Do you need a baseline mammogram?


I recently went to the doctor for a past due exam – all clear, but the doctor reminded me that I would need a baseline mammogram at age 35."Umm ... 35? I thought it was 40 or 50? Why do I need a mammogram so early?""That's just what we do here," she replied.To my doctor's credit, I didn't question further about why a baseline mammogram is the norm in her practice, or what benefit it would give me. But I did want to do more research before I made a decision. Let's be perfectly clear. This is a baseline mammogram we're talking about. A baseline mammogram is taken first to compare to future mammograms when a woman decides to begin routine screening at 40 or 50. There's no evidence that this comparison between a baseline mammogram and the first routine screening holds any benefit. In addition, the baseline mammogram isn't looking for anything at this point. I have no family history of breast cancer. I don't have a suspicious lump or any other symptoms. I don't have dense breasts. I checked with my insurance company and they cover mammograms, regardless of age or reason. However, I can't find a professional group that recommends a baseline mammogram. The American College of Obstetricians and Gynecologists don't recommend them unless there is a family history. The American Cancer Society recommended baseline mammograms several decades ago, but removed it back in the early 1990s. So, why do some gynecologists still recommend them? I talked with Dr. Len at the ACS and he gave me some important background. He said the ACS recommended baseline mammograms from 1980 to 1991 because of the belief that they could help detect cancers in the future – comparing the mammography images from baseline and those taken later. (Here's a chronological depiction of the various guidelines from the ACS over the years.)Unfortunately, he says, baselines mammograms didn't help find cancers. Many times those baseline images weren't even available to compare with later images, and ultimately they just didn't prove to be very valuable. Women depend on their doctors to understand these guidelines and they should be comfortable being able to discuss the pros and cons with their patients, Dr. Len says. And an answer of "That's just what we do here," isn't helpful. This isn't to say I don't think young women should be screened for breast cancer. I know several young women who had symptoms, a family history or just a nagging concern that something was wrong but had to jump through hoops to get a mammogram or other screening test to finally diagnose breast cancer.When I asked on my Facebook page what other women thought of baseline mammograms, it generated a great discussion. Lisa, who was diagnosed with breast cancer at a young age only 18 months after a clean baseline mammogram, had some great advice: Any doctor should be able to give an answer to the question, "Why are you ordering this test, and why now?" If not, I'd press for better explanation for the timing. When told "that's just what we do," I'd definitely press that. "Why do you do what you do if research on screening's effectiveness contradicts your practice?"For now, I'm going to hold off. I have a few more years before I decide whether to start routine screenings at 40 or 50--and I have a feeling that will be a much harder decision. What do you think? Did you get a baseline mammogram?

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