Are you as confused as every other woman I’ve talked to about the latest recommendations for having a mammogram to screen for breast cancer?

Does it ever seem that every other day, some group of experts is contradicting previous guidelines and the result is a lot of confusion. Who needs a mammogram? How often and what other tests are important?

Here are 6 essential questions that will help you decide what to do about breast cancer screening:

1.  When Should Mammograms be Started?

In general, for women without a family history of breast cancer, According to the American Cancer Society, women should have the choice to start having mammograms at age 40. It’s recommended that women have them every year until age 55, when they and their provider may switch to every 2 years. If there’s a strong family history of breast cancer, your health care provider may recommend earlier and additional screening tests. 

2. Should I have 3-D Tomosynthesis mammography?

If your breast health center offers this option, it’s a good idea to take advantage of it. Not all insurance companies pay for 3-D mammography, though it’s more accurate and reduces the call backs for additional views. 

3.  Is Mammogram Enough?

For many women who have increased breast density, mammography is the first step. If her mammogram shows dense breasts, it’s now recommended that she have an additional ultrasound to help to detect breast cancers.  

On mammography, dense breast tissue shows up as a field of white. The problem is that breast cancer is also white, so looking for breast cancer in a woman with dense breast tissue, is like looking for a snowflake in a snowstorm. This is why ultrasound is used after a mammogram because breast cancer shows up differently on ultrasound.

Yes, you’ll still need the mammogram first as breast density can change over time, and we need to establish the breast density prior to the ultrasound. 

Breast Density is reported as a Bi-Rad classification.   For women with a Bi-Rad classification of 3 or higher, an ultrasound should also be offered. At the very least, women need to be informed about their Breast Density so that they can ask for additional screening. You can visit AreYouDense.org for more information.

4.  When Should Women Stop Having Mammograms?

There are wide differences in opinion for this question also.  Some groups only advocate screening until age 70, others until age 75. Since women are living longer now than ever before, I find myself agreeing with the American Cancer Society, who advocate annual screening as long as a woman is in good health. I have many patients in their 80’s who are strong and vigorous and who plan to be around for another 20 years, and want their annual mammograms, which I’m happy to order for them.

5.  Who Needs Genetic Testing for Breast Cancer?

Any woman who has a one or more close family members, such as a mother or sister with breast or ovarian cancer should consider genetic testing for the BRCA 1 and 2 mutations. These are the most common genetic mutations associated with breast cancer, though over 100 different genes have been shown to be associated with breast cancer. 

The BRCA mutations are associated with an increased risk of breast and ovarian cancer. Though only about 15% of breast cancers are hereditary, it’s helpful to know if a person is at higher risk. My mom was BRCA 1 positive, had breast cancer at age 32 and luckily survived following a mastectomy. I have been tested and thankfully am negative. 

If possible the person with a history of breast or ovarian cancer should have the genetic test to see if they carry any of the genes associated with those cancers. If that person is positive, then other family members can be tested for the specific gene mutation. If the family members who had breast or ovarian cancer can’t be tested, then other family members might consider how many other relatives are affected and whether testing makes sense.  

6.  Who Needs MRI for Breast Cancer Screening?

mammogram with tumor

Women with a family history of breast cancer, those with a personal history of breast cancer and those who are at higher risk from having had previous breast biopsies may benefit from the additional screening possible with MRI.  Though there can be many false positives leading to biopsies and procedures, MRI can help detect early breast cancers.

Some women with a family history of breast cancer or who have the BRCA -1 or 2 genetic mutations may also need to have MRI every 1-2 years. Since everyone’s situation is unique, it’s best to talk to your own health care provider about your family history, any other risk factors and what’s best for you. 

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