Mammography guidelines muddy the waters

I’d be hard pressed to think of a more controversial screening test than the mammogram.

Well, perhaps the test itself isn’t controversial (unlike the prostate-specific antigen, or PSA, cancer screening for men) — at least everyone generally agrees that mammograms are worth getting. But the specifics — such as when you should get one, and how the results should be addressed — have never been more hotly contested.

Case in point: The American College of Obstetricians and Gynecologists (ACOG) has just issued new breast cancer screening guidelines. And they pretty much say to do whatever you and your doctor decide is best.

The focus, as usual, is on average-risk women. But in a move that’s a little more out of the ordinary, they actually acknowledge the lack of consensus in the medical community with regard to key details (including when to have your first mammogram and how often you should keep getting them).

With so many different organizations weighing in on the question right now — not to mention the mammography practices in other countries — the ACOG decided (rather wisely, if you ask me) that maybe a one-size-fits-all approach isn’t the best one to take.

Instead, they encourage doctors to personalize their recommendations to each individual patient. (What a novel thought!)

In particular, women and their doctors should thoroughly discuss medical history, and give thoughtful consideration to the risks and benefits of breast cancer screening — including any concerns and preferences the patient might have.

Makes sense, doesn’t it? Well let me stop you right there. Because the ACOG couldn’t throw patient-focused medicine a bone without turning around and talking out of the other side of their mouth. In this case, by stating that average-risk women should be offered breast cancer screening at 40 — and that they should absolutely start getting mammograms by 50 at the very latest.

Clearly, they just couldn’t resist throwing their unilateral hat into the ring. Alongside the U.S. Preventive Services Task Force, which also recommends starting mammograms at 50 — and as early as 40, based on individual preference. And the American Cancer Society, which recommends mammography at 45 — or as early as age 40.

The ACOG also advises that women get mammograms annually, or at least every two years, until they turn 75. And then they can make the decision as to whether or not to continue screening based on their health status. (In other words, based on whether or not treating any cancer they might find could cause more harm than good — sound advice, yet again.)

This is all well and good. But as I’m sure you’ve noticed, these recommendations are all over the board… So how, exactly, are they coming up with them in the first place? Are they just guessing? You really have to wonder…

Mammograms are not simple or risk-free tests. They’re painful for most women. And results often trigger a call-back for more imaging — and all the radiation that comes with it — year after year.

These guidelines shouldn’t be arbitrary. And yet, that’s exactly how they appear.

Meanwhile, breast self-exams are apparently frowned upon now. They’re no longer recommended for average-risk women due to the potential of false-positive results and supposed “lack of evidence” that it actually benefits patients.

But I suppose the false positives we see in mammography are okay? Something about this just doesn’t sit right with me.

And this is just the confusion that women with so-called “normal breasts” are up against. Can you imagine what women with strong family histories and dense breasts are put through?

This whole industry is obviously due for an overhaul… But sadly, it doesn’t look as though that will be coming anytime soon. Which leaves women as overwhelmed with conflicting advice as ever.

And that’s why I return to this topic so often. In case you were wondering, my own recommendations are not at all arbitrary — and you can find them detailed in full by visiting my archives. (Simply visit the Subscriber section of and sign in with your username and password. You can find these particular articles by searching with key terms including “breast cancer” or “mammogram”).

Subscribers have access to everything I’ve ever written on the subject. So if you’re still unsure about how to proceed with breast cancer screening or interested in the latest developments not found in mainstream health news, consider signing up today.