October is Breast Cancer Awareness Month, making it a good time to answer an important question: When should you get a mammogram? At what age should you start and how often should you be screened?
You may have encountered slightly different answers. That does not mean mammograms are controversial or that screening is unimportant. Medical organizations agree that mammography can detect breast cancer before symptoms appear, when treatment is often more successful. The differences involve when routine screening should begin, how frequently it should occur, and when it may be appropriate to stop.
What do the current guidelines recommend?
The American Academy of Family Physicians and the U.S. Preventive Services Task Force recommend a mammogram every two years from ages 40 through 74.
The American Cancer Society recommends at ages 40–44 women should have the option of beginning annual mammograms. It recommends annual screening from ages 45–54. Beginning at age 55, women may continue annual screening or switch to every other year.
The American College of Radiology, Society of Breast Imaging, recommend annual screening for normal-risk ladies at age 40. This is why your radiologist or cancer center may suggest yearly screening even if another guideline suggests every two years.
For adults 75 and older, the decision is more individualized. Overall health, life expectancy, previous screening results, and personal preferences should be considered.
These recommendations differ because expert groups weigh the benefits and possible drawbacks of screening somewhat differently. More frequent screening may identify some cancers sooner, but it can also lead to more false alarms, additional imaging, and biopsies that ultimately do not show cancer.
When should you get a mammogram? Beginning at age 40, talk with your healthcare professional about a regular mammogram schedule—and follow through with it.
Who is at increased risk?
General screening recommendations are intended for people at average risk. Ladies at increased risk may need earlier or additional screening evaluations. If you have any of the follow, it would increase your risk:
- A strong family history of breast or ovarian cancer
- A known inherited genetic change, such as a BRCA1 or BRCA2 mutation
- A personal history of breast cancer or certain high-risk breast conditions
- Radiation treatment to the chest at a young age
- A calculated lifetime breast cancer risk of approximately 20%–25% or higher
What if you have dense breasts?
Breast density describes how breast tissue appears on a mammogram. Dense tissue can make breast cancer more difficult to see and is also associated with a higher risk of developing breast cancer.
Federal rules require mammography facilities to tell patients whether their breasts are dense. However, having dense breasts does not automatically mean that everyone needs an ultrasound or MRI. The best next step is to discuss your density report along with your family history and other risk factors with your healthcare professional.
If extra imaging is recommended, it is worth knowing that MRI is generally the most sensitive supplemental test, while options such as contrast-enhanced mammography, molecular breast imaging, and ultrasound may be used in certain situations. Each of these extra tests can find additional cancers, but each also increases the chance of false alarms and biopsies, and some involve contrast dye or a small amount of additional radiation. There is no single right answer for everyone.
Many facilities now offer 3D mammography, also called digital breast tomosynthesis. It takes multiple images of the breast from different angles. Compared with traditional 2D mammograms, 3D mammography can find somewhat more cancers and lead to fewer “call-backs” for additional pictures. If you are scheduling a mammogram, it is reasonable to ask whether 3D is available.
Do not wait for a mammogram if you notice a change
A screening mammogram is intended for someone who does not have symptoms. Contact a healthcare professional promptly if you notice:
- A new breast or underarm lump
- Swelling or a change in breast size or shape
- Skin dimpling, thickening, redness, or irritation
- A nipple that begins turning inward
- New nipple discharge, particularly bloody discharge
- A persistent or otherwise concerning breast or nipple change
Most breast changes are not cancer, but they should still be evaluated. Mammograms also do not find every breast cancer, so knowing what is normal for your body remains important.
When should you get a mammogram?
If you are still wondering when you should get a mammogram, we can help create a screening protocol unique to your individual risk. Rather than trying to choose among guidelines on your own, let’s start with a conversation. In our concierge medical practice we take the time to review your age, health history, breast density, family history, and preferences. Together, we will create a plan tailored for you.
Breast cancer screening is not one-size-fits-all. Our goal is to help you understand your options, choose the right plan, and stay on track over time.
Not sure whether you are due for a mammogram? Contact us to start the conversation.