tuesday, may 14, 2024 . the washington post eZ ee e5 And estrogen is without question the most effective treatment for the symptoms of menopause.” Overall, the benefits of shortterm hormone therapy to treat menopausal symptoms and prevent bone loss have been shown to outweigh the risks for most healthy women, according to a long-term follow-up to the randomized trial called the Women’s Health Initiative, which studied the risks and benefits of hormone use in millions of women. There is still some question about whether hormone therapy may help with cognition. Age may be a factor. A 2010 study of 5,504 postmenopausal women found that compared with women who were never on hormone therapy, those taking it only in midlife, around age 49, had a 26 percent decreased risk of developing dementia, while those taking it only in late life, about 76, had a 48 percent increased risk. Aside from medication, diet and nutrition, exercise and sleep have been associated with “a gentler menopause for many women,” Mosconi said. There are also non-hormonal options for treating the symptoms of menopause, including antidepressants, blood pressure medication and anti-seizure drugs. “There’s a lot of talk about a window of opportunity — that perimenopause should be viewed as a critical window for improving women’s health,” said JoAnn Manson, a professor of medicine at Harvard Medical School and Brigham and Women’s Hospital and a lead investigator on the Women’s Health Initiative. with participants two years later, they found that metabolic activity tends to stabilize in some regions of the brain and that gray matter volume can rebound for some — but not all — women after menopause. More research is needed to better understand when these changes are permanent and when they are temporary, Mosconi said. Mosconi added that some clinical symptoms of menopause, such as hot flashes, also tend to be temporary, suggesting that the brain has the ability to adapt. Easing the brain symptoms of menopause Women’s health experts agree that a combination of a healthy lifestyle and pharmaceutical interventions, when needed, may lead to an easier transition into menopause. In perimenopause, the years leading up to menopause, doctors may prescribe birth control pills to stabilize erratic periods, prevent unwanted pregnancy and ease symptoms, said Sharon Malone, chief medical adviser of Alloy Women’s Health and author of the book “Grown Woman Talk.” Women who are not experiencing irregular or heavy periods and do not need birth control may opt for menopausal hormone therapy, which uses estrogen or estrogen plus a progestogen to treat hot flashes, night sweats and other symptoms caused by reduced hormone levels. “Estrogen is not the danger most women think it is,” Malone said. “For the overwhelming majority of women, estrogen can be used safely and effectively. [email protected] As my husband, Ward, and I drove away from the two-story white house that had been our cozy home in Falls Church for the last 25 years, the cold fact of what we had done hit me hard. We had sold our house, and now, in our 70s, we were going to live in a retirement community. We loved our home of 25 years. We had watched it being built, but in our hearts and gut we knew it was time to plan for the future. It helped that the young couple who bought our home loved it and would care for it as much as we did. We decided it was time to move to a retirement community because the work of maintaining a large home, with a hilly lawn and garden was becoming too difficult for our aging bodies and increasing problems with health. (I was 78, and Ward was 73.) Moreover, we wanted the freedom from home and lawn care so we could travel while we were able. But like many people who leave their homes as they face the realities of aging, we also worried about maintaining independence and losing our privacy. Before making this life-changing decision, it helped that we had done the necessary homework, analyzing finances and poring over articles about retirement, debating the pros and cons endlessly and praying. But that didn’t make it easy. Fortunately, we found a faithbased nonprofit retirement community close to where we lived. We moved into a two-bedroom apartment with a balcony. That was 14 years ago. To help you make a decision about retirement living, I suggest getting on mailing lists of various communities, looking at their websites and attending their open house days. Speak with residents, ask questions about relationships with staff and get a feel for the vibe. At one community where we had dinner, the residents didn’t interact with the servers. It was very formal. In our community, the staff and residents are friends. Many of us feel almost like grandparents of the young people who work here. We know their names and their goals in life. Finances also play a role in deciding whether to move to a retirement community. We were fortunate to have adequate income from my husband’s career as a naval officer. I strongly suggest that before making a decision about a retirement community, it is wise to discuss not only current expenses but also future needs. As we were making our decision, we both had chronic obstructive pulmonary disease, mild at the time, but what of the future when we required nursing care? I know people who have found quality care on tight budgets. My sister is a widow on a teacher’s pension. She lives in a small apartment, but she tells me she is happy and secure because of how caring and helpful everyone is, including top management, the staff