Mammograms in 40s

[Anonymous]

Anonymous wrote:

Anonymous wrote:When I was in my 40s, there were conflicting recommendations. ACS said yearly at 40, ACOG said yearly at 45, USPSTF said yearly at 50.

I am low-risk and waited to 48 to start. During that time, I was being periodically reminded by FB friends who had caught DCIS or even higher-stage breast cancers via mammograms done early how important it was to do this.

Usually these folks did not share information about their own risk factors, which can be quantified using this tool: https://magview.com/ibis-risk-calculator/ (warning: it's a long intake--quite thorough).

To date, I have not gotten breast cancer, and earlier mammograms would not have impacted any breast cancer I might eventually get. It was a good choice for me.

The risk calculator is based on family history. That's it.

The calculator gives me very high risk - 60% - because I have a sister and a cousin with breast cancer. But they were both low risk, because there was no family history before them (both diagnosed the same year, one with stage 3 at her first mammogram). We have all done the genetic testing now and have no genetic markers, which is common.

I think there are discussions to be had about false positives and additional screening/biopsy because of frequent screening. But the idea you are "low risk" does not mean what people think it does. It just means you don't (yet) know if your relatives have or will have cancer.

You might click through and see. The statement that this risk screen covers only family history is not accurate. It also covers age of first menstruation and pregnancy, hormone exposure, height, weight and breast density, among others. They’re are all known risk factors.

It’s true that the family history questions are lengthy—because of all of the other cancers genetically related to breast cancer.

FWIW, this is also the screen that is used to determine whether to recommend regular MRI to women with dense breasts.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Some medical groups recommend waiting til 45 or 50 if you don’t have risk factors. Most of the physicians I know say we are massively over screening and it isn’t resulting in better outcomes but most women I know who are not physicians are going every year.

How would it not result in better outcomes to find the cancer early on mammogram?

The over simplified answer is that slow growing cancers grow so slowly you don’t need to catch them all that early, and the fast growing aggressive cancers tend to kill you regardless of when you catch them.

This is very simplified. Catching breast cancer early often means no chemotherapy. That is a huge benefit.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I was not high risk, athletic, fit, moderate alcohol use, breastfeed years….I had my first mammogram at 41, “dense breasts” ignored the recommendation that comes with it for extra screening as overkill, second mammo a year later, boom. Stage 2 breast cancer. Currently in chemo, after a double mastectomy. I’m so grateful I didn’t delay screening till 50! I might have died first. I want to live a long long life with my family.

What is the extea screening? I just had my first one at 40 last month. My results had some verbiage about dense breasts, but I didn't see anything about extra screening and nobody has called me otherwise.

Ultrasound and MRI. Ultrasound is a lot cheaper.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:When I was in my 40s, there were conflicting recommendations. ACS said yearly at 40, ACOG said yearly at 45, USPSTF said yearly at 50.

I am low-risk and waited to 48 to start. During that time, I was being periodically reminded by FB friends who had caught DCIS or even higher-stage breast cancers via mammograms done early how important it was to do this.

Usually these folks did not share information about their own risk factors, which can be quantified using this tool: https://magview.com/ibis-risk-calculator/ (warning: it's a long intake--quite thorough).

To date, I have not gotten breast cancer, and earlier mammograms would not have impacted any breast cancer I might eventually get. It was a good choice for me.

The risk calculator is based on family history. That's it.

The calculator gives me very high risk - 60% - because I have a sister and a cousin with breast cancer. But they were both low risk, because there was no family history before them (both diagnosed the same year, one with stage 3 at her first mammogram). We have all done the genetic testing now and have no genetic markers, which is common.

I think there are discussions to be had about false positives and additional screening/biopsy because of frequent screening. But the idea you are "low risk" does not mean what people think it does. It just means you don't (yet) know if your relatives have or will have cancer.

You might click through and see. The statement that this risk screen covers only family history is not accurate. It also covers age of first menstruation and pregnancy, hormone exposure, height, weight and breast density, among others. They’re are all known risk factors.

It’s true that the family history questions are lengthy—because of all of the other cancers genetically related to breast cancer.

FWIW, this is also the screen that is used to determine whether to recommend regular MRI to women with dense breasts.

PP you're responding to - I did click through and take it, that's how I got the 60%. I've also taken a similar test through my doc (gave me 56%). The family history is the most relevant factor because the majority of women have dense breasts, the majority of adult women have been pregnant, etc.

You can't get insurance to cover a breast MRI just because you have dense breasts + you're overweight or take HRT or got your period at age 9. Those won't move the risk needle enough. It really just turns on family history. Or genetic tests, but a minority of breast cancer patients have genetic markers that we know how to test for.

My point is, the absence of "high risk" factors does not make you low risk. It just means your risk is not known to be high.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:When I was in my 40s, there were conflicting recommendations. ACS said yearly at 40, ACOG said yearly at 45, USPSTF said yearly at 50.

I am low-risk and waited to 48 to start. During that time, I was being periodically reminded by FB friends who had caught DCIS or even higher-stage breast cancers via mammograms done early how important it was to do this.

