Screening for Breast Cancer

Most consensus guidelines agree that mammograms for an average risk woman should begin at age 40 and continue annually.

Ask your doctor what guidelines they use for their patients.

I recommend following the American Society of Breast Surgeons and National Comprehensive Cancer Network guidelines which also aligns with the American Medical Association and the American College of Radiology's guidelines. I strongly do not recommend the United States Preventative Services Task Force guidelines , as this task force focuses on cost containment and is not a patient focused guideline.

A Mammogram is an X-ray of your breast tissue. You do not see or feel X-rays as they pass through your body to take pictures of your breast tissue.

Mammograms can generally see the breast tissue and in some pictures we can see your underlying chest muscle and sometimes part of the underarm called the axilla.

Screening mammograms for breast cancer are done when you have no complaints or concerns related to your breasts. This means you do NOT feel any lumps or masses, you do not have any nipple discharge, you do not have any pain, and do not have any skin changes. If you have any of the above concerns you should have a diagnostic mammogram, meaning the pictures are investigating the concern.

Your mammogram report is will tell you if there are any findings such as masses, cysts, calcifications, etc. The report is required to report what level of breast tissue density you have. The report will include a grading system, called a BIRADs score, that your doctors use to interpret what follow up is recommended after your mammogram.

A screening mammogram typically contains a very low dose of radiation and is considered safe for periodic breast cancer screening. To put in perspective, the average dose of radiation from a mammogram is about 0.4 millisieverts (mSv). To compare, the average person in the United States is naturally exposed to an average of about 3 mSv of background radiation each year from their natural surroundings.

It is well known that prognosis of breast cancer is directly related to catching breast cancer early. Breast cancer screening therefore MUST function to help us catch disease in these early stages. Most breast cancers in early stages are not able to be felt externally and thus why mammograms are essential for an otherwise silent disease.

For women who have family members with an inherited genetic mutation (such as BRCA1 or BRCA2), family members with breast cancer without genetic mutations, a personal history of high risk lesions, personal history of chest radiation, personal history of dense breast tissue etc., should start to be evaluated by their doctor at age 25-30 for a "high risk assessment". After screening for a multitude of factors , your doctor may recommend you to start mammograms earlier than age 40 and to see a breast specialist provider.

If you are found to be at high risk for breast cancer at a younger age than 30, generally screening for breast cancer is performed by a breast MRI or ultrasound. This is because younger breasts are generally very dense and generally density decreases with age. MRIs and ultrasounds can see through dense tissue better.

High risk breast cancer screening age 30 and above, is generally recommended to have annual mammograms and consideration for adding annual breast MRI. We tend to recommend separating these tests to be 6 months apart, that way your breasts are evaluated with some form of imaging every 6 months.

At this time, we recommend mammograms to continue annually and starting at age 70-75, we recommend evaluating overall health status related to continuing mammograms. Those who are otherwise still healthy and are expected to live at least another 10 years, are recommended to continue the annual mammogram. If there are other health factors which limit overall functionality or would prevent breast cancer treatment if it was found, then recommendation is to stop mammograms. This becomes an individualized recommendation decided between you and your doctor.

So, now that you know, how can you help?

Encourage all of the women friends , colleagues, family members in your life to get their mammogram! If you personally have had a mammogram, talk about your experience to help others know what to expect. Spread the word how important mammograms are! Send my post to your people to spread knowledge!

Thank you for joining me!

https://www.breastsurgeons.org/docs/statements/Position-Statement-on-Screening-Mammography.pdf