6 Common Mammogram Questions, Answered
Around 13 percent of women, or 1 in 8, will be diagnosed with breast cancer in her lifetime, according to the American Cancer Society. Despite that staggering statistic, advances in screening procedures, increased awareness, and improved treatment options have all likely contributed to the disease’s steadily declining rate of death in the United States. Between 2002 to 2003 alone, death rates dropped 7 percent.
Mammography is the most common and widely used of the screening tools available. Others include ultrasound and MRI (magnetic resonance imaging). A mammogram is an X-ray of the breasts that makes it possible to detect cancer more easily and earlier than it can be felt, often leading to faster treatment and better outcomes.
“[Mammography] is our best test for detection,” says David Gruen, M.D., chief medical officer for imaging at Jefferson Radiology, in Enfield, Connecticut, and a radiologist who specializes in breast and body imaging.
While they’re a must for women 40 and over, mammograms can be uncomfortable and sometimes even scary. To demystify the process and hopefully relieve some of the stress of it, here are answers to some of the most common questions about mammograms.
1. At What Age Should I Have My First Mammogram?
For a woman of average risk—having no family history of breast cancer and no genetic predisposition to the disease—the American Cancer Society (ACS) and the American College of Obstetricians and Gynecologists (ACOG) both recommend annual screening mammograms starting at age 40 for all women, not just those who have high risk factors. This is because 75 percent of women who get breast cancer have no family history or other risk factors.
A screening mammogram looks for signs of breast cancer in asymptomatic women via X-ray images of both breasts. If a problem is detected on a screening mammogram or a woman is experiencing symptoms (such as a lump), she may also need to have a diagnostic mammogram.
Higher-risk women—those with a strong family history of breast cancer or known genetic mutation carriers—may be advised to start mammograms as early as age 25, says Liane Philpotts, M.D., professor of radiology and biomedical imaging at Yale School of Medicine, in New Haven, Connecticut. These higher-risk and younger patients may start with an MRI before progressing to a mammogram, as mammogram images may not be as accurate to detect breast cancer in a younger population.
If you’re unsure whether and how often you should be getting a mammogram, ask your doctor.
Niko Harriton, 47, of Weston, Connecticut, who was diagnosed at age 39 with breast cancer, says she also asked her doctor when her daughter should start screening, given her own genes and diagnosis. “I was on the younger side when I was diagnosed, and I have a gene that increases my chances of a recurrence or secondary cancer.”
2. What Type of Machine Will Be Used for My Mammogram?
From the 1950s until around 2000, breast images used physical film. Now, most radiologists use digital mammography. Each breast is compressed on an X-ray machine, where a series of pictures are taken using a low dose of radiation. The compression, while uncomfortable, is essential to the accuracy of the procedure.
“Digital mammography is the best test,” Gruen says. “The compression immobilizes the breast, which reduces the chance of the image turning out blurry and reduces the chance that we’ll miss something.”
The highest standard used today is 3D mammography, which isn’t always available at every office and can be more expensive. Both Gruen and Philpotts recommend it.
But what if your breasts are especially dense? In that case, even 3D mammography can miss a mass or calcifications (tiny calcium deposits in the tissue that may be a sign of cancer). Breast tissue contains a combination of milk glands, milk ducts, and supportive tissue, known as dense breast tissue. The rest is fatty tissue (nondense breast tissue). On a mammogram, dense breast tissue can appear solid and white , which makes reading it more challenging.
For that reason, women who have dense breast tissue—which is approximately 50 percent of women—may need supplemental imaging, says Philpotts.
3. Do Mammograms Hurt?
The short answer is yes. “It can be uncomfortable—they’re basically flattening your breasts like pancakes,” Niko says. “But it’s only seconds, and then it’s over. It’s worth it.”
“The machines must have been invented by men,” says Martha McCully, 60, a writer and editor who lives in Los Angeles. “The experience is uncomfortable and a bit painful, but it’s a good feeling to check it off your list and to have peace of mind with a negative result.”
Heidi Wald, 60, of New York City, agrees. “As a small-breasted woman, it is probably more painful [for me],” she says, but she never skips her annual screening. “They hurt, and it’s cold in the room, and the machine is freezing,” she says, “but it seems irresponsible to oneself, and family and friends, to not get it done.”
4. How Can I Make Myself More Comfortable Before and During a Mammogram?
“The first mammogram is anxiety-provoking,” Gruen says. “But most women walk away saying, ‘That wasn’t so bad.’” He adds that improvements in technology in recent years have made the procedure a bit more comfortable and faster, too.
Try to schedule your mammogram for a day when your breasts are unlikely to be swollen or tender (avoid the week before your period), and discuss any breast changes or problems (things like pain or discomfort, new spots on the skin around the breasts, or lumps found in a self-exam) with the technician before the procedure.
If you’re called back for additional images, try not to worry. Philpotts, who is 59, points out that being called back, particularly after a first mammogram, is extremely common: Since there is no baseline image to compare a first mammogram to, additional images can give the radiologist a more complete picture.
Also, young breasts tend to contain dense areas, and screening mammograms are not as sensitive to dense breast tissue as they are to fatty tissue. So, a radiologist may call a first-timer back to get a better baseline for future exams.
5. When Can I Stop Getting Annual Mammograms?
The American Cancer Society says that, after age 55, women can switch to getting a mammogram once every two years or continue with yearly screenings, though ACOG still recommends yearly screenings. The U.S. Preventive Services Task Force recommends screenings every other year for women ages 50-74.
After age 75, Philpotts says, there’s not a lot of data. A person’s individual risk, as well as other health factors, is what determines the need for continued screenings.
6. What Other Questions Should I Ask?
Gruen suggests acting as your own health advocate:
- When you schedule your mammogram, find out if the facility uses 3D technology.
- Make sure the radiologist specializes in breast imaging.
- Ask to schedule your following year’s appointment when you check out. That way, you’re less likely to forget.
Usually, the technician performing your mammogram will not explain the images to you, which can be frustrating. Gruen says you should ask if you will receive your results while you are there, and if not, ask when you can expect them. Often, the images are sent to a primary care physician who will then call the patient and discuss findings.
Heidi asks her radiologist what she can do for prevention. While there isn’t a lot a woman can do to prevent breast cancer if she’s predisposed or has independent risk factors (such as obesity), most doctors recommend eating a healthy diet and exercising regularly—and always attending your annual screening.
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