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Mammograms are x-rays that provide an image of the internal breast structure. Screening mammograms refer to x-rays of the breasts of healthy women in order to find abnormalities. However, mammography is not perfect, nor is it highly sensitive— the technology misses some breast cancers (false negatives), especially in younger women who have denser breasts. Many changes (false positives) detected by mammograms require a biopsy and turn out to be non cancerous.
Because of the rate of false positives, there is much controversy on the age to begin regular mammorgrams in women at average risk for breast cancer. Current guidelines vary, but all consider mammograms the standard screening tool for finding breast cancer in the general population of women after age 50, with many suggesting mammograms beginning at age 40 or 45. It is important to remember that these guidelines do not apply to women at increased risk for breast cancer due to mutations in BRCA, PALB2, PTEN, TP53, STK11, CDH1, CHEK2, ATM, NBN, or NF1 and/or a strong family history of breast cancer.
Most studies of mammograms in high-risk women or BRCA carriers involved comparison with other imaging techniques such as Magnetic Resonance Imaging (MRI). An article addressing MRI and mammograms in BRCA carriers pointed out that while mammograms had a low sensitivity of 36% (meaning the technology failed to identify many cancers), they had a specificity of 99.8% (meaning there were few false positives and most of the abnormalities identified by mammograms as cancer turned out to be cancer). In another study comparing MRI and mammograms in high-risk women (including but not exclusive to BRCA positive women), MRI generally found more cancers than mammograms, but missed some cancers found by mammography. Although imperfect and not as sensitive as MRI, mammograms are readily available. For these reason, annual mammograms beginning at age 25 are still recommended for high-risk women.
A 2008 publication explored the theoretical benefits and risks of mammography in young, high-risk women younger than 30. The study affirms the benefits of mammograms for BRCA carriers over age 30, but raises questions about relative risks versus benefits for younger women. One of the researchers said these results raise questions about the practice of recommending mammograms beginning at age 25, but do not provide enough evidence to change protocols.