and the community’s driver. For both of us, we’ve learned that a caring staff is a top priority, and it seems to me you can only find out about that by talking with the residents who live in the places you are considering. Speak candidly at the open houses and watch how residents interact with the staff. I chuckle to think of what we had expected in an apartment building. What about our precious privacy? Without a house and yard to care for, what would we do? Would our lives have a purpose? Some people struggle to embrace living in a retirement community — perhaps they had less choice in the matter because their families insisted they move. Or they miss the familiarity of the homes where they lived and made memories for decades. For us, it was important to embrace this new chapter in our lives. We joined the community with enthusiasm, and we made deep, loving friendships and expanded our horizons with people of other faiths and interests. And we achieved our goal of traveling more, visiting 15 countries since moving here. Ward, a wine aficionado, initiated a fine wine seminar that continues. I discovered my latent artistic talent in our art center, where I happily dripped watercolors on paper to create abstract art. Amazingly, these “masterpieces” were hung in the resident exhibit in our large art gallery — and six sold! Our community is a hive of activity, buzzing with whitehaired residents crafting, exercising and doing charity work, like knitting sweaters for needy children or packing canned goods for the hungry. Some of us lead singalongs for the less mobile residents on the nursing care floor. We have an annual spring talent show and tech support to learn how to use digital devices. We can do plenty of quiet reading if we want, and we comfort one another in grief or caregiver groups. Outdoors, volunteers tend to a tree-shaded garden with birdbaths and bird feeders. One friend heads up the Silver Panthers, a large group of residents who peacefully advocate for government policies and programs that uphold the well-being of our democratic institutions. When, three years ago, after 10 wonderful years here, Ward unexpectedly died of COPD and pneumonia, I was flooded with comfort and love. Ward’s memorial service in our lovely chapel was standing room only. Not long after Ward died, God sent me a sweet rescue cat, Cora, whose owner also had died. With purrs and petting, we comforted one another until her passing last year. With her beside me I finally plowed through all the complicated stuff I call “widow’s work” — dealing with our finances, basic tax obligations, assets and other matters. Through research and asking zillions of questions, I got through it. Now, at the age of 92, I know Ward and I made the right decision. Here on my balcony with a glass of chilled pinot grigio and fond memories of Ward and Cora, life is good in the retirement home. voices Tips to pick a retirement home where you’ll thrive illusTraTiOn by OWen genT fOr The WashingTOn POsT keeps singing, but the tune is not quite the same, and many women can feel the changes.” Why the brain changes during menopause and what it means Women’s brains evolve throughout their lifetimes — during puberty, pregnancies and the menopause transition, which for many women includes erratic menstrual cycles and an onslaught of hot flashes, night sweats and other symptoms. The neurons in the brain that were once essential for menstruation and pregnancies are no longer needed, so the brain goes through a “renovation,” Mosconi said. It is not known whether there is a way to prevent, stop or reverse the changes that occur in the brain during menopause, but at least some of them appear to be temporary. When Mosconi and her colleagues followed up During the menopause transition, which usually starts when women reach their late 30s or early 40s, there is a dramatic drop in estrogen. In the hypothalamus, which regulates body temperature, dropping estrogen levels can lead to hot flashes. In the hippocampus, which is important for learning and memory consolidation, estrogen loss can affect memory and cognition. Declining estrogen can disrupt the amygdala, which influences emotional responses; the prefrontal cortex, which is involved in decision-making, attention, multitasking and language; and even the brainstem, which includes some structures regulating sleep-wake cycles, Mosconi said. Mosconi likened estrogen to an orchestra conductor. “When it withdraws after menopause, the brain keeps going, the orchestra illusTraTiOn by geOrge WylesOl fOr The WashingTOn POsT diet or their adherence to the Mediterranean diet, which consists of plenty of fresh fruit, vegetables, whole grains, nuts and moderate amounts of fish and poultry. Researchers found replacing about one teaspoon of margarine and mayonnaise with the equivalent amount of olive oil was associated with an 8 to 14 percent lower risk of dying of dementia. The study observed two cohorts of more than 92,000 male and female U.S. health professionals over 28 years. Roughly 65 percent of the participants were women. And 4,751 of the participants died of dementia during the study period. But while the observational study found an association between the consumption of olive oil and a comparatively lower risk of dying of dementia, the researchers did not find a causal relationship. Olive oil use has been associated with a reduced risk of cardiovascular disease. The oil is a fixture of the Mediterranean diet. One study published in 2014 found extra virgin olive oil, specifically, to be associated