At age 40 your primary care doctor may start talking to you about getting annual mammograms. After just leaving your 30s, this may feel like the aging process is piling on! But the reality is that as we age, the likelihood for breast cancer becomes higher. It's our job to own that, check our bodies, and control the narrative as best we can.
If you feel some anxiety about your first mammogram that's completely normal, but it may help to know more about what to expect.
Why Do I Need a Mammogram?
Like most cancers, breast cancer is much easier to treat when you catch it early. A mammogram is a low-dose x-ray, of just your breasts, that allows your doctor to see every inch of breast tissue very clearly. As a result, doctors are able to spot the tiniest of tumors and address any possible issues as early as possible.
Many health experts advise that you do a monthly self-check for lumps in your breasts at least once per month. Many women do their exam (usually called a breast self-exam) in the shower. When you check for lumps in the shower (a worthwhile practice), if you feel any lumps or something that feels out of the ordinary, you should call your healthcare provider right away. An annual mammogram, along with your monthly self-checks, provides an important opportunity to find a potential tumor while it's still small.
When Should I Get My First Mammogram?
Breast cancer is a highly studied process. As a result, the guidelines for the best time to begin screening can change somewhat frequently. Guidelines are generally based on your risk level for breast cancer.
Breast Cancer Risk Level
To determine your risk level, your doctor will ask you a series of questions and follow a complex algorithm. Once you know your risk level, your doctor can tell you when to start getting mammograms and how often to get them. You can also check your own breast cancer risk level by taking the online assessment tool provided by the National Cancer Institute.
Your risk level depends on many factors. Because of this, very few single facts can determine if you are low, average or high risk. An exception to this rule: you are considered at high risk if you have a family history of breast cancer, personal history of breast cancer or you have an inherited mutation in your BRCA 1 or BRCA 2 genes. Changes in these two genes have a high correlation with cancer development.
Risk Factors
According to the CDC, some other factors that may increase your risk for breast cancer are:
- Age >50
- Alcohol intake
- Dense breasts
- Exposure to diethylstilbestrol (used to prevent miscarriage)
- Female at birth
- First pregnancy after age 30
- High BMI (body mass index)
- Hormone replacement therapy or birth control
- Poor physical fitness
- Previous radiation treatment
- Starting menopause after age 55
- Starting your period before age 12
Some of these risk factors you can change, some you can't. Try not to stress about any of them. (Easier said than done, right?) If you want to change the few you can, like getting back to the gym or cutting back on alcohol, check with your doctor first and then go for it!
When To Get a Mammogram
Currently, according to the American Cancer Society (ACS), women with an average risk for breast cancer can follow the following mammogram timeline:
- Between ages 40-44, you have the option to get a mammogram annually.
- Between the ages of 45-55, the ACS strongly recommends annual mammograms.
- If older than 55, you may get mammograms every other year.
The ACS states, "Screening should continue as long as a woman is in good health and is expected to live at least 10 more years." If you are considered at high risk for breast cancer because of your personal medical history or family history, your doctor may want to begin mammograms before you turn 40.
If you are concerned you may be high risk but don't have a doctor, you can still get a mammogram. You can call local hospitals and clinics to see if they offer mammograms without a doctor's order. Many clinics offer free screening days. You can also contact your local health department to find the nearest clinic.
How to Prepare for Your First Mammogram
Once you decide to get your first mammogram, you may wonder, 'What now?' First, you will need to schedule this important procedure.
Make an Appointment
Mammograms are a well-established screening tool and are readily available. You can schedule one through your primary doctor or you can call an imaging center directly to make an appointment. The American College of Radiology provides a handy search tool to find accredited imaging centers near you.
If you go through your doctor, they will likely recommend a place or two. If you choose yourself (which you always have the right to do, even through your doctor) you can pick anywhere your insurance accepts. No insurance? That's okay! Your state health department should have a list of facilities you can go to at minimal cost or free of charge.
Choose a Facility
Each accredited facility should give you the same results: a clear image of your breast tissue. The biggest difference between a hospital-based imaging department and a private imaging center is patient experience. Private imaging centers have historically offered lower costs and some have claimed a better patient experience. However, hospitals have stepped up their game, lowering their prices and fine-tuning their process. You can read facility reviews online to see how they rate, and then pick your favorite.
If transportation is an issue, many large hospitals have a 'mammovan' - a mobile mammography unit. You can do an internet search for 'mobile mammogram' to find local mobile units, or check with nearby hospitals and ask if their unit will be traveling to your neighborhood anytime soon.
