Mammograms at 50 Instead of 40? New Guidelines Controversial

When should a woman get her first mammogram?

The automatic answer for me and for most women I know has been as soon as she turns 40.

But on Monday, the federal government released new guidelines pushing the recommended age from 40 to 50, citing a higher instance of false positives for women who get the breast exam between 40 and 49 and a lower overall risk of breast cancer -- one in 69 at age 40, compared to one in 42 at 50.

The new guidelines also state breast self-examination should no longer be taught because it is ineffective in reducing the number of deaths from breast cancer.

The new guidelines reverse previous advice, and not surprisingly, they've generated plenty of controversy among doctors and women. On Monday, the American Cancer Society responded with a statement from its chief medical officer, Dr. Otis Brawley, saying that he recommends mammograms "unequivocally" to "any woman 40 and over, be she a patient, a stranger, or a family member."

The U.S. Preventative Services Task Force's report said the harms of beginning mammograms age 40 outweigh the benefits. Specifically: "The harms resulting from screening for breast cancer include psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results."

Here's how the New York Times worded it: "While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman's lifetime, resulting in unnecessary treatment." Sphere's Andrea Stone describes that experience here.

I've noticed one puzzling word that keeps popping up on both sides of the argument: anxiety.

Those who advocate that women get their first screening at 50 complain about the anxiety caused by the tests themselves and by the higher number of false positives women are hit with before the age of 50. Those who advocate first screenings at 40 counter that, with later test guidelines, women will be stuck for years with the horrible anxiety of not knowing if they might have cancer.

Excuse me for a moment while I go sit in the corner and rock.

Before we pat women on their heads and direct them to the nearest fainting couch, here's something we might try: honesty. Keep the screening guidelines at 40, but be honest with women from the get-go about the flaws and inexactitudes in the test and that it's less likely to be accurate before the age of 50. And be honest about the fact that, if the mammogram is positive, she very well may end up being one of the women who unnecessarily go through cancer treatments on the strength of faulty tests, and that, if it's negative, she quite possibly still could have breast cancer.

Is this comforting? Of course not. But, if I wanted comfort, I'd brew a cup of milky ginger and anise tea, to be sipped slowly on my porch while re-reading "Sense and Sensibility"; if I wanted reassurance, I'd call my mother; and, if I wanted to be condescended to, I'd take my laptop in to be fixed.

What I want from my doctor is a strong grounding in science and an honest presentation of the facts even -- maybe especially -- when the facts are murky.