For American women, turning 40 means more than just a birthday cake and candles.
When you reach this milestone date, you’re typically faced with a decision: to start regular screening for breast cancer or to push off commencing this annual or bi-annual wellness ritual. Although the recommendation of when to start varies based on personal risk and which agency’s guidelines you’re using, the fact remains that mammographic screenings have been shown to detect breast cancer at earlier stages when it’s more treatable.
Dr. Kristi Funk, breast cancer surgeon, author of “Breasts: The Owner’s Manual” and co-founder of the Pink Lotus Breast Center in Beverly Hills, California, says she advises her patients who are at normal risk of developing breast cancer to “begin at age 40. Do it every single year, and don’t stop or don’t skip a year until you plan to die in the next five years.”
Dr. Elizabeth Arleo, a radiologist at New York-Presbyterian and Weill Cornell Medicine, agrees. “Most women — those at average risk — should start annual screening mammography at age 40, as per the recommendations of the American College of Radiology and the Society of Breast Imaging,” she says. “The reason for this is the greatest mortality reduction is achieved with annual screening starting at age 40 — a nearly 40 percent decrease in breast-cancer-specific mortality compared with only a 23 percent decrease in breast-cancer-specific mortality associated with the U.S. Preventive Services Task Force recommendation of biennially screening women 50 to 74.”
Higher risk
If you’re at higher than average risk for breast cancer because of a known genetic mutation or a family or personal history of breast cancer, you should begin screening earlier. Talk to your doctor about determining when you should start and how frequently you should be screened.
No matter how old you are when you start having mammographic screenings, there are a few things you should know before you head into that first exam:
1. Ask about the technology before you go.
Tomosynthesis, or 3D mammography, is becoming more commonplace, and Dr. Mitva Patel, a radiologist at The Ohio State University Wexner Medical Center in Columbus, says this technology results in fewer false positives, meaning you’ll have further testing or treatment for something that’s not cancer, than conventional mammography. “Sometimes when we look at 2D images, you have tissue superimposition, which makes something look like cancer but it’s just overlapping tissue. Most studies show there’s a 30 percent decrease in the recall rate for patients who have tomosynthesis, so I think it’s a good option,” she says. When you book your appointment, ask the scheduler whether tomosynthesis is an option.
2. Don’t wear deodorant.
“Aluminum hydrochlorides in antiperspirants look like calcifications on your mammogram,” Funk says. These compounds commonly found in deodorants and some lotions and powders can show up on mammographic images as white spots, which look a lot like tumors, so it’s better to be a tad stinky than wear deodorant to your mammogram. This however is “not true for ultrasound” screenings, Funk says, so it’s OK to wear deodorant if you’re having an ultrasound rather than a mammogram.
3. The technician will take four images — two of each breast.
When you arrive at the imaging center, you’ll be asked to disrobe from the waist up and put on a hospital gown. You may be directed to an inner waiting room for a few minutes until a mammography machine becomes available.
Once you’re in the room with the mammography machine, the technician will take four pictures — two images of each breast. “They will do an up and down [view], what we call the craniocaudal, head-to-toe position, where the beam is shooting straight down. And then they position you for an oblique, or mediolateral [view]. Those four views will always be taken,” Patel says.
Arleo says although taking two images of each breast is standard, some women will have additional images made, usually for one of three reasons: “to make sure that as much of the far lateral (side near the armpit) aspect of the breast is included in the field of view; if a patient has particularly large breasts (in order to image them entirely); or if the patient has implants (additional ‘implant displaced’ views are taken).” For patients with implants, the technologist will “push the implant back and compress the tissue that’s in front of the implant,” so the implant doesn’t obscure a clear view of the breast tissue surrounding it, Patel says.
Regardless of how many images are taken, Arleo says it’s important for women to relax during the procedure. “Work with the technologist to relax the body as much as possible to allow for the most all-inclusive images, even though it may feel for a few seconds like [you’re] a contortionist.”
4. Diagnostic mammograms are different from standard screening mammograms, but may still be your first mammogram.
Diagnostic mammograms, which is what you’d receive if a mass is detected on a screening mammogram or if you’ve felt a lump, can include several more views than the standard four views most women have during a screening mammogram. Patel says visits for diagnostic mammograms take significantly longer than screening mammograms. “If it’s your first mammogram but you’re feeling a lump, you’re going to be scheduled for what’s called a diagnostic mammogram.”