with lower cardiovascular risk in older adults. A 2022 examination of the same two cohorts in the study published May 6 found higher olive oil consumption was associated with a roughly 19 percent lower risk of dying of cardiovascular disease, as compared with those who never or rarely consumed olive oil. And olive oil, when used in the Mediterranean diet, “appears to have a beneficial effect against cognitive decline,” said Marta Guasch-Ferré, an adjunct associate professor in nutrition at the Harvard T.H. Chan School of Public Health and a co-author of both studies of the two cohorts. The more than 92,000 participants in the two cohorts studied were asked how frequently they consumed different foods every four years for 28 years, starting in 1990. The respondents recorded how frequently they used olive oil in salad dressing, in food or bread, and in baking or frying at home. A physician reviewed the death certificates of the participants who died during the study period to determine whether dementia was the cause of death, Tessier said. It was determined that 4,751 of the participants died of dementia. David Knopman, a professor of neurology at Mayo Clinic in Rochester, Minn., said the observational study is “very nice” research but those who consumed more olive oil may just be “more health conscious than their peers.” There are a number of lifestyle factors that affect cardiovascular health and, in turn, cognitive health — including exercise, diet, sleep and whether someone smokes. Those factors tend to correlate with each other, he said. “The only way to establish causality of a treatment intervention is with a randomized trial,” Knopman said. BY TEDDY AMENABAR A study published in JAMA Network Open last week rekindled a debate over whether olive oil is really a health boon or just a sign of healthy eating habits. The observational study led by researchers at the Harvard T.H. Chan School of Public Health examined two groups of U.S. health professionals and found daily olive oil consumption is associated with a lower risk of dying of dementia. Consuming at least a half tablespoon of olive oil every day was associated with a 28 percent lower risk of dying of dementia, as compared with those who never or rarely consumed olive oil, the study found. Participants who reported more olive oil consumption had a lower risk of dying of dementia, regardless of the quality of their Olive oil associated with lower risk of dementia, but questions remain well+being regions become more connected. And there are declines in brain energy levels, meaning the brain pulls glucose from the bloodstream and does not burn it as fast or, perhaps, as efficiently as it used to, Mosconi said. Further research is needed, but some of these changes could help explain some of the symptoms of menopause. And the news is not all bad. For most women, symptoms tend to be temporary and then improve or dissipate after menopause, suggesting that “the brain is adapting to its new biology,” Mosconi said. These “intelligent adaptations,” she said, allow women to live up to a third of their lives after this transition. “Every time we talk about menopause, it’s always doom and gloom,” she said. “There’s no sense of achievement. There’s no sense of status gained. There’s no sense of having crossed an important milestone. I think that’s absolutely unfair. I’m hoping that we can break the stigma and make menopause an accepted and welcomed part of a woman’s life.” An orchestra conductor in your brain Estrogen is important for women’s brains, playing roles in regulating behavior, cognitive function and neuronal health. For decades, some doctors have told women that the brain fog, insomnia and mood swings they experience in midlife are “all in their heads.” Now, emerging brain research shows they’re right — but not because women are imagining it. Brain imaging studies of women — conducted before, during and after menopause — reveal dramatic physical changes in structure, connectivity and energy metabolism. These changes are not only visible on the scans, but many women can also feel them, said Lisa Mosconi, a neuroscientist and author of the book “The Menopause Brain.” “Menopause does impact the brain,” said Mosconi, an associate professor of neurology and radiology at Weill Cornell Medicine in New York City. “We’re not crazy. We’re not losing our minds.” Mosconi and her colleagues have been imaging women’s brains and have found that gray matter volume is reduced in areas of the brain involved in attention, concentration, language and memory. There also are changes in connectivity, meaning some areas involved in reproductive functions become less connected, while other Behind the reality of how women’s brains change as menopause arrives Brain Matters LINDSEY BEVER
