Mammograms Sought By Most Women Over 40

The majority of women in the US are getting their first screening mammogram for breast cancer at age 40, as recommended by health experts, according to a new report in the medical journal Cancer.

The American Cancer Society guideline for screening mammography states that women 40 years of age and older should have a screening mammogram every year.

The National Cancer Institute guideline for screening mammography states that women in their 40s and older should have a screening mammogram on a regular basis, every one to two years.

Access To Mammograms Not Always Easy

However, certain women - particularly those who are poor, lack insurance, or do not speak English - are failing to get the imaging tests by 40, the researchers say.

The findings are a follow-up to a study published last year by the same group that found only 16 percent of women who have their first mammogram return at the correct annual interval for follow-up mammograms.

Taken together, the two studies give women good marks for an initial mammogram but not for follow-up screenings, says James A. Colbert, lead author of the latest study.

Colbert and his colleagues looked at more than 72,000 women who got screening mammograms at Massachusetts General Hospital in Boston between January 1985 and February 2002.

"From that we selected a subpopulation of 940 who we found had a first mammogram between January 2000 and February 2002," says Colbert, a research assistant in the division of surgical oncology at the hospital.

The fact that 60 percent of the women had their first mammogram by the end of their 40th year is "considered very good," Colbert says.

However, according to the new study, some women fell short of the recommended guidelines. For instance, African-American women began screening at a median age of 41 years, about 0.7 years later than white women, the researchers found. And Hispanic women began screening at a median age of 41.4 years, 1.1 years later than non-Hispanic women.

Women without private health insurance began screening even later - at a median age of 46.6 years, or 6.3 years later than women with private health coverage. And non-English speaking women began screening at a median age of 49.3 years, or nine years later than the English-speaking persons, the study found.

The last to get their first mammogram were women who lacked private insurance and did not speak English. They had their first screening at a median age of 55.3 years.

In the study published last year, the researchers found the median time for return for a follow-up screening for women who had a mammogram in 1996 was 1.3 years. And about 25 percent failed to return by three years. Only 16 percent of the women who had a mammogram at the hospital in 1996 had five subsequent screenings during the next five years.

The new study was not designed to tell why the rate of the first screening mammogram was lower for those who did not speak English or did not have health insurance, Colbert says. "We hypothesize that it is due to a communication problem," he says.

Lack of Access a Concern, Expert Says

The new study's findings ring true with Dr. Melvin Silverstein, a breast surgeon at USC's Norris Comprehensive Cancer Center and chief of the breast service at the USC/Los Angeles County Medical Center, a county hospital that serves many poor patients.

Dr. Silverstein sees a wide spectrum of patients. The women who get mammograms at the Norris Center tend to get their cancers detected early because they don't miss their screenings.

At the county facility, Silverstein often sees women who have skipped their annual mammograms and, as a result, may have their breast cancers diagnosed at a later stage.

"They are people who have to work, who can't take a day off" to get a screening mammogram, he says.

"It's a very good study," Dr. Silverstein says of the latest research. "It points out that some groups of women are doing a good job - that is, English-speaking, well-insured, affluent women."

What is needed, Dr. Silverstein and Colbert agree, is a way to get the message out to all women about the necessity of beginning mammograms at age 40, and getting follow-up screenings annually.

"At Massachusetts General, the staff spends two hours a day on the phone to remind patients about their mammogram appointments," Colbert said.

If a woman's hospital or HMO does not do that, he says, one way to remember is to schedule the annual mammogram on or near the same date each year. Or pick a date that is easily remembered, such as a day before or after a birthday.

Always consult your physician for more information.

Online Resources

American Cancer Society

American Society for Clinical Oncology

Centers for Disease Control and Prevention (CDC)

National Cancer Institute

National Institutes of Health (NIH)

National Women's Health Information Center

Susan G. Komen Breast Cancer Foundation

November 2004

Mammograms Sought By Most Women Over 40

Access To Mammograms Not Always Easy

Other Resources:

St. John's Mercy Cancer Services

Find a St. John's Mercy Physician

Breast Health Information

Women's Health Information

St. John's Mercy Classes and Programs

What Is a Mammogram?

A mammogram is an X-ray exam of the breast. It is used to detect and diagnose breast disease in women who either have breast problems such as a lump, pain, or nipple discharge, as well as for women who have no breast complaints.

The procedure allows detection of breast cancers, benign tumors, and cysts before they can be detected by palpation (touch).

Mammography cannot prove that an abnormal area is cancer, but if it raises a significant suspicion of cancer, tissue will be removed for a biopsy. Tissue may be removed by needle or open surgical biopsy and examined under a microscope to determine if it is cancer.

Mammography has been used for about 30 years, and in the past 15 years technical advancements have greatly improved both the technique and results. Today, dedicated equipment, used only for breast X-rays, produces studies that are high in quality but low in radiation dose. Radiation risks are considered to be negligible.

The recent development of digital mammography technology shows promise for improved breast imaging.

Digital mammography provides electronic images of the breasts that can be enhanced by computer technology, stored on computers, and even transmitted electronically in situations where remote access to the mammogram is required.

The National Cancer Institute describes the following types of mammograms:

screening mammogram
A screening mammogram is an x-ray of the breast used to detect breast changes in women who have no signs of breast cancer. It usually involves two x-rays of each breast. Using a mammogram, it is possible to detect a tumor that cannot be felt.

diagnostic mammogram
A diagnostic mammogram is an x-ray of the breast used to diagnose unusual breast changes, such as a lump, pain, nipple thickening or discharge, or a change in breast size or shape.

A diagnostic mammogram is also used to evaluate abnormalities detected on a screening mammogram. It is a basic medical tool and is appropriate in the workup of breast changes, regardless of a woman's age.

X-rays of the breast are different than those used for other parts of the body. The breast X-ray does not penetrate tissue as easily as the X-ray used for routine X-rays of other parts of the body.

The breast is compressed by the mammogram equipment to spread the tissue apart. This allows for a lower dose of radiation. Compression of the breast may cause temporary discomfort, but is necessary to produce a good mammogram.

The compression only lasts for a few seconds for each image of the breast. A breast health nurse or X-ray technologist usually takes the X-rays, but the resulting films are read and interpreted by a radiologist, who reports the results to your physician.

A mammogram may show calcifications, tiny mineral deposits within the breast tissue.

One type of calcification is called macrocalcifications, where the coarse calcium deposits may indicate degenerative changes in the breasts such as aging of the breast arteries, old injuries, or inflammations.

Microcalcifications are tiny (less than 1/50 of an inch) specks of calcium. When many microcalcifications are seen in one area, they are referred to as a cluster.

Masses, which may occur with or without associated calcifications, and may be due to different causes, include:

cyst - a non-cancerous collection of fluid in the breast. It cannot be diagnosed by physical exam alone nor by mammography alone. Either breast ultrasound or aspiration with a needle is required. If a mass is not a cyst, then further imaging may be obtained.

benign breast conditions - masses can be monitored with periodic mammography, but others may require immediate or delayed biopsy.

Always consult your physician for more information.