Breast cancer surgeon weighs in on new mammogram guidelines

City of Hope breast surgeon Dr. Anita Johnson says the US Preventive Services Task Force's new recommendation women start getting mammograms at age 40, came as a relief, sort of.

"Well, finally, we're back to 40," Johnson smiles. "In 2016, we were at 50."

But she disagrees with the USPSTF's recommendation that women get follow-up mammograms every other year from age 40 to 74.

"The American Cancer Society, as well as other societies, still recommend annual screening, and annual screening has been proven to lower the mortality rates," Dr. Johnson says.  

These screening guidelines are for women at average risk of developing breast cancer.

"If you are any woman, and you've been you have a strong family history, particularly of early age-onset breast cancer, younger than 45 years old, then you need to talk to your primary care doctor about when you need to start having screening mammography," Johnson says.  "You definitely need to start having clinical breast exams at a much younger age.  It's around 25-years-old."

Johnson says the American College of Radiology recommends women in higher risk groups, such as those of Ashkenazi Jewish descent and Black women, get a breast cancer risk assessments by age 25, to determine if they need to start breast cancer screenings before age 40.

Women of Ashkenazi descent, Johnson says, are more likely to carry the BRCA1 or BRCA2 breast cancer gene mutation, which raises their risk.

What is still not clear, but is being researched, is why Black women are at increased risk. 

Johnson, who is African American, says she sees younger Black women every day at City of Hope Atlanta, where more than a third of their breast cancer patients, she says, are under the age of 40.

Why the is increased for African-American women, we still don't know," Dr. Johnson says.  "What we know is that they present at a much younger age," Johnson says. "They can present with a more aggressive breast cancer. Then, when we look at their survival rates, they are significantly worse than their Caucasian counterparts', with a 40% mortality rate stage for stage."

The bottom line, Dr. Johnson says, do your breast exams, and read your mammogram report, because if you have extremely dense breast tissue, you may need additional screening, such as a breast MRI.

"So, all women should know what their mammogram looks like," Johnson says.  "It's not just doing a breast exam, but knowing if you have dense breast tissue or not. But we encourage women here at City of Hope to have mammograms starting at the age of 40 every year."