October is breast cancer awareness month. Luckily, breast cancer is among the most treatable cancers if diagnosed early enough. Medical providers use mammograms, an X-ray that scans the breasts, to detect any abnormalities.
“Mammograms can detect breast cancer well before it would be detectable in a physical exam, so patients are more likely to have better treatment outcomes,” says Dr. Miraj Shah-Khan, medical director of the Beast Cancer Program at Northwestern Medicine Palos Hospital outside Chicago.
We break down everything you should know about this common screening.
When should you get a mammogram?
Your medical provider might recommend a mammogram if you have certain symptoms, like lumps or pains in the breast, changes in your breast’s skin or nipple discharge. Meanwhile, women and AFAB people above a certain age are encouraged to get screening mammograms. As a general rule, the American Cancer Society recommends all women and AFAB people 40 and older get mammograms once a year.
The conversation is changing, if slowly, around breast cancer care for transgender and gender-minority patients; as Los Angeles’ Cedars-Sinai health system puts it, breast cancer has no gender. There isn’t a lot of good data available for patients who’ve had gender-affirming hormonal and surgical care, but what we do have suggests that trans individuals may be at higher risk for breast cancer thanks in part to barriers to screening access and trans-friendly healthcare. The Create Your Guide tool from Cedars-Sinai may be helpful for formulating individual conversations with healthcare providers across the spectrum of trans health literacy.
If you have certain risk factors, your medical provider might want you to follow different guidelines. For instance, if a close relative (like your mom or sister) was diagnosed with breast cancer at a younger age, then you might need mammograms sooner, typically around the same age of the relative’s breast cancer diagnosis.
If you know you have a genetic mutation that increases your risk of developing breast cancer — such as the BRCA mutation, which is usually identified in people with a family history of breast cancer — you also might start breast cancer screening earlier.
Your provider might also recommend more frequent screenings, like a mammogram and breast MRI, alternating every six months.
Even so, Shah-Khan says it’s uncommon for doctors to recommend mammograms before someone turns 30, because the risk of getting breast cancer then is relatively low, even if breast cancer runs in your family.
There’s no official cut-off when women and other people with breasts don’t need mammograms anymore; if you’re 40 or older, you should get them as long as you want to prevent advanced breast cancer. Shah-Khan recommends healthy women who are expected to live at least five years more continue their annual mammograms, but everyone should work with their medical provider to come up with a screening plan that makes sense for them.
How do you get a mammogram?
It’s fairly easy to get a mammogram to screen for signs of breast cancer. You can get one through your ob-gyn or even your primary care provider. The X-ray is performed by a specialist called a radiologic technician. You might get your mammogram at your normal clinic or hospital, or you might go to another location.
Most insurance companies cover the full cost of mammograms for women above the age of 40.
What happens during a mammogram?
During a mammogram, the technician will place your breast between two plastic plates and compress the breast so the X-ray can take a picture of your breast tissue.
The process can be a little uncomfortable, but it only lasts a few seconds.
What happens after a mammogram?
After the screening, the radiologist — a medical doctor who specializes in X-rays and other medical imaging — will interpret your mammogram and contact your provider, who will let you know the results.
If the screening comes back with some abnormalities, your doctor might refer you to a breast specialist for a biopsy. Using breast tissue taken from your body, a doctor will examine the sample for cancerous cells).
Breasts are made up of glands and fat. Dense breast tissue or breasts with less fat composition can look white on an X-ray, as does cancer, which can make mammograms more difficult to interpret. If your mammogram shows you have dense breast tissue, your doctor may recommend a different type of screening, such as an ultrasound, MRI or a more detailed X-ray called a 3-D mammogram.