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Announcer: Covering all aspects of women's health, this is the Seven Domains of Women's Health with Dr. Kirtly Jones, on The Scope.

Dr. Jones: Women get a lot of different information and they get a lot of different opinions about when they should start mammography. Some group of advocates which include OBGYN's and includes radiologists and includes the and the says women should start having regular mammograms at 40.

Mammograms at 40 vs. 50

Now the people who do science and actually look at how many women have to be screened for how long to save a life from breast cancer say that, in fact, we should probably start at 50 and that's what they do in Europe.

Now there are people who are in between that say, "Well, what you ought to do is just see what your breasts look like at 40, so get a baseline mammogram." So the concept of the baseline has never been adequately tested scientifically to see whether having that baseline and then not having another until you're 50 actually makes a difference. So in fact, I don't think it's a bad idea to get a baseline mammogram, but I don't have any evidence that it's going to save a life. And at 40, there are lots of things in an active, young breast - when I say that to 40-year-old women they don't, they say, "My breast isn't young." I say, "Oh, honey, you just wait till you get older. You still have a young, dense breast." So even that baseline mammogram, the nature of what makes a breast a breast at 40, when there are lots of hormones around makes it harder to see through and you end up getting called back. So even your baseline ends up causing a bunch of extra investigations and maybe some extra biopsies.

Life at 40: To Screen or Not To Screen

Having said all that, it ends up being a very individual choice because the science doesn't support routine mammography at 40 for everyone. The culture does. So the culture of regular mammography between 40 and 50 is such that, your girlfriends are getting mammograms and it's recommended by your doctor, so the culture in the United States is to get mammography. But the science actually doesn't support it, when you look at how many women have to be screened and how many lives are saved from screening compared to how many lives are disrupted with extra x-rays and extra biopsies and maybe even not very necessary chemotherapy. It's a tough call for women to know what to do.

Mammograms Are a Personal Choice

Here's my take on it. I have women who come to me and say, "My girlfriend had breast cancer and I want a mammogram today." And my answer for that is you're 45. You haven't had a mammogram before. I think that's a reasonable thing to do. But remember breast cancer isn't catching and you can't catch it from your girlfriend, but if you don't feel safe right now and a mammogram will make you feel safer, then that's something that's okay. But remember mammography in the 40s, you find stuff that you have to investigate that isn't necessarily cancer.

I have women who come to me and say, "You know, my family we're down winders." Those are people who are exposed to nuclear radiation from the atomic bomb testing in Nevada and they are really anxious about radiation and they say, "You know what? I really don't think I want to do any extra radiation until it's really recommended." And for them I say, "You know what? I'm going to do your clinical breast exam even though there's no good evidence that doctors doing breast exams saves lives either, but if you feel better saving till 50, that's fine."

And then I have a few patients who say, "You know, my mom had mammography all the time and she still got breast cancer and died and I'm never getting a mammogram." That's a tough sell, because for them I think some screening is good in the 50s and 60s. On the other hand, I think it's going to be up to them and I don't want to make them feel like they're bad people because they choose not to have a mammogram, but every time I saw them I'd remind them and say, "What do you think about this year? How about a mammogram this year?"

So I think women are getting lots of different messages and I think it's a discussion. But I let women drive the agenda about how often they're going to have mammography within the parameters of either the advocates or the scientists.

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