One of the articles reviewed at our quarterly journal club was on indications for a preoperative mammogram. Since that time, however, the U.S. Preventative Services Task Force recommended that baseline mammograms for most women begin at 50 instead of 40 years old. This change takes into account the significant toll caused by false positive mammographic findings and the ensuing unnecessary breast biopsies. The panel claimed that monetary factors were not a consideration in their recommendations. When they site as supporting evidence that in order to save the life of one woman in her 40’s from breast cancer, 1,904 women would have to be screened every year for up to 20 years, it is hard to deny that cost must have entered their calculations. From a public health standpoint, their screening recommendations may make sense… unless you are that one in 1,904 women who has her life saved. I do not have the answers for the best way to screen the general population of women and would defer to my gynecologic and oncologic colleages for direction. With the massive upcoming changes in health care, do expect more of these controversies.
We Boise Plastic Surgeons agreed that when to do a preoperative screening mammogram was an entirely different question than when to do routine population screening. If you are operating on a breast and incidentally discover a breast cancer, this may change how the cancer is treated. Also, if you have just paid for a breast surgery, your results may be compromised by any necessary treatment for cancer. That said, there are no firmly established guidelines for when to do preoperative mammograms and breast cancers may definitely be missed by mammogram or may develop shortly after a normal mammogram.
Our consensus was to obtain a preoperative mammogram for most women over 35 and for women who are younger with difficult to examine breasts or with a significant family history. The mammogram should be within approximately one year of the planned operation. This should not be considered a standard of care as some surgeons may order the test more or less frequently. Ultimately, breast health is also the responsibility of the patient and her primary care physician as well. I try to obtain indicated mammograms well before an operation so that any suspicious finding may be investigated without delaying the surgery date.