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When should I be screened for breast cancer?

By Ashlyn Seeley Everett, M.D., radiation oncologist at Alliance Cancer Care, and Caroline Schreeder, M.D., breast surgeon at Huntsville Hospital’s Clinic for Breast Care

October is breast cancer awareness month.  Breast cancer is the most common cancer in American women, and it accounts for the second highest number of deaths from cancer in women.  According to the CDC, about 265,000 cases are diagnosed annually and 42,000 women died of breast cancer in the United States in 2019.

You might be wondering if or when you should have a screening for breast cancer.  There are several factors to take into consideration to answer this question.  If you have any symptoms in your breast, including a mass, lump, pain, or nipple discharge, you should have this evaluated immediately.  Any person with symptoms in the breast should have this checked, regardless of age.

What are the screening recommendations for average-risk patients?

For someone at average risk of breast cancer with no symptoms, the National Comprehensive Cancer Network recommends having an annual screening mammogram starting at age 40. A screening mammogram involves an x-ray of the breast tissue to look for any early signs of breast cancer, including calcifications, distortions, or masses in the breast tissue.  If one or more of these characteristics is seen, you may be asked to come back for further evaluation.  This may include additional imaging with magnified mammograms or ultrasound and potentially a biopsy.

What about women who are at increased risk of breast cancer?

If you have a strong family history of breast cancer (first-degree relative: mother, sister, or daughter), a known genetic mutation related to breast cancer, or a personal history of receiving radiation therapy in the chest, you may be at increased risk of developing breast cancer at a younger age.  In this situation, you and your doctor should consider your family history and risk of having breast cancer when deciding on screening for breast cancer.  There are several calculation tools to help with this, including the Gail model.  This considers your age, your age when you had your first period, your age when you delivered your first child, your family history, any past breast biopsies, and your race or ethnicity.  The Gail model is a tool to estimate your lifetime risk of developing breast cancer and will guide the age when you start screening and if you should have anything in addition to a mammogram.

Why is having a mammogram important?

Mammograms have been shown to find breast cancer in earlier stages when the cancer is more likely to be curable.  Many breast cancers are detected by mammograms before your doctor would be able to feel a lump in the breast, or possibly when the cancer is pre-invasive.

Will having a mammogram hurt?

During your mammogram, everything is done to ensure that you are comfortable, but also that the x-ray is of optimal quality.  The majority of women report some discomfort, but no frank pain with having a mammogram done.

I need to schedule a mammogram. What now?

If you need to schedule your mammogram or have further questions about this important screening tool, we recommend you call your primary care physician or gynecologist to have this ordered.