e6 ez ee the washington post . tuesday, may 14, 2024 for their pioneering work, Li and fraumeni together were feted in 1995 as winners of the Charles S. mott Prize, one of the most prestigious awards for cancer research. Though far more is known about Li-fraumeni syndrome than even three decades ago, when the p53 mutation was identified, there is no cure. And there is a lot that still isn’t known. Why do some people with the mutation, like my nephew Charlie, develop their first cancer as infants, while others, like his dad, Paul, not develop cancer until their 40s? Why do some people get leukemia, others get lung cancer and others brain tumors? Why do perhaps 5 percent or so of people with Li-fraumeni syndrome live long lives and never have cancer? The answers will have to come — and someday, I believe, will come — from the researchers following in the footsteps of Li and fraumeni. That will be in the future, too late for my family. But this journey into the past has been, for me, its own reward. I have been awed and deeply moved by the dedication of the pioneering doctors who pressed forward despite skepticism. And I also have been brought to tears while reconnecting with long-lost friends of my siblings and reading words — of hope and fear — written by my sisters during their final months that I had never seen before. I’ll never forget an email I got from michael, my sister Gina’s husband, after I sent him a note on the anniversary of her death to let him know how much I missed her. His poignant reply captured my feelings. “I ponder the life not lived, both hers and mine. The adventures we had, and those adventures we had planned but never realized.” This essay is adapted from the book “a fatal Inheritance: how a family Misfortune revealed a deadly Medical Mystery,” published on May 14 by henry holt. Lawrence Ingrassia is a former senior editor at the new york Times, wall Street Journal and Los angeles Times. cially, researchers were becoming more adept at using a technique developed in the mid-1970s to examine microscopic fragments of individual genes to help spot mutations. In 1989 and into 1990, a team at a laboratory in Boston — mostly using tissues from patients presciently collected over the years by Li and fraumeni — started looking for a mutation causing their cancers. for many months, their efforts were fruitless. Eventually, they zeroed in on the p53 gene. Even then, the search was laboriously slow, akin to finding a particular apartment in a giant city like New York — without having a street map and not knowing where to begin. finally, after many more months, lab workers late one evening spotted the culprit. They found a mutation on fragments of the p53 gene from family members who had cancer, while the same p53 fragment from cancerfree family members didn’t have the mutation. (remarkably, they narrowly beat a rival team of researchers led by Esther Chang at the Uniformed Services University of the Health Sciences in Bethesda, who found the same p53 mutation in another cancerprone family at almost the same time.) The medical mystery had been solved. on Nov. 30, 1990 — 21 years after the publication of Li and fraumeni’s widely dismissed original paper speculating about a genetic cause to familial cancer clusters — Science magazine set the medical world abuzz, publishing news of the p53 finding. The guardian of the genome Continuing research has since determined that p53, when working properly, is so central in defending against malignancies that it has been dubbed the “guardian of the genome” and has become the single most studied gene in the human body. only perhaps 10 percent of cancers are hereditary. But the vast growth in knowledge of cancer genetics has helped improve treatment and prolong lives, not just of patients with inherited cancer syndromes but of all cancer patients. it was called. over generations, they found, members of the family — including other infants — were riddled with cancers of all kinds. Three other families they added to their study had similar cancer histories. Li and fraumeni wrote an academic paper raising the possibility of an “inherited predisposition.” But they also acknowledged there might be other explanations: It could be a fluke. or the high cancer rates could be caused by some unidentified environmental factor or — in keeping with the latest thinking — by an unknown virus, even though no viruses were detected in the tissues of family members they tested. Their study got little notice, as senior experts expressed doubt, noting that the variety of cancers surely meant they were unrelated. Knowledge of genetics, and the human genome, was fairly limited, and there were no scientific tools to probe the details of individual genes that might offer clues. Undeterred, Li and fraumeni kept tracking family A, and eventually a couple dozen cancerprone families. As often is the case in science, progress was slow and halting. Even in cancer-prone families, it can take years for new tumors to develop and patterns to emerge. But as Li and fraumeni published subsequent studies, in 1975, 1982 and 1988, each showed the same thing: more cancers in more family members, at a far higher rate than in the overall population. Still, proof remained frustratingly elusive about what triggered the cancers. Spotting the culprit Advances in molecular biology were helping scientists understand the human genome. CruAnd of the 50 or more known cancer gene mutations, the p53 mutation is especially pernicious, as it leads to a variety of cancers all over the body, unlike most inherited cancer mutations that are site-specific, such as BrCA genes, which cause mostly breast and ovarian cancer. The story of ‘Family a’ Another fact caught my attention: one of the two doctors who discovered the syndrome, fraumeni, who like Li had spent his career at the National Cancer Institute (NCI), was still alive, in his late 80s. So I called him, and what he told me in the first of many conversations started me on a journey of discovery that would take me back a half-century — a journey I would find to be heartbreaking but also inspiring. fraumeni and Li, then young epidemiologists, both the children of immigrants, had started at the NCI in the 1960s. Their mission was to study unusual patterns of disease for clues about susceptibility