Higher risk-radiologist said not to have a mammogram?
Comments
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My mom was 42 when originally diagnosed stage I...age 57 for bone mets. I am 28 and the radiologist "strongly advised" me not to undergo a mammogram (and subsequently talked me out of it) until I was at least 35. My mom's oncologist told me that my chances (despite BRCA neg), were 1 in 4 for developing breast cancer and told me to undergo a mammogram soon. Can anyone offer advice regarding a mammogram at my age? Should I be pushing for an MRI instead? Since my mom was premenapausal, it seems that my sister and I should not wait until we're 40 (when our insurance companies will pay for it!). The radiologist told me that the risk of radiation outweighs the benefit. I can't help but feel that I should have at least one baseline screening before I'm 30. If anyone could offer any thoughts, I would greatly appreciate it!
Thank you,
Alyssa
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The rule of thumb is to start screening 10 to 12 years before the age your mom got diagnosed. So since she was 42, age 30 sounds just about right to start screening. I would ask your gyn and push for one at 30.
Anne
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Hi Anne,
Thank you for this information. It is greatly appreciated! I think I am going to ask my doctor to start screening at 30.
Thanks,
Alyssa
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Hi Alyssa,
I think that the benefits outweigh the risk of radiation exposure. The dose that you are receiving from the mammogram is even less now with digital because there are fewer repeat films with this new system. I would listen to your moms oncologist in this case. Better safe than sorry. MRI will be harder to persuade the doctor for. Good luck with everything. It looks as though are are being proactive early on so I am sure you will be an excellent advocate for yourself.
Julie
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Current models probably still suggest there is no absolutely 'safe' dose of radiation (there is no 'threshold' of safety-where below this dose there is no significant risk for cancer), but we are all exposed to some levels of radiation throughout our lives (if nothing else by cosmic rays). The breast/breast buds of girls/women before age 20 may be at highest risk. There are different types of radiation, and that may be a factor also.
I know you tested negative for BRCA. It is possible, though, as you probably know, that you could have some as-yet undiscovered single gene mutation. Another complication is that at your younger age, most women have dense breasts, so mammography may not show anything anyway.
They do know that childhood radiation treatment to the chest (such as with Hogkin's disease) does put one at subsequent risk of breast cancer. There is an association with high doses of radiation (such as atomic bomb survivors, and other types of radiation exposure) and breast cancer. http://www.ncbi.nlm.nih.gov/pubmed/12105993
But you would be getting a much lower dose than that, of course, in a mammogram. This study of people exposed to prolonged low doses of radiation (from Cobalt 60 in the steel reinforcement of their buildings) showed a very low correlation with breast cancer (marginally significant correlation). http://www.ncbi.nlm.nih.gov/pubmed/18666807
More to the point, this study, using many assumptions and models, opined that mammography is probably not of benefit for BRCA carriers in ones 20s. http://www.ncbi.nlm.nih.gov/pubmed/19176458 This European study found a risk for chest Xrays (which have much more radiation than mammograms) in BRCA carriers before age 40. http://www.ncbi.nlm.nih.gov/pubmed/16801631
In the UK, they do not normally use mammography for screening for women under 50. This study opines there is some evidence that low-dose radiation may be more mutagenic than higher dose radiation. http://www.ncbi.nlm.nih.gov/pubmed/19454801 "Annual two-view screening should not beconsidered below age 35 years for women with no family history,and even for those who do have such a history, it should onlybe considered if the index patient was diagnosed below age 40years."http://bjr.birjournals.org/cgi/content/full/80/952/261
I am just giving you some examples of the data that the high-risk radiologist is using.
I think the evidence would certainly support the idea that MRIs would be safer (because there is so much less ionizing radiation exposure), but, as you say, your insurance will almost certainly not cover.
I'm sure there is controversy because of all the assumptions in these models.
Its not an easy decision to make.
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Since young women tend to have dense breast tissue, mammogram can be innacurate which is why MRI is often suggested. You might also want to ask about ultrasound which is another useful screening tool.
Leah
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Hi ladies,
Thank you so much for all of your wonderful advice. My mom and I definitely get better advice from this site than we do from the oncologists! Everyone is so well-informed and the experience everyone shares is invaluable. I know my mom would not have had her most recent scans (that showed mets increase) if it weren't for the advice from women in this forum. It pays to be proactive and have a network of support. I know my mom has appreciated the support she gets here and she feels very lucky to be connected to this community.
Many thanks!
Alyssa
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