Jefferson radiologists discuss breast cancer risk factors, how to prepare for routine screening, and debunk common misconceptions, including how COVID-19 vaccines could affect results.
Mammograms are the most essential screening tool for the early detection and diagnosis of breast cancer. As recommended by the American College of Radiology (ACR) and American Society of Breast Surgeons (ASBrS), all women, or those who are born female, should begin yearly mammograms at age 40 (or earlier, depending on individual risk factors).
1. Preparing for your mammogram is simple.
There are no complex or tedious restrictions required as there may be for other procedures, notes Dr. Shames. All you should do is dress comfortably; you will need to take off your top and bra for the exam, says Dr. Zorn. The only thing advised to avoid is deodorant, as the residue can leave marks on the mammogram that mimic calcifications, or deposits within breast tissue that are commonly harmless, but may indicate a need for treatment.
2. Providing past documentation can help streamline the diagnostic process.
If you have had prior screenings at outside locations, try to bring your imaging and results with you – or have them sent over in advance – to aid in interpretation, advises Dr. Shames. “This helps us determine whether anything has gradually changed, or if there’s anything of concern that needs additional testing. Assessing subtle changes from year to year is one of the best methods we have to support early detection.”
3. Mammograms are generally quick and painless, and mammography techs are highly skilled at ensuring this.
A typical mammogram lasts about 10 minutes, says Dr. Zorn. During the exam, each breast is compressed in the mammogram machine, which can be the main culprit of discomfort. It’s worth noting that the purpose of the compression is to keep the breasts from moving, generate the highest quality image capable of detecting changes, and ensure the lowest dose of radiation needed for the exam.
“Discomfort levels vary from patient to patient, and even from year to year. Try not to be discouraged by others’ stories or past experiences,” says Dr. Shames. “Mammography technologists are specially trained to position patients to help reduce discomfort. If you have a physical limitation or an injury to the neck or shoulder area, they can work with you to minimize discomfort and maximize range-of-motion, all while maintaining the best quality image.”
Modern mammograms are performed using 3-D mammography technology, or digital breast tomosynthesis, which can evaluate multiple layers of breast tissue for a more accurate diagnosis, as well as reduce discomfort. Some patients may require additional imaging, such as a breast ultrasound or breast MRI, depending on their individual risk factors.
4. You can and should move up your appointment if you suspect something is wrong.
Potential warning signs of breast cancer can include a lump or bump that grows or evolves from cycle to cycle; a persistent or worsening focal pain in the breast; skin changes; and clear or bloody discharge from the nipple.
If you notice any of these, notify your provider as soon as possible, urges Dr. Shames. Supplemental imaging may be necessary in leu of screening. If you experience any symptoms closer to your exam, and are unable to tell your provider, you may inform your mammogram technologist the day of, so they can document it.
Some breast changes only become apparent due to self-examinations, notes Dr. Zorn. Self-exams are important to do monthly, starting in your 20s. It’s often recommended to perform self-exams while showering – you’re already unclothed, plus it may be easier to feel a mass when the skin is moist.
5. Family history plays a role, but it’s not the biggest risk factor.
The most prominent risk factors for breast cancer are getting older and being born female, explains Dr. Zorn. In fact, the vast majority of patients – around 80 percent– have no family history or genetic ties, adds Dr. Shames. “It’s an incredibly prevalent cancer, which, again, is why routine screening is critical.”
However, if you do have a family history of breast cancer, other cancers, or certain genetic mutations (such as the BRCA gene), earlier screening is recommended. If you have a first-degree relative who has/had breast cancer, screening should start 10 years younger than when said relative was diagnosed, explains Dr. Shames. “It’s wise to start conversations about your individual risk factors by age 30.”
Other risk factors include, but are not limited to, dense breast tissue (a higher ratio of normal glandular tissue compared to normal fatty tissue in the breast); race (non-Hispanic black women are at a slightly higher risk); alcohol consumption; being overweight and/or sedentary; not having children; and use of hormone therapy.
6. The COVID-19 vaccine may have a temporary impact on lymph nodes.
Recent concerns have surfaced over the possibility of false positives from mammograms after receiving the COVID-19 vaccine. Why are we seeing reports of this?
“The vaccine triggers a strong immune response with various side effects; part of that response can involve temporary lymph node enlargement under the arm,” explains Dr. Zorn. “It’s important to let your provider and mammogram technologist know this, so they know what they’re looking at.”
Current recommendations are to not reschedule screening or diagnostic breast imaging secondary to a recent history of COVID-19 vaccination, notes Dr. Shames. However, if possible, try to schedule your routine breast imaging prior to receiving your first dose.
7. Radiation exposure from screening is very minimal.
Because prior radiation exposure is a known risk factor for cancer, there are concerns about mammogram radiation. However, modern mammography equipment uses very small doses of radiation – even less than most standard X-rays, explains Dr. Zorn. “They’re around the same level of radiation you would absorb on a cross-country flight. Not to mention, the benefits far outweigh the risks.”
To put this into perspective, Dr. Shames shared the following study: “People in Denver, CO are exposed to naturally occurring radiation from outer space that is equal to the average amount of radiation omitted during a mammogram. If this amount were to impact an individual’s likelihood of developing cancer, you would expect the cancer incidence to be significantly higher in Denver. However, it’s actually lower than the national average. This suggests the amount of radiation from a mammogram plays an insignificant role on cancer risk.”
8. Being re-called after screening doesn’t necessarily mean you have cancer.
There are various reasons a patient might be called back in after their screening, says Dr. Zorn. “More often than not, we need extra imaging to ensure what we’re seeing is normal breast tissue. This happens more commonly with patients who don’t have past documentation because we have no baseline for comparison.”
Try not to jump to the worst-case scenario, suggests Dr. Shames. Studies show that among patients who get called back, only about five percent are diagnosed with cancer.
9. Our comprehensive team can guide you step-by-step through the process.
You will likely encounter several Breast Care Center team members – including breast radiologists; mammography technologists; nurse practitioners; and support staff – all of whom can help answer any questions or concerns you may have, says Dr. Zorn.
If you don’t have a mammogram scheduled yet, your primary care provider or OB/GYN can refer you; in many cases, you may also schedule a mammogram without a referral, explains Dr. Shames.
Results typically come back within a day or two. For diagnostic imaging, results are provided same day. At Jefferson, test results can be conveniently accessed on MyJeffersonHealth, our free online portal, where you can connect with your providers, adds Dr. Shames.
10. You should never delay your mammogram.
We strive to do everything we can to find cancer as early as possible, and mammograms are an essential part of that effort, says Dr. Shames. When screening is delayed until symptoms are present, it usually indicates an advanced stage cancer. We want to avoid this.
Getting your mammogram is a good thing; it is one of the best preventative measures we can take for our health, says Dr. Zorn.