What to make of the new mammography guidelines, from the January 2015 Harvard Women's Health Watch

Women who tend to "go by the book" for preventive health care probably get a flu shot each fall, have a colonoscopy every 10 years, and generally follow the experts' recommendations. But what to do about mammograms? For decades, the two most influential expert groups — the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF) — haven't agreed about when to start having mammograms, how often to have them, or how long to keep on having them. The ACS recommends annual screening for women ages 45 through 55 and biennial screening thereafter for as long as a woman is healthy. The USPSTF advises biennial screening for women ages 50 through 74.

Although the two groups come a little closer together with their most recent guidelines, they still disagree about breast cancer screening for women ages 45 to 55. Dr. Nancy Keating, professor of health care policy at Harvard Medical School and an internist at Harvard-affiliated Brigham and Women's Hospital, sums up the situation: for women older than 40 who are at average risk, there is no single right answer to the question, "Should I have a mammogram?"

The guidelines are only suggestions. Women trying to decide when — or whether — to have their next mammogram may want to have a conversation with their clinician. They can work together to estimate her personal risk for breast cancer, weigh the benefits and risks of mammography, and consider her values and preferences. Dr. Keating suggests exploring the following questions:

· What is my personal breast cancer risk?

  • What are the risks and benefits of mammography for me?
  • How would I react if I chose not to have a mammogram and developed invasive breast cancer?
  • Am I willing to undergo treatment for ductal carcinoma in situ — abnormal tissue that may not progress to invasive cancer?
  • What are my preferences?

The article includes a risk chart and other detailed information to help women answer them.

Read the full-length article: "What do the new mammography guidelines mean for you?"