If you are experiencing a medical emergency, please call 911 or seek care at an emergency room.
A mammogram is an imaging test used to screen the breast tissue for breast cancer, which affects about one in eight U.S. women, and potentially catch it early when it’s easier to treat. Unfortunately, it’s common for women to be confused about mammogram screening guidelines, as organizations tend to change them every few years.
To keep women up-to-date, it’s important that doctors reiterate the guidelines and personalize them to patients based on their family histories and breast cancer risk factors.
The 2018 mammography guidelines issued by the American Cancer Society (ACS) suggest that women at average risk for breast cancer have yearly mammograms starting at age 45, then switch to every other year at age 55. Additionally, the ACS notes that women should have a choice to start screening as early as age 40, and that screening should continue as long as women are in good health and are expected to live 10 more years or longer.
However, these guidelines are not set in stone. Let’s discuss how a woman and her doctor can use these guidelines to personalize a plan for optimal breast health, including when to start and how to prepare for the exam.
LISTEN: Dr. Chitalia discusses mammograms in the Medical Intel podcast.
1. When should I get my first mammogram?
Shared decision-making is key to determining when a woman should get her first mammogram. This is when a doctor and patient discuss all the options and risk factors to come to an informed and individualized decision, and this model is recommended by most cancer organizations’ guidelines—especially between ages 40 and 45, or when women at average risk are encouraged to start their screenings.
For example, it’s important to consider women’s family history when determining mammography options. If a woman has a family history of breast cancer or ovarian cancer, we might recommend earlier or more frequent mammograms because their risk of the disease is greater. For the majority of these women, we recommend starting breast cancer screening with mammography at age 30. Similarly, we might also recommend more frequent screenings if a woman has had abnormal mammograms or any breast biopsies in the past.
A woman’s family history is important to consider when deciding mammogram options, says Dr. Ami Chitalia. Discover why it might mean more frequent screenings are necessary. bit.ly/2IzbdUb via @MedStarWHC
2. How do I prepare for a mammogram?
For optimal screening, women should schedule their mammogram when their breasts are the least tender, which usually is the week after their period. If they’ve had mammograms at another imaging center, it’s a good idea to bring those images and reports to their next mammogram, so a radiologist can compare them with current imaging. Furthermore, women should let the technician know if they have breast implants or have had previous breast biopsies, as these factors affect the shape and look of breast tissue under imaging.
Women should not use deodorants, perfumes, or lotions under the arms or around the breast area on the day of their mammogram. While most women say the breast-flattening technique used in standard mammography is just uncomfortable, some women find the process somewhat painful. Women can take a mild, over-the-counter pain medication before they come to the office to reduce discomfort or pain, as long as a doctor approves.
Once finished with their screening mammogram, women can expect to see results in about a week.
3. What happens if my mammogram is abnormal?
To address abnormalities, radiologists use what’s called a Breast Imaging-Reporting and Data System, otherwise known as the BI-RADS grading system. This system grades the abnormality from zero to six, with zero requiring additional imaging to look at an area of concern, 1 and 2 being normal with no further imaging required and six being a known malignancy, or cancer, in the breast. We will then make a recommendation based on the BI-RADS score—for example, depending on the score, it may be recommended to undergo another mammogram in six months, rather than the usual 12, or getting additional imaging over the next few weeks.
Additionally, a targeted ultrasound typically is done near a visualized abnormality. If an ultrasound shows a benign abnormality such as a cyst, it usually will be monitored annually or twice a year for the first few years to demonstrate stability. Some women also can have an excision to remove something benign that is found, such as a fibroadenoma, which is one of the most common breast lumps seen in women under 30. Women can then usually resume their regular mammography schedule if the lump is non-cancerous.
Expert mammogram care
We care for women at MedStar Washington Hospital Center with state-of-the-art equipment and imaging techniques, such as MRI-guided biopsies, which are only offered at select imaging centers. Moreover, we provide comprehensive care, so if patients have an abnormality, they can see a large team of experts all in the same building, including nurses, radiologists (who have expertise specifically in reading mammograms), surgeons, and medical oncologists.
Knowing when to get a mammogram can be difficult with all the information online and guidelines that seem to change every few years. To stay ahead of your breast cancer risk, talk to your doctor about personalizing a mammography schedule that considers your health history and unique needs.