It’s Breast Cancer Awareness Month, which means it’s time to talk about everyone’s favorite topic (kidding!), mammograms.
Though it’s an uncomfortable — literally — topic, mammograms are as critical to your health and longevity as your annual teeth cleaning, physical exam or yearly trip to the optometrist. So it’s better to start having conversations about mammograms sooner than later — even if you’re below the recommended screening age of 40 years old.
And with updated guidance on mammograms, related to age, dense breastsand more, it can be confusing or a little intimidating to go into the appointment unsure of what information is relevant to you (and what questions to ask to be sure you’re getting the most out of the mammogram).
Dr. Roxanne Pero MD, OB/GYN, FACOG, FACLM, IFMCP of Alive and Well to give us the rundown on some key things people need to keep in mind when it comes to mammograms.
Understand What a Mammogram Is and How They Work
Technician Explaining Mammogram to Adult Woman Patient.
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Recently, there have been some concernsover the fact that older women who get routine mammograms are at risk of being overdiagnosed or overtreated. As Dr. Pero explains that as helpful as they can be, mammograms also come with limitations.
“Mammograms are one tool for screening for breast cancer. It’s an early detection, not a preventive test,” explains Dr. Pero. “[Which means] it’s going to have high sensitivity — meaning if you have a negative result, then you’re likely not to have cancer; but it’s going to have a low specificity, meaning that it may pick up concerning lesions that, most of the time with follow-up imaging or a breast biopsy, will yield a negative result.”
That means sometimes it can pick up on a mass that may not be cause for concern, which is nerve-wracking — but also critical for early detection of cancerous cells, which leads to better outcomes after treatment.
There’s a Difference Between Screening Mammograms and Diagnostic Mammograms
Knowing the basics then leads to the next step: Understanding the difference between a screening mammogram and a diagnostic mammogram.
“A screening mammogram is [when] you have no complaints, you’re not having breast pain, you don’t feel a lump,” Dr. Pero explains. In other words, this is just a checkup to assess the health of your breasts.
If something of concern is spotted during that initial screening, your OB/GYN might request an additional screening, which can be a diagnostic mammogram.
“A diagnostic mammogram is [when] they’re actually focused on the area of concern that you’ve brought to light and they’re going to do a closer look,” she says.
“And then they’re also going to do a breast ultrasound usually at the same [appointment]. After that, they can tell you, based on the characteristics of the area of concern, whether or not you should schedule a biopsy of that area.”
It’s Important to Understand Your Breast Density
Doctor is explaining with breast model.
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When it comes to mammography, knowing your breast density can help you set up a plan of care. And while doctors are supposed to tell patients what their breast density is, Dr. Pero says she’s still surprised by the number of patients who come to her and don’t know their breast density.
“Breast density is graded on an A to D [scale]. Category C and category D — about 10 percent of women have category D breast tissue — means you have more glands and fibrous tissue. So it’s harder to see a lesion or a mass through that,” she explains.
“Having dense breasts in and of themselves increases your risk of breast cancer, which is why it’s something you need to know,” she says, adding that she sees many patients who she doesn’t think have been given clear guidance on this subject by their doctors: “If they do know [their breast density], they weren’t told that the recommendations are to have more consistent screenings.”
According to the National Cancer Institute, “screening mammograms miss about 20 percent of breast cancers that are present at the time of screening,” and one of the causes for false-negative results is high breast density.
“They usually recommend a screening mammogram every year, and then six months after your screening mammogram, to get a breast ultrasound or a breast MRI,” says Dr. Pero.
The Process of Getting a Mammogram Isn’t Time Consuming
Outside of your travel time and perhaps filling out some paperwork and waiting at the facility, the actual mammogram doesn’t take much time — “if you follow directions,” Dr. Pero jokes.
“Wear loose, comfortable clothes that are easy to take off — a loose top or a sports bra,” she advises.
“You go in, get changed, [they’ll ask you to take] everything off from your top, and then they give you a nice pink gown. The techs will tell you where to position yourself and are [often] very communicative about, okay, ‘I’m going to place my hand on your breast just to cup it and bring it in onto the plate,'” she explains.
“There are two plastic plates. They’re not cold or hot, they’re just room temperature. You put your breasts on top of it, and then they take two images, one laterally, and then one straight on of each breast. And it takes less than seven minutes to do!”
The American Cancer Society also advises against wearing any deodorants, antiperspirants, powders, lotions or perfumes under your arms as they may show up as white spots in the images.
Research, Review and Weigh All Your Options
Doctor doing ultrasound examination of breast of patient.
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One common barrier of entry Dr. Pero encounters when it comes to getting people to do their mammogram screenings is the fear of radiation. However, given that mammograms can be beneficial, she urges people to fully weigh their options.
“If I’m counseling a patient about radiation risk associated with mammograms, studies have shown that about 20 out of 100,000 women that have had a mammogram annually and consistently will develop breast cancer because of radiation exposure,” she says — and while that may seem high, the cancer they may detect should outweigh the radiation risk in a cost/benefit analysis.
“When we think about it, we have risks and we have benefits, and we’ve got to weigh those risks versus those benefits,” she says. ” Every time we get in a car, we know that we might get into a car accident, and you’re more than likely to get into a car accident and have a fatal accident than you are to get breast cancer from radiation mammogram exposure. So it has to be risk-based always.”
(Dr. Pero also says there are other options to consider, but they’re not going to be the “gold standard’ of treatment that a mammogram is: “A breast MRI … [but] most insurance companies are not paying for MRIs, and that’s a lot of money out of pocket,” as well as “a breast ultrasound, but it’s not FDA-approved for first-line therapy for early detection for breast cancer and then thermography, which is really not a validated test for breast cancer diagnosis.”)
In other words, before you start going down scary rabbit holes on TikTok or floating theories with your friends, talk to a qualified medical professional and choose a screening option that is both comfortable and cost-effective for you.
There Are Online Assessment Tools to Help Calculate Your Risk
Earlier this year, Olivia Munn revealed that taking a breast cancer risk assessment testallowed her doctor to catch an “an aggressive, fast moving cancer” in both breasts while it was still in its early stages.
While the 43-year-old actress used the Tyrer-Cuzick test, those who want to take the test can also utilize The Gail Model. Both are free.
Those types of tests are great for assessing your breast cancer risks “if you have a negative result and you have no mutations,” says Dr. Pero.
“They’ll give you a score based on one of those models and will [take into account] your age, if you’ve been on oral contraceptives before, your weight, your family history, if you’ve gotten a callback for a mammogram or if you’ve gotten a breast biopsy,” she explains.
Still, those risk assessments also have their limitations.
“What it doesn’t take into account — that I think, hopefully, soon they’re changing these models — are lifestyle factors that really do increase your risk of cancer,” she says. “Alcohol intake, a sedentary lifestyle, a low plant-based nutrition plan — those types of things.”
