With everyone making different recommendations about when to start getting mammograms for breast cancer screening – and how often to get them – women may be wondering what to do.
“If a woman has a question about when she should begin screenings, she should talk to her primary care provider,” said Mary Saeger, general surgery physician assistant and High Risk Breast Service Coordinator at Marshfield Clinic Health System. “Your doctor can determine the best frequency based on cancer risk and health status.”
A doctor may recommend starting breast cancer screening at an earlier age or supplemental screening in addition to mammography if a woman has any of the following risk factors for breast cancer:
- Family history of breast cancer
- Personal history of breast cancer
- Genetic predisposition
- Prior atypical breast biopsy result
- Prior chest radiation exposure due to other cancer treatments
Some women may be at an increased risk for breast cancer and certain preventive options are available for these women. Talk to your doctor about your risks, if you should consider genetic testing and if you should participate in these preventive options.
When to start mammograms
Saeger recommends following the National Comprehensive Cancer Network (NCCN) recommendations for breast cancer screening.
According to the NCCN, average risk women greater or equal to age 40 should have a yearly screening mammogram and yearly clinical encounter, that ideally includes a clinical breast exam.
Breast cancer screening with a mammogram should continue if a woman is in good health and expected to live at least 10 more years.
However, there are many organizations that provide breast cancer screening recommendations. Your insurance and health care provider may follow other recommendations, so it may be best to talk with them before scheduling a mammogram.
Saeger recommends that a woman stay aware of changes in her breast by practicing self-breast awareness. All breast cancer starts as a small tumor. However, some eventually grow and, as the cancer grows, it can cause noticeable changes, including different appearance of the nipple, skin dimpling, breast pain or other issues.
“Look at yourself in the mirror before getting into the shower and take note of any changes,” she said. “If you are comfortable doing so, check your breasts for any new changes. If changes are found, bring it up with your provider.”
A self-exam or clinical breast exam should not replace a mammogram. Mammograms are the most reliable way to detect breast cancer and you should follow your doctor’s screening recommendations. However, some breast cancers may first be found by self-exam rather than by mammography.
Importance of a breast cancer screening
Mammograms are one of the best preventive measures because they can help detect the cancer when it is small. Most newly diagnosed breast cancer patients don’t have a family history of breast cancer or any signs or symptoms of breast cancer.
The benefits of screening mammograms outweigh the risks. A woman is more likely to die of undetected breast cancer than she is to develop cancer caused by exposure to radiation during screening.
A mammogram is the best way to detect asymptomatic breast cancer, and technology is improving, said Dr. Kristie Guite, a Marshfield Clinic Health System radiologist who specializes in mammography. Many health care facilities offer 3-D mammograms, which can make it easier to find breast cancers in women, especially if they have dense breast tissue.
If you are pregnant and notice a mass or change in your breast, you can still safely get a mammogram. A shield will protect your belly from radiation.
3D Mammograms and MBI
Conventional mammograms are 2D pictures of the breast. 3D mammograms and molecular breast imaging (MBI) are advanced imaging techniques that improve the detection and treatment of breast cancer.
“Screening for breast cancer with mammograms has been proven to reduce mortality from breast cancer,” Dr. Guite said.
Breast imaging technology available at Marshfield Clinic Health System makes it possible to find cancer more easily so women have a better chance of cure.
A radiologist can perform 3D and 2D mammograms at the same time. It takes only a few extra seconds to capture the additional image.
“Looking at smaller sections of breast tissue allows us to more easily detect breast cancer in all women, but even more so in women younger than 50 and women with dense breast tissue,” Guite said. “3D mammograms allow us to detect breast cancer when it’s smaller, in an earlier stage and easier to treat.”
About 10% of women get called back for more imaging after basic screening mammograms. Although 99% of patients who return for imaging don’t have cancer or a breast abnormality, the experience can be stressful.
“3D imaging reduces the number of patients who have to come back for additional imaging by 40%,” Guite said. “It saves them from having to go through the anxiety of more testing.”
Molecular breast imaging (MBI) finds more cancers
MBI involves injecting a small amount of radioactive material into the bloodstream. Cancer cells in the breast take up more of the radioactive material than normal breast tissue, which allows doctors to locate small tumors.
“It finds two to three times as many cancers than regular or 3D mammography,” Guite said. “The likelihood of missing a breast cancer is almost none.”
MBI isn’t a replacement for mammography, and not all patients need it, she said. Women who have dense breast tissue, family history of breast cancer or personal history of non-cancerous breast tissue biopsies are potential candidates for MBI.
Doctors use molecular imaging to check effectiveness of chemotherapy, develop surgical plans and scan patients who are unable to have a breast MRI.
Additionally, some women have “lumpy” breasts or breast implants that make it difficult to feel for changes. You can talk to your doctor about an MRI to take a closer look at your breast and detect any cancer.
Cost of mammograms
Medicare provides coverage for 3D mammograms. If you have other insurance or have MBI scheduled, ask your insurance carrier about coverage prior to your appointment.
A Marshfield Clinic Patient Financial Services representative can provide a fee estimate for MBI.
All Marketplace health plans and many other plans must cover screening mammograms. The Wisconsin Well Woman Program pays for mammograms for women with little or no health insurance coverage.
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