When should you get a mammogram?

The controversy over mammograms continues: This past summer, results of a nearly 30-year Swedish study found that 30% fewer women die from breast cancer if screened regularly.

What the study doesn't do is recommend the best age to start getting mammograms and how often to have them. And there lie the points of contention: The U.S. Preventive Services Task Force says to start at age 50 and repeat every two years; the National Cancer Institute, the American Cancer Society and the American College of Obstetricians and Gynecologists all say to start at age 40 and get screened annually.

There's still no bottom line on who should get mammograms and who should wait. Talk to your doctor to determine what's best for you. But once you start, it's important to keep up with screenings. The National Cancer Institute estimates that more than 230,000 new cases of breast cancer will be diagnosed this year. Here's a look at the latest research in treatment for different cases:

For younger patients: Consider a lumpectomy.

Early research suggests women under 40 who choose to remove only a portion of their breast survive just as long and aren't any more likely to have a recurrence than women who get a mastectomy, removing their entire breast. More women opt for a mastectomy over a breast-conserving lumpectomy based on the assumption that they'll live longer. Talk to your doctor about all your options before making a decision.

For older patients: Skip hormone therapy.

Women over age 60 with a small, hormone-receptor positive tumor may pass up hormone therapy without increasing their risk of death, suggests a new study published in the Journal of the National Cancer Institute. Those type of tumors need estrogen to grow; hormone therapy is designed to starve breast cancer cells by lowering estrogen in your body, it may also help prevent recurrences. But taking hormones also comes with side effects, which can be debilitating (like hot flashes and joint pain) and occasionally life-threatening.

For inherited breast cancer: Ask about chemo first.

Patients with the passed down BRCA1 gene mutation had a much better response to chemotherapy given before any other treatment than other patients, say researchers at the University of Texas M.D. Anderson Cancer Center. Of the more than 300 women in the study, nearly half experienced complete pathological response (pCR), or the disappearance of all evidence of cancer from the breast tissue and lymph nodes. About 5 to 10 percent of breast cancers are hereditary; of these, roughly one-third are due to mutations in the BRCA1 gene. More research is needed to determine optimum treatments.

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