By Amy Banulis, M.D., OB-GYN, FACOG, and Helen Schneider, M.D.
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As doctors specializing in women’s health and as women, we can’t underscore enough the importance of October as Breast Cancer Awareness Month. Breast cancer remains the second most common cause of death among women. After skin cancer, it’s the most common cancer for women in the United States. In fact, one in eight women in our country — about 12%— will develop invasive breast cancer.
Getting a mammogram remains your best screening option for breast cancer. But wading through often conflicting guidelines on when and how often to get mammograms can be challenging. We demystify your mammogram, below.
A screening mammogram is given annually or every two years to women after a certain age as part of their preventive health routine.
About 10% of women who receive a screening mammogram are asked to return for additional imaging (such as an ultrasound) or a diagnostic mammogram, which takes longer and allows the technologist to magnify a suspicious area to produce a more detailed picture for the doctor. Women who have had any kind of prior lump or have discharge or thickening of their breasts may receive a diagnostic mammogram as their routine mammographic screening.
While women often need to wait for results of a screening mammogram, the results of a diagnostic mammogram typically are given at the end of the appointment. Either we tell a patient that everything is fine (our favorite conversations) or we recommend a short-term follow-up, a biopsy or a follow-up within the year.
2D or 3D?
Long-term studies are still determining the benefits of 3D mammography versus 2D mammography, and for now, the latter remains the recommended screening by the United States Preventative Task Force because of proven reduction in breast cancer mortality.
When and how often to screen
You may have heard conflicting advice about when to start getting a mammogram and how often to follow up. Today there is no longer a one-size-fits-all recommendation on this. Different medical organizations have different recommendations. The bottom line is that you and your OB-GYN or primary care physician should determine when it’s best for you to start, based on your health history, age and comfort level.
We recommend our patients begin screening around age 40, unless they have additional risk factors, such as a first-degree relative with early onset breast cancer. Some medical organizations recommend beginning at age 45. Age 50, though, should be the absolute latest that you begin having regular mammograms.
Risk factors for breast cancer include family history, never giving birth, being older at the birth of your first child, lifestyle (smoking, alcohol use, a higher body mass index) and rarities, such as prior exposure to chest radiation during childhood lymphoma. It is important to remember, though, that the most significant risks for breast cancer are age and gender, not family history. In fact, 85% of breast cancers develop in women without a family history of breast cancer.
The exact guidelines of how often to screen vary, too. But generally speaking, it’s recommended that women over 50 get screened annually or every two years. We typically recommend continuing screening until age 75, but the decision as to when to stop screening is best made collaboratively with your doctor.
Preparing for your mammogram
Avoid having a mammogram the week before your period when your breasts are at their most tender.
In addition, steer clear of using deodorant, creams or powders before you go. Some of these products contain metals that can be confused with calcium deposits known as breast calcifications, which are tiny and quite common. While calcifications can indicate breast cancer, in 85% to 95% of women, calcifications are benign. Since the metals found in self-care products can make it difficult for radiologists to interpret calcifications as benign or as changes due to cancer, it’s best to avoid using these products before your screening.
Getting the most from your mammogram
Radiologists need to treat anything we haven’t seen before as new. Many women don’t realize how important it is for the radiologist to have previous views of past mammograms. If you have your screenings done at the same facility, the radiology staff will have access to your past screenings. If you are going to a new facility, bring your last two to three mammogram results on a CD (or better yet, give it to the radiologist before your appointment). Make sure that the radiology center you are using is certified by the American College of Radiology.
How long will it take to get results?
Once you’ve completed your visit, the amount of time it takes for your provider to process, analyze and then prepare your mammography study results can vary widely—from just a few minutes to over a week. Radiologists and health care teams usually take great care in their accuracy and speed in determining the result of your mammogram, and how long it takes can depend on their level of coordination.
What can you expect afterward?
For most of us, no news is good news after a mammogram, but anxiety is common, so it’s important to talk with your doctor in advance about how results will be communicated: through a letter from the radiology center, your doctor a secure portal? One option is to schedule your mammogram before your next regular exam with your doctor, so that you can discuss the results at that appointment.
Staying informed, creating open dialogue with your OB-GYN, being candid about your health history and your screening preferences are all important factors in maintaining your best breast health—this month and throughout the year.
So long to breast self-exams
If you’re like many women, you may be surprised to learn that the medical community no longer recommends monthly breast self-exams for women of average risk. That’s because there is no research to show that regular breast self-exams help to reduce deaths from breast cancer. In addition, researchers found that too many women didn’t know what to look for, and so self-exams led to more false positives and unnecessary biopsies.
The focus now is on breast awareness and being attuned to noticing a change in what is normal for your breasts. If you detect something different—a mass, nipple discharge, a redness or skin change on your breast—talk to your doctor right away.
For more information on mammograms, visit The American College of Obstetricians and Gynecologists.
Amy Banulis, M.D., OB-GYN, FACOG, is a board-certified obstetrician-gynecologist with the Mid-Atlantic Permanente Medical Group. She sees patients at the Kaiser Permanente Falls Church Medical Center.
Helen Schneider, M.D., is a board-certified diagnostic radiologist with the Mid-Atlantic Permanente Medical Group. She sees patients at the Kaiser Permanente Kensington Medical Center.