and detection; they were especially intrigued with childhood cancer because it was so rare — and so tragic. At the time, relatively little was known about the causes of cancer. The prevailing theory was that most cancers were caused by viruses. much of the NCI’s research money went to top scientists conducting laboratory experiments trying to prove this, albeit without success. In 1967, fraumeni and Li came across a young father and baby son who had cancer at the same time — the dad had leukemia, and his son had a very rare soft-tissue tumor in his arm. The odds against this were so high that the doctors became medical detectives, spending two years painstakingly gathering the records of different branches of family A, as in our family on our mother’s side by nature in its random complexity. The doctors said it had materialized seemingly spontaneously in my mother’s genetic code when she was conceived — that it wasn’t there for her parents and grandparents. Paul would live just five more years, succumbing not to prostate cancer but to yet another cancer — pancreatic cancer, which developed in 2017 and then metastasized to his lung, killing him at age 69 in 2019. In 2016, I tested negative for the p53 mutation, which explained the reason that I — alone among the four siblings — have never had cancer. Even then, I knew little about Li-fraumeni syndrome beyond what Paul told me in our initial conversation. Paul’s death jarred me in ways I hadn’t expected. He was just two years older, and we were very close because of the shared heartbreak in our family and because we had been professional colleagues, having worked together at the Wall Street Journal for 25 years early in our careers. Now, with all my siblings and parents gone, I was the last living member of my immediate family. I suddenly — belatedly — felt an urge to know more. So I went online and did a search for “Li-fraumeni syndrome.” An estimated 5,000 to 10,000 families in the United States are afflicted with Li-fraumeni syndrome, a tiny percentage out of more than 125 million families in the country. People with the inherited p53 mutation develop cancers at very high rates, sometimes starting in childhood — like my nephew Charlie, who died of his third cancer at age 39 just seven months before Paul. None of their doctors over the years could explain the many cancers, other than suggesting that our family (other than me) had bad luck. But for a long time, we were nonetheless convinced we knew the reason: our dad was a chemical engineer and must have brought carcinogens home on his clothes. After being ingested, we speculated, they would lie dormant for years, eventually causing tumors. We were about to find out that we — and the doctors — were wrong. Discovering a fatal inheritance A couple of days after learning his prostate cancer had come back, Paul called to tell me that his longtime oncologist recommended he take a test for a hereditary cancer condition called Li-fraumeni syndrome, named after the two doctors — frederick Pei Li and Joseph f. fraumeni Jr. — who had discovered it. I asked Paul to spell it for me, as that was the first I could recall hearing of it. I jotted a brief email to myself, to make sure I understood him correctly. “Still waiting to get final results,” I wrote. “But the doctors say they can almost guarantee that he has Li-fraumeni syndrome, which means that a gene P-53 — that usually shuts down or kills small tumors before they become big — doesn’t work properly.” A few weeks later, Paul got back the lab tests and emailed a copy to me. At the top was stark wording in capital letters: “rESULT PoSITIVE — CLINICALLY SIGNIfICANT mUTATIoN IDENTIfIED.” There it was. It wasn’t a chemical our father had unknowingly carried home from work. It wasn’t bad luck, or a statistical coincidence. It was a very rare, very bad genetic mutation, in what is called a cancer suppressor gene, hidden cancEr from E1 After losing all 3 siblings to cancer, journalist goes on a quest for answers ILLuSTraTIOnS by eLIzabeTh vOn OehSen/The waShIngTOn pOST; phOTOS cOurTeSy Of Lawrence IngraSSIa BY LINDSEY BEVER A national health panel has recommended lowering the age for routine screening mammograms by 10 years, now advising women ages 40 to 74 at average risk of breast cancer to get screened every two years. Previously, the guidance from the U.S. Preventive Services Task force was for women to make individual screening decisions in their 40s but start no later than 50. The change has left many women with questions about how the new guidance affects their personal health. We spoke with experts to get answers. Why were the mammogram guidelines changed? Cancer rates among younger Americans are on the rise. And more women in their 40s are getting breast cancer, with the number of newly diagnosed women increasing about 2 percent each year, said John Wong, an internist and professor of medicine at Tufts University School of medicine, who is a vice chair on the task force. Black women are more likely than White women to be diagnosed with breast cancer at a younger age and more likely to be diagnosed with an aggressive form called triple-negative breast cancer. They are also about 40 percent more likely to die of breast cancer than White women, research shows. overall, more than 42,000 women die of breast cancer each year in the United States, data shows. The task force proposed the new guidelines last year to address the rising breast cancer rates among younger women and also mitigate racial disparities, and has now formally approved