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[M. Swanson] All of the research has indicated that women should have at least a base-line mammogram in their forties. Women at higher risk should have annual mammograms. There are certain populations that are at high risk in their forties, and those are African American women and Latina women. Research has shown that they have a higher mortality rate from breast cancer before the age of forty than other women do.

The American Cancer Society has had guidelines for many years that say that you start screening at age forty, and after age fifty, you screen every year, and that is consistent with research. It’s essentially an x-ray of the breast that’s used to detect cancer cells at an early stage before you’re able to feel them.

Women can do a breast self-examination and sometimes detect a lump, but usually by the time you could detect it or your physician can detect it through a clinical exam, it’s grown so large that it may have metastases. The x-ray, the mammogram, can find cancers at a much smaller stage, often less than half a centimeter, and the smaller the cancer is, the lower the probability that it’s metastasized to other places of the body.

In 1994, fifteen years ago, the National Cancer Institute put out guidelines saying the same thing essentially that women in their forties shouldn’t have a mammogram and that older women should have them every other year, and the director of the National Cancer Institute and I and some others got into a debate about this, and I was invented to write a commentary for the journal of the National Cancer Institute, which was published in 1994, and essentially what I said in that is, just like these guidelines, they were saying that the guidelines were based on science. They’re not. The science would never support this kind of a recommendation.

At that time, it was pretty clear that politics were involved. Today, a lot of people wonder if the recommendation isn’t based on the health care reform debate, and saying basically we can save money. It’s fine to have guidelines that are put out there for economic reasons, but be honest about it. Say that we’re doing it because we can’t afford to do everything that we’d like to do in the health care system, so we have to cut corners somewhere, and this is one of them that we’re recommending.

You should have at least, for average risk women, a base-line mammogram at age forty, and the base-line is to show what your breasts look like when it’s normal, so that as you do annual ones after the age of fifty, if there are changes, you compare the earlier mammograms with each new one, and so you have a base line that says this is what you look when your normal, and then if something shows up, you’ll know that it’s something new and different.

Women at high risk, though, should have annual mammograms. Basically, women should talk to their physician about their risks and go over their personal history and their family history and decide whether they need just a base-line at age forty or whether they should have more frequent ones depending on their own risks and their family risks.

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