBobble that raising awareness of early symptons of all cancers is a far better way forwards, and somehow getting the publicity out there to remind people to actually check themselves for lumps and bumps. It was only because I was reminded, that I checked myself and found a lump. It was because I found it early that my outcome is so positive.
Ladies - please have a quick check today, and remind your sisters and friends and daughters or Mums. Thank you.

Agreed, ultrasound more effective ( and MRI even more so)- believe it is due to the expense that these techniques are not usually more widely used. In terms of family history I had 2 generations, mother and grandmother, who had breast cancer in their thirties. Dippy, you say that you are not based in the uk, over here I was referred to a genetics clinic after giving detailed family history information to my gp. Hope this helps.

I lived with a woman who came home from her first mammogram saying what a degrading & unpleasant experience it was. She was on the verge of tears. Has stuck with me.

May I ask, do mammograms reliably detect lumps at a very early stage that wouldn't be found with tactile examination? Assuming D cup or smaller, I can see the advantage of mammogram for mahoosive norks.

Ragged, mammograms can detect lumps when they are too smalll to be felt and are a very useful tool. Please don't be put off by your friend. They're not fun in the way a smear isn't most people's idea of a good time but they can save your life and are worth having.

The argument regarding age that mammograms should start routinely for all is being decided as Bartlett said. I'm not up on the latest but as BackforGood said that age may be 47 or 48 not the current 50. That doesn't mean that it would be beneficial for all from 40 though.

Ragged Please don't be put off by your friend. It's exactly what HappySeven says - no-one's idea of a fun day out, but possibly a life saving procedure. Doesn't hurt or anything. Personally, given the choice, I'd rather have a mammogram than a smear test, but, because the potential is there to save my life, I'll actually go for both as and when I'm called.