the advice. “It could potentially save as many as 1 in 5 women, or 20 percent, from dying from breast cancer,” Wong said. Why aren’t older women advised to get screened? The task force concluded there wasn’t enough evidence to assess the benefits vs. harms for screening mammograms for women older than 74. Potential harms include false positives that may take a psychological toll and lead to unnecessary follow-up tests and procedures, as well as the added — yet minimal — radiation exposure, the task force noted. What are the screening recommendations for women with dense breasts? Guidance for women with dense breasts was also inconclusive in some ways. While all women are encouraged to start screening mammograms at age 4o, mammograms may not be as effective for women with dense breasts, who make up nearly half of women 40 and older who get screened, research shows. The task force did not find enough evidence for supplemental screenings such as ultrasounds or mrIs for women with dense breasts. Women at high risk of developing breast cancer — including those who have a genetic marker or syndrome associated with a high risk of breast cancer such as a BrCA1 or BrCA2 genetic variation — are not covered by the new task force recommendations. In 2019, the task force advised that primary care providers assess women who are considered high risk and, when indicated, prescribe genetic counseling and then, if needed, genetic testing. In these cases, private insurers and state medicaid expansion programs are required to cover the cost for the counseling and testing. Will the new guidelines change insurance coverage for mammograms? most insured women in the United States are already covered for annual screening mammograms without cost-sharing starting at age 40 based on existing guidelines from independent medical and scientific recommending bodies. “The task force recommendation is not going to change what insurance plans are required to cover,” as far as mammograms are concerned, said Alina Salganicoff, a senior vice president and director of the Women’s Health Policy Program at Kff, formerly the Kaiser family foundation. Women with employer-based insurance and private insurance, which include nearly 70 percent of women ages 19 to 64, are covered starting at age 40 at least biennially but as frequently as annually through at least age 74, though “age alone should not be the basis to discontinue screening,” according to guidelines from the Health resources and Services Administration. Women who qualify for medicaid expansion are subject to the same coverage rules as the private insurance plans. for women who are not part of the expansion program, the scope of coverage is up to the states. medicare, which has its own rules but considers recommendations from the task force, covers screening mammograms once a year for women 40 and older, with a one-time baseline screening between ages 35 and 39. “We think of our recommendations as more of a floor than a ceiling,” Wong said, noting that lawmakers, regulators and insurers can make their own coverage decisions. “We do seek to inform clinicians, but we also seek to inform the public and people who are thinking about decisions to help themselves live longer and better lives.” Why do different medical groups give different advice? William Dahut, chief scientific officer of the American Cancer Society (ACS), said he thinks the task force is “moving in the right direction” by lowering the age for screening mammograms to 40. But the task force guidelines still differ from other recommendations. The ACS, for instance, recommends that all women at average risk of breast cancer start annual screening mammograms, not biennial screenings, by age 45 and continue annual screenings at least to age 54. Starting at age 40, women can consider speaking with their medical provider about starting annual screenings, and those 55 or older can consider switching to biennial screenings. Unlike the task force guidelines, the ACS does not put an age limit on screenings, stating that women should continue as long as they are healthy and expected to live at least 10 more years. The American College of radiology and Society of Breast Imaging recommend that women at average risk start at age 40, but by 25, all women should talk to their doctors about their individual risk factors to determine whether earlier screening may be needed for them. The American College of obstetricians and Gynecologists (ACoG) recommends mammograms every one to two years beginning at age 40 for patients at average risk of breast cancer. After age 55, it is “reasonable” to reduce screening to every two years “to reduce the frequency of harms, as long as patient counseling includes a discussion that with decreased screening comes some reduction in benefits,” according to ACoG. “The good news is, every major national guideline in the United States is now recommending that women at average risk of breast cancer should be offered screening or recommended to have screening starting at age 40,” said mark Pearlman, professor emeritus at the University of michigan Health System and senior author of ACoG’s most recent practice bulletin on breast cancer screening. well+being What to know about the revised guidelines for routine mammograms andreSr/ISTOck In 2016, Lawrence Ingrassia tested negative for the genetic mutation that afflicted his mother, seemingly spontaneously. It explained why he hasn’t had cancer. Black women are more likely than White women to be diagnosed with breast cancer at a younger age.