Breast Cancer Screening and Mammograms: When to Start and What to Expect

What it involves

MedlinePlus explains that a mammogram is an x-ray picture of the breast, used to look for early signs of breast cancer that cannot be felt during a breast exam. A screening mammogram is for women without signs or symptoms. A diagnostic mammogram is longer and is done when there is a lump, pain, skin thickening, nipple discharge or a change in size or shape.

Who this is for

• Women in their 40s and older who want to know when to start or how often to be screened.
• Patients with a family history of breast cancer or other risk factors for it.
• Women who are overdue for a mammogram or have never had one.
• Anyone with an abnormal mammogram report who needs help understanding the next step.

What to expect

• A review of your age, family history, past breast problems and when you last had a mammogram
• A breast exam when you have a symptom, and a talk about the benefits and drawbacks of screening
• A referral to an imaging center for the mammogram, since the practice does not list mammography
• Help reading the result and arranging follow-up if anything needs a second look

Screening versus diagnostic mammograms

The two kinds answer different questions. A screening mammogram is routine and looks for cancer in women who feel fine. A diagnostic mammogram takes longer and is done after a symptom or an unclear screening result, and it may also be used with breast implants or when the tissue is difficult to see. MedlinePlus also notes that a lump or other sign can have a benign cause. A provider helps decide which type is right, and the order goes to an imaging facility.

Benefits and limits

MedlinePlus says regular screening mammograms help reduce breast cancer deaths in women 40 to 74 because they find cancer early, sometimes before it spreads. It also lists real drawbacks. A mammogram can look abnormal when there is no cancer, which leads to more tests and worry. It can miss cancer that is there. And it uses a small amount of radiation. These are reasons to talk it through with a provider rather than treating the decision as automatic. Mammograms are one of several preventive checks that can be discussed at a yearly visit, and the annual physical page for Wellington patients describes what that visit covers.

How the mammogram is done

You stand in front of an x-ray machine, and your breast is placed between two plastic plates that press it flat. MedlinePlus says this can be uncomfortable but gives a clearer picture. Each breast is imaged from the front and from the side. A radiologist reads the pictures, and results usually come within a few weeks, sooner if something is not normal. Ask your provider when and how you will receive them. Scheduling a mammogram away from your period may be more comfortable for some women.

Risk factors that change the conversation

MedlinePlus lists factors that raise breast cancer risk: older age, a personal history of breast cancer or benign breast disease, inherited changes in the BRCA1 and BRCA2 genes, dense breast tissue, more lifetime exposure to estrogen, past radiation to the chest, obesity, alcohol use and hormone therapy for menopause. Knowing your family history lets a provider judge whether a standard schedule fits. Alcohol and weight also matter, and the alcohol use screening guide describes how those conversations go.

What an abnormal result means

MedlinePlus is clear that an abnormal mammogram does not always mean cancer. You may need additional mammograms, tests or exams before your provider can tell, and you may be referred to a breast specialist or surgeon, which is not the same as needing surgery. If you already feel a lump, the breast lump evaluation page describes the visit. Bring the written report to your appointment, since the images themselves stay with the imaging center.

Symptoms to report at once

According to MedlinePlus, signs of breast cancer include a new lump or thickening in or near the breast or armpit, a change in breast size or shape, a dimple or puckering of the skin, a nipple turned inward, nipple discharge other than milk, scaly or red skin around the nipple, and breast pain. These do not wait for a screening date. Many have benign causes, but each needs an exam. Screening is one part of preventive care, and the preventive care page explains the rest.

Sources

• MedlinePlus: Mammography (health topic)
• MedlinePlus: Breast Cancer (health topic)