06/14/2024
Breast Mammograms - A Perimenopausal Conundrum
In Canada, women are recommended by the Canadian task force to get mammograms every two years from age 50 through 74. Depending on where you live in the world, the recommendations differ. In the UK, women are recommended to get mammograms every three years from age 50 through 69. Women in Uruguay ages 40 to 59 are obliged to get mandatory mammograms every two years and in Austria, women are told, “Participation is entirely up to you!”
Confused? We all are!
Why do the recommendations differ so much?
Depending on which panel of experts you listen to, recommendations differ over the age at which screening should start and how often it should be done. This means doctors and women are left to decide which advice to follow. While one panel recommends less frequent screening to reduce the risk of overdiagnosis and overtreatment, the other recommends more frequent screening in hopes of catching a few more tumors at an earlier stage. Doctors and women are left to decide which advice to follow, and the information we have to make that decision is as clear as a murky swamp.
The Grey Area - What about women ages 40-50?
Currently, if you’re a woman who has just entered her 40th decade, you are able to receive mammograms through MSP every 2-3 years if you want, but you will not get an official invitation for one.
Just in May of this year, the Canadian Cancer Society called for breast screening to routinely begin at age 40 based on a review study from the University of Ottawa that compared breast cancer statistics from screened women in their 40s to data from women who started screening in their 50’s. They concluded earlier screening led to significantly improved survival rates. But the Canadian Task Force will not budge on the pleas from the Canadian Cancer Society and Dense Breast Canada to change the recommendations to include 40-50yr olds. This is because mammograms come with harm to women as the incidence of overdiagnosis and overtreatment increases (stress from false alarms, unnecessary biopsies, and unnecessary mastectomies), and this will only increase when we screen women earlier in life.
If the experts can’t agree, how do I decide what is right for me?
Although the advice is not clear, mammograms are the best things we got for breast cancer screening, and there is no doubt that they saves lives. When making the decision about what age to start screening for breast cancer with mammography, it comes down to you. I encourage every woman to have an in-depth conversation with their doctor about how the evidence that is available right now relates to you personally, so that you can make the most informed decision possible.
Things to consider in your decision with when to start your mammograms:
Know the benefits & risks – Understand both the advantage and the harm that comes with mammogram screening. Discuss with your doctor the statistics on this based on your age, so you can make the most informed decision, and to reduce your worry should you be one of the many women who get called back for a false-positive.
Personal History – previous cancers, proliferative breast disease, obesity/weight gain, use of hormone therapies including the birth control pill, Type 2 Diabetes, pregnancy/breastfeeding, and age of menarche can all contribute to your breast cancer risk assessment.
Your age – As we get older, breast cancer prevalence increases.
Your breast density – Higher the density = Higher the risk of breast cancer. Breast density decreases with age. If you have had a previous mammogram, I encourage you to go over your results in detail with your doctor so you can understand what to expect with future mammograms and how to advocate for breath health monitoring.
Family History – genetics and family history have a large role to play the risk for breast cancer.
Your Ethnicity – Hispanics, Asian and African decent have a higher incidence of breast cancer compared to Caucasian.
Diet & Lifestyle – What you eat, how much you exercise, if you drink alcohol, if you use ci******es, stress…these all play a role in breast cancer risk.
Consideration of Hormone Replacement Therapy – Perimenopause and menopause can be a time of great suffering for women where supplement of hormones can be important and necessary. Discuss with your doctor how hormone replacement therapy is implicated in your breast cancer risk.
If your struggling to find clarity on what is best for you, please reach out to me to discuss your breast cancer risk and better understand what role mammograms have for you.
Thank you Dr. Bobby Parmar, ND, Dr. Paul Maximus, ND and CytoMatrix for a very informative talk and fresh perspective in HRT, perimenopause and breast cancer risk!
Articles:
https://fivethirtyeight.com/features/science-wont-settle-the-mammogram-debate/
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2463847
https://www.cbc.ca/news/health/breast-cancer-screening-1.7219152 #:~:text=Health-,Breast%20screening%20at%20age%2040%20not%20routinely%20advised%2C%20Canadian%20task,new%20Canadian%20screening%20guidelines%20suggest
https://www.uottawa.ca/about-us/media/news/study-shows-annual-screening-age-50-leads-lower-proportions-advanced-breast-cancer
https://canadiantaskforce.ca/understanding-the-benefits-and-harms-is-key-to-breast-cancer-screening/
