Together Stronger: Breast Health, Mammograms and Early Detection

Breast health brings a lot of questions. When should you start mammograms, and how often? What does it mean if your report says your breasts are dense? Does family history change anything? And when is a change worth a call rather than a wait?

Breast cancer is the most common cancer among women, and about 1 in 8 women will be diagnosed in her lifetime. It is also one of the most treatable cancers when it is found early. When breast cancer is found before it spreads beyond the breast, the five-year survival rate is over 99 percent.

That is why we emphasize screening. Below are answers to the questions we hear most often, along with the changes in your breasts that should always prompt a call to your care team.

1. Why Does Breast Cancer Screening Matter?

A screening mammogram is designed for women who have no breast symptoms. It can identify a change in breast tissue and find breast cancer early, often before a lump can be felt, when treatment may be less extensive, and outcomes are generally better.

Cancer found early is usually smaller and less likely to have spread, which often means less extensive surgery, a shorter recovery and a better long-term outlook. Cancer found later means fewer options and a longer road.

A mammogram is a highly effective screening tool, though not a perfect one. It can miss some cancers, and it can flag findings that turn out to be benign and require additional images. Most callbacks do not turn out to be cancer, and your provider can help you understand what to expect if further evaluation is recommended.

2. When Should You Start Mammograms?

For most women at average risk, we recommend beginning screening mammograms at age 40 and continuing every one to two years.

If you are in your twenties or thirties, your annual visit is still a good time to discuss breast cancer risk. Your provider can review your personal and family history and determine whether you need screening earlier than age 40.

Some women are at higher risk and may benefit from earlier or additional screening, such as breast MRI. This may include women with:

• A strong family history of breast or ovarian cancer

• A known genetic change such as BRCA1 or BRCA2, or a close relative with one

• A previous breast biopsy that showed higher-risk cells

• A history of radiation to the chest at a young age

If any of these apply to you, mention it at your next visit. This information helps your provider better understand your individual risk and make the most appropriate screening recommendations for you.

3. What Should You Expect at a Mammogram?

A screening mammogram takes about 20 minutes. Each breast is briefly compressed between two plates to obtain clear images. You may feel firm pressure or brief discomfort, but the compression lasts only a few seconds at a time.

A few simple steps to make the appointment easier:

• If you still have periods, consider scheduling your mammogram when your breasts are usually least tender.

• Avoid deodorant, powder and lotion on your chest and underarms that morning, as they can interfere with the images

• Wear a two-piece outfit so you only need to undress from the waist up

• If you have had mammograms elsewhere, make sure the imaging center has access to your prior studies for comparison.

• If you have breast implants, or have had previous breast surgery, let the scheduler know. They may take additional or specialized views to ensure the best possible images

4. What Are the Most Common Mammogram Myths?

A few misunderstandings keep women from being screened.

“Breast cancer does not run in my family.” About 85 percent of women diagnosed with breast cancer have no family history, and only a small percentage of cases are linked to an inherited gene change. Family history can increase your risk, but not having one does not mean you are not at risk.

“I am too young to need a mammogram.” For women at average risk, routine screening generally begins at age 40. Some women may need to start earlier based on their personal or family history.

“Mammograms are too painful.” The compression is brief and most women tolerate it well. Let your technologist know if you are anxious or if the pressure becomes uncomfortable.

“My last mammogram was normal, so a new lump can wait.” A mammogram does not detect every cancer, and breast changes can occur between screenings. Any new lump or concerning breast change should be evaluated promptly.

“The radiation is a concern.” The radiation dose from a screening mammogram is very low. For women 40 and older, the benefit of finding cancer early outweighs that small exposure.

5. What Increases Your Risk of Breast Cancer?

Every woman has some level of risk, and having risk factors does not mean you will develop breast cancer. Understanding your individual risk allows your provider to recommend a screening plan that is right for you.

Risk factors you cannot change include age, family history of breast or ovarian cancer, certain inherited genetic mutations, dense breast tissue, starting your period before age 12, menopause after age 55, and a previous breast biopsy that showed higher-risk cells.

Risk factors you may be able to influence include alcohol intake, physical activity, weight after menopause, smoking, and the type and duration of hormone therapy. Breastfeeding for a year or longer is associated with a modest reduction in risk.

These choices cannot eliminate the risk of breast cancer, and many women who develop breast cancer have done everything “right.” Healthy lifestyle choices may help lower risk while also benefiting your heart, bones and overall health.

