The talk shows and women’s magazines are ablaze this month with “You must get your annual mammogram.”  And “Mammograms save lives.”  Those statements may not hold up in the face of analysis.

The central question in the mammography debate has to do with the matter of when to begin mammography.  Should women start at age 40 or wait until, they turn 50?  The National Cancer Institute and the American cancer Society recommend starting at 40.  The U.S. Preventive Services Task Force says 50.

Last year a Swedish study was praised for its depth and breadth.  It measured more than 100,000 women over a period of 30 years.  The conclusion?  Women whose doctors offered regular mammograms cut their risk of dying of breast cancer by 30 percent.  Clinicians globally touted the results.  But the study did not factor in the age question—do we begin at 40 years or wait a decade.  Nor did the study control for nutrition—the typical Swedish diet favoring much more fish and less processed foods than a typical American diet.

A growing number of organizations believe mammograms are more likely to lead to overtreatment.  This is particularly true of women in the 40-50 age bracket, a group whose breasts are comparatively dense.  Both breast density and breast cancer appear as “white” on mammograms.  This makes malignant cells difficult to distinguish.

If there is a suspicion, biopsy is often ordered.  Worse, even in Stage 0 and Stage I ductal carcinoma in situ (DCIS), prevailing medical practice says, “Get it out.”  This very often leads to aggressive treatment for something that wasn’t really dangerous.  This past week I spoke to a woman with a Stage 0 DCIS.  The surgeon was insisting on a double mastectomy as the “only alternative.”  I advised that woman not to walk away from that surgeon, but run!

Breast cancer is an exceedingly emotional issue.  I have had countless women tell me, “Mammography saved my life.”  Judging just from the statistics, that statement is very, very unlikely to be true.  But I no longer debate those statements.

What’s reasonable?  Here is my best guidance based on the actual evidence:

For women under 50-years old:

• Employ annual clinical breast examinations and monthly breast self-examinations as your primary early detection protocol.
• Once a year, every year, without fail, schedule an appointment with your healthcare provider to perform a clinical breast examination.  We recommend you schedule it on or near your birthday.
• Once a month, every month, without fail, set aside 15 minutes to conduct thorough breast self-examination.  We recommend you schedule it on the first day of menstruation.
• Schedule a mammogram only if needed for diagnosis of a suspected lump.  Even then, be sure to schedule that mammogram within the first 14 days of your menstrual cycle.
• In addition, you may wish to employ annual thermography screening between the ages of 30 and 50.
• If you are between the ages of 20 and 30, consider a thermogram every two years in addition to your monthly breast self-examinations.

For women over 50-years old:

• Employ annual clinical breast examinations and monthly breast self-examinations as your primary early detection protocol.
• Once a year, every year, without fail, schedule an appointment with your healthcare provider to perform a clinical breast examination.  We recommend you schedule it on or near your birthday.
• Once a month, every month, without fail, set aside 15 minutes to conduct a thorough breast self-examination.  We recommend you schedule it on the first day of your period if you are still menstruating.
• Schedule a mammogram if you discover a lump.  Even then, be sure to schedule that mammogram within the first 14 days of your menstrual cycle if you are still menstruating.
• Employ mammography screening every other year.
• Consider thermography screening on alternate years.
• If a positive result comes back from the thermogram, schedule a mammogram.

I have come to understand mammography screening as an unreliable, mistake-riddled profit-driven technology.  In striking contrast, annual clinical breast examination by a trained health professional, together with monthly breast self-examination is safe, at least as effective and lower in cost.