Usually these folks did not share information about their own risk factors, which can be quantified using this tool: https://magview.com/ibis-risk-calculator/ (warning: it's a long intake--quite thorough).

To date, I have not gotten breast cancer, and earlier mammograms would not have impacted any breast cancer I might eventually get. It was a good choice for me.

The risk calculator is based on family history. That's it.

The calculator gives me very high risk - 60% - because I have a sister and a cousin with breast cancer. But they were both low risk, because there was no family history before them (both diagnosed the same year, one with stage 3 at her first mammogram). We have all done the genetic testing now and have no genetic markers, which is common.

I think there are discussions to be had about false positives and additional screening/biopsy because of frequent screening. But the idea you are "low risk" does not mean what people think it does. It just means you don't (yet) know if your relatives have or will have cancer.

You might click through and see. The statement that this risk screen covers only family history is not accurate. It also covers age of first menstruation and pregnancy, hormone exposure, height, weight and breast density, among others. They’re are all known risk factors.

It’s true that the family history questions are lengthy—because of all of the other cancers genetically related to breast cancer.

FWIW, this is also the screen that is used to determine whether to recommend regular MRI to women with dense breasts.

PP you're responding to - I did click through and take it, that's how I got the 60%. I've also taken a similar test through my doc (gave me 56%). The family history is the most relevant factor because the majority of women have dense breasts, the majority of adult women have been pregnant, etc.

You can't get insurance to cover a breast MRI just because you have dense breasts + you're overweight or take HRT or got your period at age 9. Those won't move the risk needle enough. It really just turns on family history. Or genetic tests, but a minority of breast cancer patients have genetic markers that we know how to test for.

My point is, the absence of "high risk" factors does not make you low risk. It just means your risk is not known to be high.

I agree that it’s hard to prove a negative.

I was comfortable with the state of our ability to assess risk now, waited to 48 for a mammogram, and nothing bad happened.

I am sorry your family members are having to go/had to go through treatment and hope they are doing well.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Some medical groups recommend waiting til 45 or 50 if you don’t have risk factors. Most of the physicians I know say we are massively over screening and it isn’t resulting in better outcomes but most women I know who are not physicians are going every year.

How would it not result in better outcomes to find the cancer early on mammogram?

The over simplified answer is that slow growing cancers grow so slowly you don’t need to catch them all that early, and the fast growing aggressive cancers tend to kill you regardless of when you catch them.

This is very simplified. Catching breast cancer early often means no chemotherapy. That is a huge benefit.

It's complicated because getting treated for breast cancer that could have stayed early stage for a long time can also cause issues. And not just in terms of anxiety and cost, but cancer treatments are bad for you if you don't need them (some of them cause heart problems, for instance). Of course, on the individual level, you don't know what would have happened had you taken a different decisions, but starting annual mammograms at age 40 for women without additional risk factors or symptoms is actually a hotly debated topic among scientists in the field. It is not a settled issue in any way.

[Anonymous]

There is something called the Guide to Clinical Preventive Servives that tells what screening tests you need at each age. It is based upon current scientific data.

But don’t you have a primary care provider who tells you what tests you need, at what interval? Why go by DCUM advice??

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Some medical groups recommend waiting til 45 or 50 if you don’t have risk factors. Most of the physicians I know say we are massively over screening and it isn’t resulting in better outcomes but most women I know who are not physicians are going every year.

How would it not result in better outcomes to find the cancer early on mammogram?

The over simplified answer is that slow growing cancers grow so slowly you don’t need to catch them all that early, and the fast growing aggressive cancers tend to kill you regardless of when you catch them.

This is very simplified. Catching breast cancer early often means no chemotherapy. That is a huge benefit.

It's complicated because getting treated for breast cancer that could have stayed early stage for a long time can also cause issues. And not just in terms of anxiety and cost, but cancer treatments are bad for you if you don't need them (some of them cause heart problems, for instance). Of course, on the individual level, you don't know what would have happened had you taken a different decisions, but starting annual mammograms at age 40 for women without additional risk factors or symptoms is actually a hotly debated topic among scientists in the field. It is not a settled issue in any way.

But there are data, which should inform population level recommendations.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Breast cancer in younger women is on the rise, insurance will cover it yearly so that’s what I would recommend, as someone whose breast cancer was detected at an early stage on a mammogram.

Same. A mammogram caught my breast cancer at 43. Surgery, radiation, and tamoxifen. No chemo because it was caught early. Get your mammograms!

Also, I was not high risk prior to getting diagnosed. I am BRCA and other gene mutation negative. No real family history. My biggest risk factor was dense breasts, which is extremely common. And being a woman.

Most women who are diagnosed with breast cancer don’t have a family history of breast cancer.

No one is immune.

Mammography saves lives.

[Anonymous]

I see an oncologist for a blood disorder so I asked him if I needed to go every year (I'm 41) He said it was fine to go every other year but if it's not a big deal to me just go every year. I am low risk (birth before 30, breastfed, no family history, non-dense breasts.) I decided to just do it yearly so it's a habit

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Some medical groups recommend waiting til 45 or 50 if you don’t have risk factors. Most of the physicians I know say we are massively over screening and it isn’t resulting in better outcomes but most women I know who are not physicians are going every year.

