To screen or not to screen… is it really a question?

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A screening test is a procedure or test performed to detect the likelihood of having a disease before symptoms occur. The goal is to be able to diagnose the disease early and treat it effectively to decrease the number of people that die from or have complications from the screened illness.

Some of these tests include pap smears for cervical cancer, PSA for prostate cancer, and of course, mammography for breast cancer. Doesn't this sound wonderful? Being able to save people's lives by performing a test? Although these screening exams are not perfect, they have been tested extensively to prove their benefits against their possible risks. And this is true for mammograms.

Now, let’s get the facts about breast cancer straight before we talk about mammograms. We need to know who our enemy is. Breast cancer is common and deadly; it is the most common cancer in women, it is the leading cause of death from cancer in Hispanic women and second most common cause of cancer deaths among other races. We want to fight this enemy early, before it gains full force and great strength. Fortunately, mammograms have proven to be effective and safe detecting when the enemy appears. But despite the research that proves it, the benefits of screening with mammograms and the age at which one should start having them has been debated. It looks like our enemy is finding allies.

Fortunately, mammograms have proven to be effective and safe detecting when the enemy appears.

Although the amount of patients diagnosed with breast cancer has been increasing as time goes by, since the 1980’s the number of breast cancer deaths dropped up to 43%. Is it a miracle? Not really. This has happened due to the use of mammograms as a screening test for breast cancer. Multiple scientific studies prove this. It is not uncommon to have patients in the office requesting not to have mammograms performed because they have read about how harmful and useless mammograms are, most of the time from not very credible sources. Unfortunately, the USPSTF (U.S. Preventive Services Task Force) announced that mammograms in women in their 40s are not necessary and after 50, only twice a year is enough instead of every year. This recommendation is based on studies that do not show the whole picture and is putting all these young and older women at risk. They actually admit that the evidence is insufficient, lacking, of poor quality and conflicting and they cannot determine the benefits and the harms accurately. It is probably because they did not rely on experts in the topic and the studies they followed underestimated the benefits of mammography.

Why should you start getting mammograms once you turn 40?

It is not a magic number. The evidence shows that from age 40 to 44, the amount of women diagnosed with breast cancer doubles that of the women 35-39 years old. So if we know our enemy is doubling at this time, would we just let that pass and have it gain strength and potentially kill?

We also need to consider an important point. Once a woman loses her life due to breast cancer she loses years of life. Sounds obvious but it means this it is time that she would have been alive if it wasn't for breast cancer. This enemy, likes to add up years of life under its deadly badge. The younger the woman dies, the more years of life she would lose. Mammograms prevent women from dying, and 40% of the years of life it saves comes from women in their 40s. We are not letting the enemy get away with that!

We all have the right and responsibility to make decisions about our bodies and our health. We are our own best advocate. As doctors we are here to guide you and help you come to an answer that you are comfortable with.

My only recommendation would be DO YOUR HOMEWORK! You need to set your preventive measures, be vigilant and plan your strategy. If the enemy decides to appear, then you’ll be ready to fight and survive the battle.

Dr. Claudia Cotes is a Radiologist specialized  in Breast Imaging at The Rose, a non-profit organization that provides breast imaging and diagnostic services for underserved women in Houston.