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Daleela G. Dodge, M.D., said breast self-exams and clinical breast exams remain very important and save lives.

The timing, frequency and impact of screening mammography is the subject of intense debate in the medical community.

Daleela G. Dodge, M.D., of The Surgical Group, said recent changes to breast cancer screening recommendations have caused confusion for both healthcare providers and patients, which can lead to delays in diagnosis.

Experts generally agree that women ages 50 to 74 should have a mammogram at least biennially. The most recent guidelines for women ages 40 to 49 recommend leaving the decision to have a mammogram up to each individual woman and her doctor.

“There is still significant incidence of cancer in women in their 40s,” Dr. Dodge said. “Data that shows improved survival rates in the screening age group vs. the pre-screening age group has strong implications for why screening is valid.”

The newest guidelines also downplay the value of breast self-exams and clinical breast exams. However, Dr. Dodge said both remain very important and save lives. All women should be familiar with their breasts and bring any changes their doctor’s attention, she said. 

"In the last several decades, survival data in women under the age of 40 has not demonstrated any significant improvement, while there have been significant gains seen in older age groups who are having screening mammography,” she said. 

“Younger women are also more likely to present in stage 4. If you’re not aware of your breasts, you’re going to delay diagnosis.”

Dr. Dodge emphasized that the screening guidelines are meant for women at average risk for breast cancer. (“With a 12 percent incidence of breast cancer, there is no such thing as a ‘low-risk’ woman,” she said.) There is no debate about the benefits of screening women who have a strong family history of breast cancer.

All primary-care physicians should regularly assess and discuss risk factors with patients, Dr. Dodge said. The online breast cancer risk profiler tool, it also can help women evaluate personal risk.

Many risk factors associated with lifestyle can be changed. When appropriate, physicians should refer patients to the Cancer Risk Evaluation Program, she said.

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