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Should you be concerned about breast cancer? If you're a woman, the answer is yes.

The good news is mammography, although still not perfect, has been gradually improving over the past two decades. With advances in equipment and techniques, average radiation doses have declined dramatically while the images produced have become clearer and thus easier to interpret.

The bad news is there continues to be some debate about exactly when a woman should begin this testing. For a woman with no family history of breast cancer, theories range from having a mammogram at age 30 to waiting until 50 years of age. There are experts who suggest testing at age 35, regardless of other factors. These conflicting guidelines, along with other concerns, have caused women to avoid the mammogram altogether, which can have deadly results down the road.

Donna Mozdian, a Community Outreach Coordinator for the National Cancer Institute (NCI), says, "The issue about when to begin testing is more of a controversy in the eyes of the media than for most health care professionals. Clearly, the media have misinterpreted some of the statistics. In fact, we feel the situation is better labeled a difference of opinion rather than a controversy. Differences such as these can be beneficial in the long run because they spur on more testing and more research."

The NCI official word states that for women over the age of 50, breast cancer deaths can be reduced by 1/3 by routine screening mammograms every one to two years along with clinical breast exams.

For women under age 50, the NCI suggests that each woman have an individual consultation with her health care provider for a screening recommendation based on personal health history and risk factors. Mozdian adds, "We think it's very important to take breast cancer screening on a woman-by-woman basis and not get too caught up in rhetoric."

Adding to an already complicated issue, there is evidence mammograms may not work as well for younger women due to physical considerations. Because younger women have denser, less fatty breasts, the higher density makes the x-ray films difficult to read correctly. Cancers may be harder to detect while benign lumps can be tougher to distinguish from cancerous ones.

Even in the best circumstances, some tumors are missed by mammography. If, for example, a woman's tumor at the particular time she has a mammogram is the same density as the surrounding breast tissue, it may not show up on the x-ray.

Julie Gries, a Cancer Control Program Director for the American Cancer Society, reports that their official guideline is slightly different. The American Cancer Society suggests all women should have their first mammogram by their 40th birthday. Between the ages of 40 and 49, women should be tested every one or two years. Then, at age 50, women should have both periodic professional exams and mammograms annually.

Another group, the American College of Physicians, recommends that women begin to have mammograms at age 50 and continue to have the test once a year. It seems there is agreement on the value of mammograms for women in the over 50 age group.

The above screening recommendations apply to women who have no symptoms of breast cancer and who are not at high risk for the disease. Any woman, regardless of age, should see her health care professional if she has symptoms such as a lump or other change in the breast. Women who have no symptoms but may be at higher risk because of family history, obesity, or late childbearing, for example, may need earlier and more frequent mammograms.

As you can see, the experts don't agree on the role of mammograms in women under the age of 50. Until such time as more clinical trials are completed or the experts can concur, it's up to each one of us to take full responsibility for our own health. It is proven that early detection and treatment saves lives, and no one argues about that.

Components of a high quality mammogram

Mammography is still considered the best tool we have for early detection of breast cancer. Be certain the facility you select offers safe and reliable tests. Ask if:

1. a licensed or certified technologist will perform the procedure,
2. the facility is currently certified under Medicare,
3. the facility is accredited by the American College of Radiology, and
4. the physicians are specially trained and certified to interpret mammography.