During a diagnostic mammogram, the technologist will “take the standard views, but then they’re going to show [the images] to the radiologist.” The radiologist will likely request additional images or an ultrasound. There might be several rounds of the technologist taking pictures and the radiologist reviewing the images and requesting more views. From there, a decision will be made to do one of three things, Patel says: doing nothing, because the mass is nothing to worry about; sending you home and asking you to return for more images in three or six months to see if something has changed; or ordering a biopsy to determine whether a mass showing up on film is cancerous. “For diagnostic imaging mammograms, it’s a much longer exam and I think that’s important for patients to know,” Patel says.
5. It might hurt a little, but it’s worth it.
“The pain is definitely worth the gain,” Funk says. “Studies have shown it’s actually painless for about 45 percent of people, and it’s a little painful for another 40 percent.” The remaining 15 percent report that mammograms are really painful. But among that 15 percent, Funk says 89 percent of them noted that although it was unpleasant, “the pain was gone in seconds to minutes.” She likens it to stubbing a toe. “It hurts for a minute afterwards, but then you walk it off and you’re fine.”
If you’re concerned about pain, Funk recommends scheduling the mammogram during days 14 to 21 of your menstrual cycle, because this is when “you’re least sensitive and also least lumpy, which is important.” Because of hormonal shifts in the body related to menstruation, “your breast density is slightly decreased during that week, which makes it less likely that you’ll be called back.” She also recommends taking an over-the-counter pain killer such as acetaminophen or ibuprofen about 30 minutes prior to the test to lessen pain and sensitivity.
6. Understand why they compress your breast tissue.
“You want less overlapping tissue so you can see everything,” Patel says. Even with tomosynthesis, which takes a cross-sectional view, it’s still helpful if the patient’s breast tissue is flattened out because “it helps keep patients still. Motion can degrade an image,” Patel says. And if you understand why they squish you, that might make it seem a little less awful.
7. Know you can speak up.
If you’re in pain during the procedure, tell the technologist who’s taking the images. She may be able to reposition you in a more comfortable way, whether the cause is the compression or something else. “I’ve had patients say sometimes that their tummy is in the way or the machine is poking them,” and just communicating that to the technologist can help. “They have done so many mammograms, they’re able to work with the patients to get a good outcome,” she says.
8. Know it’ll be over fast.
Even if the compression is painful, it will last just a few seconds for each of the four images the technician takes. Patel says a standard screening mammogram from start to finish usually takes about 15 minutes, but of that time, you’ll be compressed in the machine for only a couple minutes total, with breaks in between views. “Each compression lasts less than a minute,” Arleo says.
9. It’ll take a few days to get the results.
You’ll get a letter in the mail and possibly an email or a phone call from the center where the mammogram was completed explaining your results. If you haven’t heard back from the center or your doctor within about a week, call to follow up.
10. Recalls for more imaging after a first mammogram are very common.
“Normally, when we look at mammograms, we compare to prior mammograms and we look for any changes,” Patel says. “Patients who’ve had multiple prior images — there’s less chance of us calling them back for additional views because we have more comparison films. For the baseline mammogram, [that’s your first one] unfortunately we don’t have anything to compare it to, so we’re more likely to find something that needs additional screening or images,” she explains. This is also why it’s important to have all your mammograms conducted at the same center. If that’s not possible, be sure to keep copies of your films or have them forwarded on to each new facility you visit so the new radiologist has your entire imaging history for comparison.
11. If you do get called back, don’t panic.
The American Cancer Society reports that just two to four screening mammograms out of every 1,000 lead to a diagnosis of breast cancer, so even if you’re called back for more views, chances are good it’s not cancer.
12. It’s OK to be nervous.
Although screening for breast cancer is a routine medical procedure that’s performed thousands of times each day across the United States, it might be a really scary thing for you, and that’s OK. “Most women are always nervous about getting their annual mammogram,” Arleo says, whether it’s their first or 20th. “It is normal to feel nervous when going for a test whose purpose is to answer the question, ‘Might I have cancer?’ However, the important thing is to acknowledge the anxiety and then not let it prevent you from going to get a simple test which can be lifesaving,” she says. If you’re really scared, bring a friend or loved one with you and “remember that it’s worth it because annual screening starting at age 40 saves the most lives.”
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12 Things to Know Before Your First Mammogram originally appeared on usnews.com
