women getting a mammogram

Part 1–Mammograms

Breast cancer remains one of the most common cancers among women, and certainly one that the vast majority of my patients worry about. Breast cancer affects roughly 1 in 8 women. Only cancer that’s more common in women is skin cancer.

New screening guidelines for breast cancer are beyond confusing because societies and healthcare professionals don’t all agree. And, just to make it more confusing, it seems like the guidelines change every 5 minutes. Patients come in for the annual exams and throw up their hands, “When should I have a mammogram? Is it every year, or every 2 years? Can’t I just get an ultrasound?  What about an MRI?”

This is Personal

Because of my family history of breast cancer, my multiple breast biopsies and dense breast tissue, I’ve had all of these procedures. 

You can read more in Do I Really Need a Mammogram? 

The answer is, it depends. It depends on your age, your risk factors, including family history, and what guidelines you and your healthcare provider choose to follow. Let’s start with Part 1 in my series on breast cancer screening. You can read more on Breast ultrasound here (link ) on Breast MRI here (link) and how we determine who needs what and how often here (Breast cancer screening tools (link) 

How Safe and Effective are Mammograms? 

Concerns about radiation should not prevent you from getting a mammogram. The radiation dose from a mammogram is equal to what you’d receive if you fly from Los Angeles to Miami.  This is equivalent to what you’re already exposed to every 2 months. 

No doubt about it, mammograms save lives. Early detection is critical because decades of research shows us that early diagnosis at stage 0 or stage 1, has a greater than 95% chance of survival into the 5th year. Most, not all, breast cancers are slow-growing. By the time a woman can feel a lump, cancer has been present for 2 – 5 years. That’s why mammography is critical, it finds cancers before the lump can be felt.

Clearing up the Confusion 

That said, understandably, many primary care providers and those who do not specialize in women’s health are not familiar with which breast imaging should be done and when. I spend a lot of time clarifying misconceptions and myths and trying to explain the nuances and complicated paths we take to provide the best care for women.

As women’s health nurse practitioners, we get regular updates and education about how to tailor our recommendations to each individual woman and her situation. 

Recently, I had a patient come in for her annual. She is 32, in good health without any complaints. She asked me to order a mammogram for her because her primary care provider suggested it. Why? I wondered. Well, it turned out that she had one distant relative, in this case, her aunt on her father’s side, who developed breast cancer at 67.

After asking about all the family history on both sides, and finding no other cancers, I was able to reassure this patient that her risk of breast cancer was the same as the general population. Whew.  First, this woman’s family history does NOT indicate an increased risk for breast cancer. Secondly, prior to age 40, most women have very dense breast tissue, making mammograms so hard to read they are of limited value.

Now, this would be a different scenario if the woman was 39 and she had a mom, a grandmother, and two aunts with a history of breast cancer, and male relatives with prostate cancer. Then I’d ask her to have genetic testing to see if there was an increased risk. Depending upon the results, and using a breast cancer risk model (link here to part 4), this patient might also need an MRI.  (link to MRI blog here)

Read more here on genetic testing for breast cancer.

Current Mammogram Guidelines from the American Cancer Society: 

  • Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so.
  • Women age 45 to 54 should get mammograms every year.
  • Women 55 and older should switch to mammograms every 2 years, or can continue yearly screening. 

– Here’s where I talk to my patients about their individual risks and what they prefer. Since most breast cancers occur after age 50, many of my patients want to continue yearly mammograms, which I agree with.  

  • Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.
  • All women should be familiar with the known benefits, limitations, and potential harms linked to breast cancer screening. 
  • Women should also know how their breasts normally look and feel and report any breast changes to a health care provider right away.

What are 3D Mammograms?

A 3D mammogram, also called digital tomosynthesis, provides a three-dimensional image of the breast using X-rays. Thin sections can be isolated, more images made from different angles, and with better clarity compared to the more common 2D mammography. 3D mammography does increase the detection of early cancers and should be considered for those with dense breasts, or family history risk factors. Though it is not only younger women or those with dense breast tissue who could benefit. 

“We’ve shown that screening mammography performs well in older women, with high cancer detection rates and low false-positives, and that tomosynthesis leads to even better performance than conventional 2D mammography,” said Manisha Bahl, M.D., radiologist, and lead author of a study out of Massachusetts General Hospital. This newer technology is more expensive, is not always available, and is not covered by some insurance. The screening itself does take a little longer to complete and more time for the radiologist to interpret the results. 

As I read this over, one thing is very apparent. Women deserve specialized care from providers who are staying up to date with the latest research and recommendations to provide personalized care to women that is tailored to their own unique experiences. 

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