7 things you should know about breast cancer screening

Early detection is crucial when it comes to catching cancer at an easier-to-treat stage, and mammograms remain the most effective tool to achieve this. Familiarizing yourself with the ins and outs of breast screening can be helpful. Aurora Luna, MD, board certified and fellowship-trained Diagnostic Radiologist based in Boca Raton, FL, answers some commonly asked questions about breast cancer screening.

For women in good health, annual screening mammograms beginning at the age of 40 are recommended by the Society of Breast Imaging. If you have a family history, or other factors such as a known genetic mutation (BRCA1/2), or have history of chest radiation before the age of 30, your doctor may recommend you start receiving mammograms earlier. Talk to your doctor about your individual situation.

When it comes to an issue as important as this, quality is essential. Always look for a clinic or center that is accredited by the American College of Radiology (ACR). When your center is ACR accredited, this means that both the radiologist and the technologist are specialty trained in mammograms and are certified to work with the mammography equipment. These centers undergo regular inspections and must meet high standards.

Weeks before your exam, make sure you collect any prior mammograms or imaging done at other imaging centers that your radiologist may need to see. If you have a physical or printed copy of your imaging order, bring it with you to your appointment. Ideally, schedule your mammogram a week after your menstrual cycle, when you are likely to be less tender. The day of your screening, eat and drink as normal and take your daily medications. Do not put on deodorant or lotion as it can interfere with your images and require repeat imaging. Leave your jewelry at home that day. It is also a good idea to wear a two-piece outfit to your appointment so you can keep the bottom half on during your mammogram. Finally, bring your ID and insurance card.

Getting called back in for more imaging after a screening mammogram is common. Your breast radiologist may ask for extra imaging, either another mammogram or an ultrasound, to take a closer look at a particular area and make sure everything is clear. This does not mean there is something wrong or that you have breast cancer.

Between normal or benign mammogram results, or even before you start screening mammograms, it is recommended to be generally aware of changes to the shape or appearance of your breasts. Most national cancer organizations are not recommending monthly self-exams anymore, but it is still important to notice any changes to the skin overlying the breast and the nipple. Any thickening, swelling, or dimpling of the skin should be brought up to your primary care physician. Also let your doctor know if you notice redness, flaking, inward pulling of the nipple or new discharge coming out of the nipple. For women who are comfortable continuing to do self-exams, this is not wrong and may help detect an early breast cancer as between 30 to 40 percent of breast cancers can be felt at the time of diagnosis.^1-2 Overall, if you experience any new symptoms, always contact your doctor.

Being told that you have dense breasts is a normal and common occurrence. Our breast density description on mammograms comes from the amount of different tissues, including: fat, fibrous tissue (supportive tissue), and glandular tissue (milk glands and milk ducts). Approximately 50 percent of women have dense breasts. If you are told you have dense breasts, you simply have more dense (fibrous and glandular) tissue than fatty tissue.

Digital breast tomosynthesis, known as 3-D mammogram, is the next advancement in breast imaging that allows improved visualization of your breast tissue. 3-D imaging allows us to see your breast tissue in thin slices, as if we were flipping through pages of a book. This may help decrease the chance of getting called back in for more mammogram images.

1. Society of Breast Imaging
2. American College of Radiology
3. American Cancer Society
4. Center for Disease Control
5. National Institute of Health (NIH/NCBI)
6. Susan G Komen Foundation
7. Breastcancer.org
8. Mathis KL, Hoskin TL, Boughey JC, Crownhart BS, Brandt KR, Vachon CM, Grant CS, Degnim AC. Palpable presentation of breast cancer persists in the era of screening mammography. J Am Coll Surg. 2010 Mar;210(3):314-8. doi: 10.1016/j.jamcollsurg.2009.12.003. PMID: 20193894.
9. Haakinson DJ, Stucky CC, Dueck AC, Gray RJ, Wasif N, Apsey HA, Pockaj B. A significant number of women present with palpable breast cancer even with a normal mammogram within 1 year. Am J Surg. 2010 Dec;200(6):712-7; discussion 717-8. doi: 10.1016/j.amjsurg.2010.08.005. PMID: 21146009.