An excellent question. First, yes: mammograms have a relatively tiny dose of radiation. Second, the North American approach, as articulated by the National Comprehensive Cancer Network offers these recommendations: In the absence of suspicious findings on physical exam, decisions on whether to proceed with screening mammography are based on risk stratification, with women falling into one of four groups.

• For women ages 20 to 39, the guideline states that physical breast examination should be repeated every 3 years.
• For women age 40 and above, the guideline recommends an annual physical examination and annual mammography. “This decision,” Dr. Singletary pointed out, “is based on the consensus of the American Cancer Society.” The committee also noted among its “breast cancer considerations” that “mammography interval and cost-effectiveness are controversial in the 40 to 49 age group.”

Note the last line. And so we turn to the European approach: Recommend against annual mammography and screening in women aged 40 to 44 years, and instead recommend screening every 2 to 3 years for those aged 45 to 74 years.

I think while there may be an exceedingly small risk of RT-induced cancer associated with mammograms (no high-level evidence, though), particularly among those with a deleterious mutation (such as in BRCA, ATM, CHEK2, or PALB), a concern for many is the false-positive rates (leading to unnecessary procedures such as biopsies). The FP rate is lower in Europe (I think the litigious nature of Americans plays a role; the radiologist can’t afford to miss, so overcalls relative to our European counterparts).

I don’t know your age or risk category (and thus would not make an individual recommendation for you), but now you have the two differing approaches.

Thanks for the insightful question.

Warm regards,

Michael