How would it not result in better outcomes to find the cancer early on mammogram?

The over simplified answer is that slow growing cancers grow so slowly you don’t need to catch them all that early, and the fast growing aggressive cancers tend to kill you regardless of when you catch them.

This is very simplified. Catching breast cancer early often means no chemotherapy. That is a huge benefit.

It's complicated because getting treated for breast cancer that could have stayed early stage for a long time can also cause issues. And not just in terms of anxiety and cost, but cancer treatments are bad for you if you don't need them (some of them cause heart problems, for instance). Of course, on the individual level, you don't know what would have happened had you taken a different decisions, but starting annual mammograms at age 40 for women without additional risk factors or symptoms is actually a hotly debated topic among scientists in the field. It is not a settled issue in any way.

But there are data, which should inform population level recommendations.

Yes, there are data, and they do inform recommendations. But scientists still disagree over the interpretation of those data. And actually running trials to look on an impact of screening procedures on mortality is extremely complicated and not really doable for breast cancer, hence modeling etc also being used. For instance, you would probably have to randomize tens of thousands of women to get mammograms every year starting at 40, every other year starting at 40, every every starting at 50, every other year starting at 50 etc. As PP mentioned, one question is: Would a slow growing cancer caught by mammogram today also have been caught in a treatable stage by a mammogram 1-2 years from now? Many women also get diagnosed with stage 2-3 cancer by mammogram, it's successfully treated in the short to medium term, but then comes back after a few years at metastatic. Did their treatment now actually help extend their lives?

I'm not saying mammograms are bad, I'm just saying that, as a person without many risk factors, I'm in no rush to schedule my mammogram, having turned 40 this year. I'll do it this year or next, but I'm pretty sure an annual one is not necessary for me.

[Anonymous]

Anonymous wrote:I’ve been getting them annually, starting at 40 (I’m now 48). It’s worth it to me even though there’s no family history. I guess I’m fortunate that I don’t find them even a little painful, it’s seriously NBD from the pain perspective, and insurance fully covers it, so why wouldn’t I spend half an hour once a year?

Exactly! Not a big deal, and in reality, having treatment for any level of BC would be so much more painful and taxing. You want to catch it early if you ever get it. Screenings are there for a reason, even if you don't have a family history (most people do not have family history)

[Anonymous]

Anonymous wrote:Screenings are there for a reason, even if you don't have a family history (most people do not have family history)

This is a wild oversimplification. The bottom line is that for with no risk factors, starting screening mammograms somewhere between 45 and 50 and doing them every other year thereafter is the 'statistically correct' answer. This is especially true for white people who have good insurance coverage and get an annual physical every year.

However, there are lots of people in their 40s who don't have stable insurance and don't go to the doctor every year - these are also the people least likely to get a regular screening mammogram. In addition, Black women - and especially young Black women - are more likely to die from breast cancer than white women. The recommendation to start mammograms at 40 was intended to remove barriers to screening for young Black women. We won't know how effective it was for a couple years because that recommendation just went into effect a few years ago.

[Anonymous]

I got them every year and now that I’m 50 and officially in menopause the drs are acting like breast cancer is inevitable and I am being asked to do mammogram then MRI every six months. I just had my regular mammogram and they found something that needed biopsy. I did not eat or sleep for two weeks due to this anxiety and had a panic attack. It was benign.

For me the big issue seems to be family history. Mother grandma and cousin all post menopause cancers.

I keep trying to talk to my Dr about how this is so disruptive and the effects of the stress on my health. No one seems to care. I am trying to get them to give me Xanax and do all the mammograms as diagnostic so they are ready right away. I am trying to be proactive but everyone is acting like I’m crazy for not just smiling and dealing with this.

Other than family history - I don’t have dense breasts, got my period late and am not overweight. But I did do IVF.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Breast cancer in younger women is on the rise, insurance will cover it yearly so that’s what I would recommend, as someone whose breast cancer was detected at an early stage on a mammogram.

Same. A mammogram caught my breast cancer at 43. Surgery, radiation, and tamoxifen. No chemo because it was caught early. Get your mammograms!

Also, I was not high risk prior to getting diagnosed. I am BRCA and other gene mutation negative. No real family history. My biggest risk factor was dense breasts, which is extremely common. And being a woman.

Exact same situation for me. I am headed to surgery and likely some radiation. No family history and I'm glad for my annual mammograms. I don't think mammograms or even follow up u/s for women with dense breast tissue (that's many of us) is overkill or over prescribing. Obviously, the vast majority of those will show no issue. That's not the right question. It's how many early breast cancers do they catch? Stage 1 breast cancer is 99% survivable, and some types of breast tumors grow very fast, where treatment gets more and more expensive and prognosis goes down.

DP with Stage 1 BC diagnosis at 49 (no family history). I am also on track for surgery, radiation, and tamoxifen, and am highly likely to not need chemo. Thank God for my proactive OB-GYN who wrote a prescription for 3D mammograms when I mentioned dense breast tissue. I noticed the lump after I was flagged on the mammogram, but I have no idea how long it would've taken me to notice it without mammograms.