Dear Dr. Garner,
I am totally confused about when I should get my mammograms. I am 42 years old and have now gotten two mammograms since I turned 40. Do I now wait eight years before getting my next one in view of the new guidelines?
Confused about Mammograms in Canarsie

Dear Confused,
You are definitely not alone in your confusion. Many patients and even doctors have asked me questions similar to yours and I would like to review the new recommendations and let you know what I think women should be doing.
The new guidelines are as follows:
• Women should wait until 50 to obtain their first mammogram.
• Women should not do self-breast exams.
• The breast exam that a doctor does in his office is probably not useful.
• After the age of 74, women should no longer have mammogram screenings.
• Women should get mammograms every two years, rather than every year.
I am not sure what prompted the change in the guidelines, but I am very concerned that they could lead to increased deaths.
One of the most significant advances in saving women’s lives is the mammography technique.
Screening mammograms began in 1990 and since that time, there has been a 30% drop in deaths from breast cancer. Forty percent of this drop occurred in women in their 40s, precisely the group that the new guidelines would eliminate from screening.
The United States Preventive Services Task Force, which released the new guidelines, admitted that the changes would lead to increased deaths, but said that it would be a small number. How can we talk about a small number in terms of a woman’s life? If that is your grandmother or sister, do you care if it only saves one life in 5,000?
The panel argued that there were many unnecessary procedures, such as biopsies, in which the final result turned out to be negative.
I am sure that a woman would gladly be inconvenienced with a negative biopsy in exchange for finding cancer early enough to save her life.
I believe women should continue to do self-breast exams. In many instances, I have had cases where a woman found a tumor that was missed by a mammogram by doing a self-breast exam. I shudder to think of lives that might be lost due to this change.
I definitely disagree that a doctor should stop examining womens’ breasts as part of an annual exam. Unfortunately, mammograms may miss up to 15% of cancers. The combination of breast exam and mammogram cuts this number significantly.
One of the things we have learned about breast cancer is that the earlier it is found, the better the chance for a cure and the less invasive the treatment will be. By stretching the exam to every two years, we are reducing our chance of finding the cancer early.
The final recommendation, regarding stopping mammograms for women 74 and above, bothers me.
With today’s increased longevity, there is a very good chance that women who live to be 74 will live into their 90s. I think it inappropriate to automatically stop screening at 74. Women should discuss this with their physician.
This panel did not have any oncologists (cancer doctors) or radiologists on it. I believe this was a big mistake. In addition, the recommendations were released without significant peer review, to see if they made sense. This is not the way to make changes in healthcare, particularly in an area as sensitive as mammography.
There should have been debate and reassessment and extensive education of doctors and patients before they were released.
Another panel recently reviewed Pap smears and how often they should be performed.
These recommendations were made by a group of experts from many different fields, and extensive studies were performed.
I believe the Pap smear suggestions are reasonable. The cancer that the Pap smear detects is usually slow-growing and fewer Pap smears are necessary. I urge women 21 and above to speak to their gynecologist and review their situation.

* Reprinted with permission of The Tablet