Stick With One Facility
If possible, choose a facility that is convenient for you so that you can go to the same one every year. They will have your records on file, and will easily be able to compare your first mammogram with results in the coming years. If you can't go to the same place one year, still get your mammogram! You can call your first imaging center and have them send records over.
Consider 2D vs. 3D Mammogram
When scheduling your appointment, you may need to indicate whether or not you need a 3D mammogram. A 3D mammogram, or digital breast tomosynthesis, captures many images of your breast from different angles. The computer then puts them all together like a puzzle to give your clinician a 3D view of your breast.
3D mammograms are most often recommended for people with dense breast tissue, as the results can make it easier to spot small tumors. You may not know if you need a 3D mammogram until after your first mammogram.
The FDA approved 3D mammograms in 2011, but trials are still being conducted to establish if they are more effective in catching breast cancer early than their 2D cousins.
Schedule According to Your Cycle
When picking a day for your mammogram, try to avoid scheduling the week before your period. Your breasts can feel more tender during that time, so if you choose a different week, you might feel less discomfort during the test.
Plan Your Outfit
Leave your super cute romper at home the day of your mammogram. For the test, you will only have to remove your shirt and bra, so if you wear a separate top and bottom, you can keep your pants on in the office. (Hooray!)
Stay Busy While You Wait
Sitting in a waiting room with the relative unknown staring you down can feel like an eternity. Many people experience waiting room anxiety, so come prepared with a crossword, a good book or some kind of fidgety gadget. Keep your mind occupied, and the time will fly!
Stay Smelly
On the day of the exam, skip your deodorant, perfume, lotion and powder under your arms or around your breasts. These products can show up on the mammogram as white spots on the image that may be confused as areas of concern.
What to Expect at Your First Mammogram
If you've never had one before, you may not know what happens during a mammogram. You can expect these basic steps with perhaps some small variations depending on your office:
1. The nurse or medical assistant will walk you to an exam room or locker room and have you undress from the waist up. They will provide a robe to wear (open in front, not back).
2. You may go straight to the mammogram suite, or you may move to another waiting room with a bunch of other people in robes before you head to your exam.
3. Your mammogram technician will show you to the room. Usually, it's just the two of you to protect your privacy. (They try to keep it a bit warmer in these rooms, too.)
4. Your tech will ask you a few questions ('Are we looking at any areas of concern today?') and prepare the machine for the x-ray. Make sure to speak up if you have any recent breast changes, you have breast implants or if you are breastfeeding or pregnant. Also, be sure to let them know if you need help standing.
5. The tech will then have you step close to the machine, and place your breast on a flat surface. They will lower a plastic shield slowly on top, checking on your comfort level, until your breast is flat as a pancake. (Or as flat as you can tolerate)
6. They will leave you there for a moment and head to their computer, ask you to hold your breath for a few seconds and take the picture.
Screening mammograms require two views of each breast, so four images total. The entire process takes about 20 minutes. For a diagnostic mammogram, it may take a bit longer as they can do spot imaging with magnification. 3D mammograms also take a bit longer.
What Do My Mammogram Results Mean?
Waiting for your mammogram results can be a nail-biting affair. You should get your results in less than 10 days. If you haven't heard from anyone in that time frame, feel free to call the office and ask.
If you get called back in for more tests, hold off on the panic. According to the ACS, "fewer than 1 in 10 women called back for more tests are found to have cancer." Your doctor may need a closer look for multiple reasons:
- Cysts
- Hormonal changes
- One breast looks different than the other
- Unclear image
You are much more likely to get called back after your first mammogram than any other because your doctor has nothing to compare it to. So, if you have to go in for further testing, take comfort that the statistics are highly in your favor.
Further Testing for Breast Cancer
If you need more testing done to check out a specific spot that showed up on your mammogram, these are some tests you might have:
Diagnostic Mammogram
A diagnostic mammogram will seem almost exactly the same to you as the patient. Your technician will simply spend more time on the specific area of interest and possibly get a few more pictures of your breast compressed at different angles.
Ultrasound of the Breast
A breast ultrasound is done the same way as an ultrasound of your uterus, using a smooth tool called a transducer and (probably cold!) gel. The technician will move the transducer around your breast to find the spot they want to look at and get an informative close-up.
Breast MRI
MRIs (Magnetic Resonance Imaging) give your doctor the most comprehensive view possible of your breast. After this series of images is taken, your doctor can look at your tissue in tiny sections and get a very clear picture of what is happening in your body.
If you are facing your first mammogram, welcome to the club! You are following a long tradition of squished breasts and anxious waiting for good news. Remember, most results come back as A-Okay! Give yourself some extra TLC and think about reaching out to an older friend or family member who has been through it before. Soon, you'll be a pro.
