Jefferson radiologists discuss everything you need to know about screening, from how to prepare and address warning signs to what to do if you’re re-called for another screening.
Editor’s note: This article has been reviewed for accuracy from an earlier version posted in October 2021.
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 and people assigned female at birth 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. All you should do is dress comfortably; you will need to take off your top and bra for the exam, says Dr. Zorn.
Additionally, deodorant should be avoided, as the residue can leave marks on a mammogram that mimic calcifications (deposits within breast tissue that are commonly harmless but may indicate a need for treatment).
2. Providing past documentation can help determine a diagnosis.
If you have had prior breast imaging, bring your results with you – or have them sent over in advance – to aid in interpretation, advises Dr. Shames. “This helps us determine gradual changes, or if there are any new concerns that need 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 cause discomfort. This compression is necessary to keep the breasts from moving, generate the highest quality image capable of detecting changes and ensure the lowest dose of radiation.
“Discomfort levels vary from patient to patient, and even from year to year. Try not to be discouraged by others’ experiences,” says Dr. Shames. “Mammography technologists are specially trained to position patients to reduce discomfort. If you have a physical limitation or injury, they can work with you to minimize discomfort and maximize range-of-motion.”
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.
4. People with dense breast tissue may need additional imaging.
When you have dense breast tissue (a higher ratio of normal glandular tissue compared to normal fatty tissue), you may need additional imaging, such as a breast ultrasound, contrast enhanced mammogram or MRI. This is because dense tissue appears white on a mammogram, similarly to what we look for that indicates the presence of breast cancer, explains Dr. Zorn.
Mammograms are still the backbone of breast cancer screening. “Supplemental screening tools are used to support, not replace mammography, as they are able to look for key indicators for breast cancer that other methods of imaging can’t see,” explains Dr. Shames.
5. You can and should move up your appointment if you suspect something is wrong.
The majority of breast cancers won’t cause symptoms unless they’re advanced. However, potential warning signs of breast cancer include a lump or bump that grows or evolves from cycle to cycle; a persistent or worsening pain in the breast; skin changes; and clear or bloody nipple discharge.
If you notice any of these, notify your provider as soon as possible, urges Dr. Shames. You may be seen earlier for additional diagnostic imaging. If you experience symptoms close to your screening, you should inform your mammogram technologist the day of, so they can document it.
Self-exams can help find changes and are important to do monthly, starting in your 20s, adds Dr. Zorn. It’s recommended to perform self-exams during your menstrual cycle and even while showering – you’re already unclothed, plus it may be easier to feel a mass when the skin is moist.
6. Warning signs are the same for males and should be taken seriously.
Male breast cancer is rare and accounts for less than 1% of all breast cancers, so routine screening is not recommended. However, it’s important to know that symptoms are the same, and while it may seem uncomfortable or unlikely, you should let your provider know if you experience any of these symptoms in case imaging is needed, urges Dr. Shames. “We, unfortunately, find male breast cancer at more advanced stages, partially because many don’t believe it could happen to them.”
7. Family history plays a role, but it’s not the biggest risk factor.
The most prominent risk factors for breast cancer are getting older (the peak age for prevalence still being 60-70 years old) and being female, explains Dr. Zorn. The vast majority of patients – around 80% – have no family history or genetic ties, adds Dr. Shames.
However, if you have a family history of breast cancer, other cancers or certain genetic mutations (such as the BRCA gene), earlier screening is recommended as your risk for breast cancer is significantly higher than the average person. If you have a first-degree relative who has/had breast cancer, screening should start 10 years younger than when they were diagnosed, explains Dr. Shames. “It’s wise to start conversations about your individual risk factors by age 20.”
Race may also play a role in one’s risk for developing breast cancer. Studies show that non-Hispanic black women are at higher risk for more aggressive breast cancers due to biological factors; socioeconomic factors that lead to lack of access to screening and dense breast tissue.
The impact of gender-affirming hormone therapy and top surgery on breast cancer risk are still being studied, however, these patients should discuss the need for breast cancer screening with their provider to determine if and when screening should be considered, notes Dr. Shames.
8. The COVID-19 vaccine may have a temporary impact on lymph nodes.
When the COVID-19 vaccine first circulated, concerns were raised over the possibility of false positives on mammograms due to lymph node enlargement.
“The vaccine can trigger a strong immune response with various side effects, one of which can be temporary lymph node enlargement under the arm,” explains Dr. Zorn. If you’ve recently received a vaccine or booster shot and are due for screening, we recommend not delaying your mammogram. If you are due for a vaccine and screening, please talk to your provider to see if it would be safe to postpone your vaccine until after your exam.
9. Radiation exposure from screening is very minimal.
Prior radiation exposure is a known risk factor for cancer, however, modern mammography equipment uses very small doses of radiation – even less than most standard X-rays, explains Dr. Zorn. “It’s roughly the same level of radiation you would absorb on a cross-country flight. Not to mention, the benefits of screening far outweigh the risks.”
To put this into perspective, Dr. Shames shares, “Every year, people in Denver, Colorado are exposed to the same amount of radiation as a mammogram from naturally occurring radiation compared to people living at sea-level. If this negatively impacted an individual’s likelihood of developing cancer, we would see significantly higher cancer rates for those in Denver. However, their cancer incidence is lower than the national average. This suggests the amount of radiation women experience from a mammogram plays an insignificant role in their risk.”
10. 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 prior imaging 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 5% are ultimately diagnosed with cancer.
11. Our comprehensive team can guide you step by step through the process.
Jefferson’s Breast Care Center team of breast radiologists, mammography technologists, nurse navigators and support staff can all help answer any questions or concerns you have.
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.
12. 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.
To help make mammograms more convenient and accessible, the Sidney Kimmel Cancer Center and Dietz & Watson put cancer screening “on wheels” throughout the streets of Philadelphia and South Jersey. The mobile cancer screening van is equipped with private changing rooms and the latest in advanced imaging technology. (See when and where the van is going next.)
Getting your mammogram is one of the best preventive measures you can take for your health, says Dr. Zorn. “Ideally, we want people to get screened before symptoms ever have a chance to start.”
[Main photo credit: pixelfit/ E+ via Getty Images]