Breast Cancer Screening Advice from Julia A. Smith, MD

"Anyone over the age of 40 should have a mammogram every one to two years, and over the age of 50 yearly."
Julia A. Smith, MD, PhD, is the director of the NYU Cancer Institute's breast cancer screening and prevention program and director of the Lynne Cohen breast cancer preventive care program at New York University in New York City.

Q: Do you recommend that all women perform breast self-exams and have clinical exams and mammograms?

A: Yes, I do. I recommend getting a baseline mammogram between the ages of 35 and 40 (to compare against tests later in life). Anyone over the age of 40 should have a mammogram every one to two years, and over the age of 50 yearly. Women should also see a doctor for a physical (or “clinical”) breast exam at least once a year. You should check your own breasts monthly. If you're premenopausal, check them as soon as your period ends.

Q: How important are breast self-exams?

A: Breast self-exams have never actually been shown in studies to decrease the number of women who die of breast cancer. However, I do advise women to check themselves because as they get familiar with their own breasts, they are more able to detect things that seem unusual.

Q: Do mammograms catch every cancerous tumor?

A: The main concern with mammograms is that they tend to produce false negatives, meaning that they will sometimes miss a lump. That happens in around 20% of mammograms. A mammogram will catch most cancers, though—and those are typically the cancers that would not have been caught by clinical breast exams or self-exams.

Q: Should more women get mammograms?

A: Yes, more women should. But unfortunately, the rate of women getting mammograms in recent years has been declining. Its not known why this is. It doesn't appear that doctors are recommending mammograms less, and it doesn't appear that women are not being properly referred. It seems that women are simply not showing up. Depending on the situation, these women are either skeptical, complacent, or scared.

Q: Should I be afraid of the radiation that mammograms produce by using X-rays? Could it give me cancer, maybe even breast cancer itself?

A: Studies have shown no increased risk of problems from mammograms, and the dose of radiation is lower than it used to be. The benefits far outweigh any risk.

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Last Updated: November 03, 2008

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