Mammography Screening for Breast Cancer

e31(1) C ase Vignet te A 40-year-old woman presents to her primary care physician for a routine health maintenance examination. Overall, she has been feeling well. She takes no medications. She lives with her husband and their two children, who are 7 and 11 years of age. She underwent menarche at the age of 12. Before the birth of her first child, she took combined oral contraceptives for 6 years. She breast-fed each of her children for approximately 1 year. For the past 4 years, she has used a levonorgestrel intrauterine device for contraception. She works as an accountant and exercises on the weekends. Her diet includes regular consumption of fish, chicken, and vegetables, and she eats red meat once a week. She does not smoke, and she consumes an average of four glasses of wine each week. Her family history is notable for prostate cancer in her father that was diagnosed when he was 75 years of age and hypertension in her mother that was diagnosed when she was 60 years of age. There is no history of colon cancer, lung cancer, or breast cancer among her parents or grandparents. She undergoes a complete physical examination, including a clinical breast examination. All findings are normal. She has never undergone mammography, and she asks her primary care physician about recommendations regarding mammography screening. Which one of the following approaches do you find appropriate for women who, like the woman in the vignette, are at average risk? Base your choice on the published literature, your own experience, recent guidelines, and other sources of information, as appropriate.