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by Featured Provider Rodion Herrera on Monday, July 25, 2022
Timely breast cancer screenings are key to early disease detection. A radiologist shares why to be proactive about scheduling your first mammogram, and what to expect from the procedure.
Getting your first mammogram is a milestone. Unlike the start of puberty, though, this rite of passage shouldn’t catch you by surprise. But conflicting information about when to start screenings and what to expect as a mammography patient can lead to confusion and concern.
Rodion Herrera, DO, a radiologist at The Iowa Clinic, demystifies breast cancer screening guidelines, and common misconceptions that keep patients from proactively scheduling the procedure—and shares why you shouldn’t delay.
Patient action is key to early detection.
Typically, a woman should plan to schedule her first mammogram around her 40th birthday. But if you feel a lump, breast thickening, nipple discharge or experience a focal pain, there’s no need to wait until you hit the recommended age to get your mammogram.
“If you have a lump, whether it hurts or not, it’s suspicious until proven otherwise,” Dr. Herrera says. If you have physical symptoms, seeing your primary care provider before a mammogram can be helpful, but time is of the essence.
“The key for mammography is to find early disease at the time that it is not palpable, or asymptomatic,” Dr. Herrera says. That means no lump, no bump, no nipple discharge, or skin changes. By the time you find [those symptoms], disease may be already progressive or invasive.
Patients do not need a referral to order a mammogram, but if you don’t notice any warning signs, you might need a reminder to set up an appointment. Dr. Herrera follows screening guidelines set by the American College of Radiology. He says that while genetic predispositions or family history can trigger earlier screening, one common myth is that individuals without family history of breast cancer shouldn’t worry as much about the disease.
In fact, breast cancer remains the most common nonskin cancer, the second leading cause of cancer deaths, and the leading cause of premature death for women in the United States. Regular screening is known to reduce the risk of death by breast cancer by as much as 40%.
Who’s at risk for breast cancer?
Changeable risk factors are alcohol, obesity and unhealthy diet.
Unchangeable risk factors include gender, age, genetics, family history, personal history of breast cancer, race and ethnicity, breast density, early menstruation, late menopause, and history of previous chest radiation.
A patient with genetic mutations (e.g., BRCA1, BRCA2 or CHECK2) are the most common hereditary mutations. These are often found in young women.
Dr. Herrera says the recommendation for women with a first-degree relative who has been diagnosed with the disease is to schedule their first screening as soon as 10 years before it was detected in her relative. (So, if your mother was diagnosed at age 42, you would want to start screenings by age 32.)
But women whose mothers, sisters, aunts or grandmothers have been diagnosed with breast cancer aren’t the only ones at an elevated risk for the disease. Men with a genetic predisposition should also consider screening.
“I want to tackle the myth that men don't develop breast cancer,” Dr. Herrera says. “That is completely wrong. Do I mean men develop cancer the same way as woman? No. Only less than 1% of all breast cancer occurs in men. However, cancer in men tends to be more aggressive and advanced. By the time it is found, the disease has usually metastasized to the lymph nodes.
Dr. Herrera points patients to the Breast Cancer Risk Assessment Tool, which is used alongside the mammogram. The brief questionnaire includes a multitude of questions about personal medical history, reproductive and breast cancer history to estimate the risk of developing cancer over next 5-10 years.
Because hormone levels can be a contributing factor, new breast cancer screening guidelines call for increased attention for transgender individuals. Biological males transitioning to female are at increased risk for breast cancer compared to other males.
Other common myth Dr. Herrera hears is that silicone breast implants cause breast cancer. “It’s not true,” he says. “The same goes for breast trauma, injury or wearing an underwire bra. It doesn’t increase your risk.”
As patients age, however, the risk of developing cancer grows. This is why — especially after you turn 40 — scheduling annual mammograms is an important element of self-care.
Preparing for your first mammogram.
Patients are usually nervous about scheduling their first mammogram because they hear the procedure is painful. Dr. Herrera let people know that the procedure is quick (exams typically take less than 10 minutes), and the discomfort of compression plays an important role in visualization of early cancer.
“We need to have good compression to have a good mammogram,” Dr. Herrera says. “If you're going to have this exam once a year, let's have the best exam that you can have so I can get all the information I need. If I don't compress you enough, the tissue may look like a mass density and you may end up back for more imaging with more compression and more cost.”
Dr. Herrera says getting ready for a mammogram is simple:
Skip your daily swipe of deodorant, as many contain aluminum and calcium, which can look like calcifications on the mammogram images.
Those with a low pain tolerance can take over-the-counter Tylenol before the appointment.
During the procedure, relax your shoulders and chest cavity to help the technologist position you correctly.
From there, the radiologist will use 3D mammogram technology that combines multiple breast X-rays to create a three-dimensional picture of the breast. It’s a much more accurate means of detection than any breast self-exam you could perform at home.
Herrera wants to dispel a lingering myth that the radiation used in mammograms can cause breast cancer. Any type of radiation can potentially be harmful. Radiation in mammography is equivalent to 2 months of background radiation. Mammography is a “low-dose radiation” exam. Most important, benefits outweigh potential risk.
You should receive your results in 24-48 hours, and a callback if there is any area of concern that may require further investigation with additional imaging, ultrasound or biopsy.
In addition to helping diagnose breast cancer, a mammogram may also help catch other diseases, such as metastatic disease from another organ. Dr. Herrera has occasionally used the images to diagnose lymphoma.
“A patient will come in for a regular screening mammogram saying ‘I've been feeling sick and weak. I do not know why,’ and we find incidental enlarged lymph nodes,” he says.
Making your annual mammogram appointment.
If your first mammogram comes back clear, you can surely celebrate the results. But because cancer risk increases as you age, put a recurring reminder on your calendar to schedule the procedure annually.