Breast Cancer and Mammography

Genetics matters in breast disease. Simple genetic tests are predictive of breast cancer in many women. MOST breast cancers, however (85%), are NOT related to genetics. Family history involving breast, ovarian or other cancers should alert yourself and provider (MD/DO/NP/PA) to obtain a breast consultation at a regional breast cancer center. Breast cancer screening with a positive family history of breast cancers, abnormal genetics or other cancers should begin at age 25. Normally, mammography begins in routine primary care patients at age 40 and is usually performed (screened) every other year. 

Women at HIGH RISK for Breast Cancer include:  

  • Someone in your family is known to carry a mutated gene.
  • Ashkenazi Jewish ancestry.
  • You were diagnosed with breast cancer before age 50.
  • A man in your family has been diagnosed with breast cancer.
  • You were diagnosed with ovarian cancer.
  • There are multiple breast cancers on one side of your family.
  • Cancer was diagnosed in both breasts.

About 13-16 percent of women diagnosed have a first-degree female relative (mother, sister or daughter) with breast cancer. A woman who has a first-degree female relative with breast cancer has about twice the risk of a woman without this family history. Women of Ashkenazi or Eastern European Jewish ancestry are more likely to have BRCA1 and BRCA2 mutations, regardless of their family health history. BRCA mutation testing (simple blood test) may help inform your clinical decisions in early-stage breast cancer.

Patients with BRCAm-positive tumors have an increased likelihood of cancer occurring in the opposite breast and a recurrence of cancer in the same breast, developing other cancers, and tend to be younger at diagnosis, necessitating the need for early intervention to manage their disease.

Testing for BRCA mutations may help inform clinical approaches such as:

  • Decisions for risk-reduction surgery, including a bilateral mastectomy
  • Increased frequency of screenings for new cancers
  • Early detection of germline BRCA mutations to determine familial risk, which allows for prompt referral to genetic counseling
  • Usage of platinum-based chemotherapy as initial treatment prior to main treatment
  • Prediction of sensitivity to DNA-damaging chemotherapies, including anthracyclines
  • Inform treatment decisions in later lines following disease relapse.

What is a Mammogram?

Mammograms are X-ray images of your breasts designed to detect cancers and other changes in breast tissue. A mammogram can be used either for screening or for diagnostic purposes:

  • Screening mammogram. A screening mammogram is used to detect breast changes that could be cancerous in people who have no signs or symptoms. The goal is to detect cancer when it’s small and treatment may be less invasive. Screening mammography completed by breast centers is done yearly or every other year. It is critical for every adult woman to have a “go-to” center for breast cancer screening. 
  • Diagnostic mammogram. A diagnostic mammogram is used to investigate suspicious breast changes, such as a new breast lump, breast pain, an unusual skin appearance, nipple thickening or nipple discharge. It’s also used to evaluate unexpected findings on a screening mammogram. A diagnostic mammogram includes additional mammogram images.

During a mammogram, your breasts are compressed between two firm surfaces to spread out the breast tissue. Then an X-ray captures black-and-white images that are displayed on a computer screen and examined for signs of cancer. Mammograms can detect breast cancer before it causes signs and symptoms. They have been shown to reduce the risk of dying of breast cancer.

A traditional mammogram creates two-dimensional images of the breast. A newer type of mammogram called a 3D mammogram (breast tomosynthesis) creates three-dimensional images of the breast. Many medical facilities offer the 3D mammogram in addition to the traditional 2D mammogram for breast cancer screening.

What are the Risks to Getting a Mammogram?

  • Mammograms expose you to low-dose radiation. The dose is very low, though, and for most people the benefits of regular mammograms outweigh the risks posed by this amount of radiation.
  • Having a mammogram may lead to additional testing. If something unexpected is detected on your mammogram, you may need other tests. These might include additional imaging tests such as an ultrasound, and a procedure (biopsy) to remove a sample of breast tissue for laboratory testing. However, most findings detected on mammograms aren’t cancer.

If your mammogram detects something unusual, the doctor who interprets the images (radiologist) will want to compare it with previous mammograms. If you have had mammograms performed elsewhere, your radiologist will ask for your permission to request them from your previous health care providers.   

  • Screening mammography can’t detect all cancers.Some cancers detected by physical examination may not be seen on the mammogram. A cancer may be missed if it’s too small or is located in an area that is difficult to view by mammography, such as your armpit.
  • Not all of the cancers found by mammography can be cured. Some breast cancers are aggressive, grow rapidly and quickly spread to other parts of the body. Thus, early detection is the solution.  

How do I Prepare for a Mammogram?

  • Schedule the test for a time when your breasts are least likely to be tender. If you menstruate, that’s usually during the week after your menstrual period.
  • Bring your prior mammogram images. If you’re going to a new facility for your mammogram, request to have any prior mammograms placed on a CD. Bring the CD with you to your appointment so that the radiologist can compare past mammograms with your new images.
  • Don’t use deodorant before your mammogram. Avoid using deodorants, antiperspirants, powders, lotions, creams or perfumes under your arms or on your breasts. Metallic particles in powders and deodorants could be visible on your mammogram and cause confusion. 

What Happens During a Mammogram?

At the testing facility, you’re given a gown and asked to remove neck jewelry and clothing from the waist up.

For the procedure itself, you stand in front of an X-ray machine specially designed for mammography. A member of your health care team places one of your breasts on a platform and raises or lowers the platform to match your height. Your head, arms and torso are positioned in order to allow an unobstructed view of your breast.

Your breast is gradually pressed against the platform by a clear plastic plate. Pressure is applied for a few seconds to spread out the breast tissue. The pressure isn’t harmful, but it can cause some discomfort. Tell your health care team if the discomfort becomes too much.

Your breast must be compressed to even out its thickness and permit the X-rays to penetrate the breast tissue. The pressure also holds your breast still to decrease blurring from movement and minimizes the dose of radiation needed. During the brief X-ray exposure, you’ll be asked to stand still and hold your breath.

What do Mammogram Results Look Like?

Mammography produces mammograms — black-and-white images of your breast tissue. Mammograms are digital images that appear on a computer screen. A doctor who specializes in interpreting imaging tests (radiologist) examines the images.

The radiologist looks for evidence of cancer and other conditions that may require further testing, follow-up or treatment. The results are compiled in a report and provided to your health care provider. Ask your provider when and how the results will be shared with you.

 NEVER think you are immune to breast or any other diseases. Breast cancer can be detected early, treated and you may otherwise live a normal life. Additionally, having reassurance through regular check-ups and mammograms will cause less anxiety for yourself and your family. Don’t think about obtaining mammography – JUST DO IT