The American Cancer Society recently released updated guidelines for breast cancer screening by mammography. The recommended starting age for yearly mammograms increased from 40 to 45. At age 55, the time interval increased from yearly to every other year. This follows on the heels of the 2009 U.S. Preventative Task Force's new draft recommendations of every other year mammography screening for women between the ages of 50-74 versus the prior recommendation of yearly mammograms starting at age 40.

It is very important to note that these recommendations are applicable only to women with AVERAGE RISK for breast cancer. Those with personal or family history of breast cancer and/or known genetic predisposition likely need to start earlier and screen more frequently.

The goal of any screening test is to reduce morbidity and mortality by detecting the disease in an earlier stage than may be clinically apparent. The underlying assumption is that earlier diagnosis leads to better treatment response and/or requires less aggressive treatment, resulting in both improved quality and quantity of life.

Ideally, a screening test would be able to accurately identify all and only those who truly have disease. In reality, the recommended test must strike a balance between the improved prognosis and saved lives against the false positives that lead to unnecessary invasive testing and undue anxiety while awaiting results. The American Cancer Society and the U.S.P.T.F. are actively searching for that balance by continuing to re-evaluate these tests and their overall impact on our health.

As with any health intervention, women need to not only discuss with their health care providers and understand their personal risk and how these recommendations apply, but to also explore where along the risk:benefit spectrum lies their own particular comfort zone. The mammogram is a very good screening test for breast cancer, even more so now with the improved technology of digital mammography, but it is not a perfect test. It is especially important for women who do not fall within the brackets outlined to educate themselves on these nuances in order to make an informed decision.

It is clear that mammograms saves lives. What is not clear is when to start and how often to screen. While the evolving and currently non-synchronous recommendations can be confusing, it is important that we continue to question our body of knowledge so that we may better delineate that border between healing and harming.

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