We may suggest genetic counseling if: several relatives have had breast, ovarian, pancreatic or prostate cancer, a relative was diagnosed with breast cancer at a young age, a male relative had breast cancer, there is a known genetic change in your family, or you have Ashkenazi Jewish ancestry. Genetic counseling starts with a conversation about your personal and family history and can help determine whether genetic testing would be useful for you.

6. What Does It Mean If You Have Dense Breasts?

Every mammogram report now includes information about your breast density. Because many women receive this result without much explanation, it helps to understand what it means.

Dense breast tissue simply means your breasts contain more glandular and fibrous tissue than fatty tissue. It is found in nearly half of women over 40. It is not a disease, and it has nothing to do with breast size or how dense your breasts may feel. Breast density is determined by mammography.

It matters for two reasons. Dense tissue appears white on a mammogram, and so can breast cancer, which may make some cancers harder to see. Dense tissue is also associated with a higher risk of developing breast cancer.

Breast density is an important part of deciding whether additional screening may be helpful. Because dense tissue can both increase breast cancer risk and make cancers harder to see on a mammogram, some women with dense breasts may benefit from supplemental imaging. The best approach depends on your density category together with your age, family history, and other risk factors. Depending on that overall assessment, your provider may discuss additional screening with breast MRI or ultrasound.

Questions worth asking at your next visit: What is my breast density category? Considering my overall risk, would I benefit from additional screening? Would it be covered by my insurance? Coverage for supplemental screening varies by insurance plan and location, so it is worth checking before scheduling.

7. What Else Can a Mammogram Show?

A mammogram can sometimes reveal findings unrelated to breast cancer. One you may see in your report is breast arterial calcification—calcium deposits in the small arteries of the breast. It becomes more common with age and is not a sign of breast cancer.

What makes it important is its association with cardiovascular disease. Heart disease remains the leading cause of death in women, and breast arterial calcification may be a clue that your cardiovascular risk deserves a closer look.

This is still an evolving area, and breast arterial calcification is not currently used as a standard cardiovascular screening test. If it appears on your report, think of it as a reason to review your overall heart health—not as a diagnosis. Your provider may want to review your blood pressure, cholesterol, blood sugar, smoking history and family history of heart disease.

A mammogram is designed to screen for breast cancer, but occasionally it can offer useful information about your health beyond the breast.

8. How Should You Check Your Breasts?

Guidance here has changed. A structured monthly breast self-exam is no longer routinely recommended for women at average risk because it has not been shown to reduce breast cancer deaths and can lead to unnecessary testing and procedures.

What we recommend instead is breast self-awareness—being familiar with what is normal for your breasts so you are more likely to notice a new or unusual change. There is no required schedule or specific technique to follow.

This matters because many breast changes are first noticed by women themselves, including changes that develop between routine screenings. If you notice a new lump, skin or nipple change, unusual discharge, or another persistent change, let your provider know rather than waiting for your next mammogram.

9. Which Breast Changes Should Never Be Ignored?

Contact your provider promptly if you notice:

• A new lump or thickening in the breast or underarm

• A change in the size or shape of one breast

• Skin that appears dimpled, puckered, red or scaly

• A nipple that turns inward or changes position

• Nipple discharge, particularly if it is bloody or clear and occurs without squeezing

• Persistent pain in one specific area

• A sore or rash on the nipple that does not heal

Most of these changes turn out not to be cancer. That is not a reason to wait and watch. An evaluation is faster and far less stressful than several months of uncertainty, and your care team would rather see you for something benign than find something late.

10. What Support Looks Like After a Diagnosis

A breast cancer diagnosis affects far more than your medical chart. It arrives in the middle of work, family and everything already on your calendar, and the practical and emotional weight of it is often the hardest part.

Your OB-GYN stays involved throughout. That includes coordinating imaging and referrals, helping you understand what you are being told, and managing the parts of your health that continue during treatment: bone health, menopausal symptoms that can begin abruptly with certain medications, sexual health, fertility questions if you hope to have children later, and your mental health. Survivorship care continues long after active treatment ends

If you are supporting someone through treatment: specific help is often more useful than an open offer. Drive her to an appointment, take notes during it, handle a week of meals, or simply keep checking in after the initial wave of support fades. And remember to stay current with your own screening, too.

Together Stronger: Taking Action This October

• Schedule your mammogram. If you are 40 or older and due for screening, make the appointment now rather than putting it off.

• Ask about your risk. At your next visit, ask one simple question: Is my breast cancer screening plan right for me?

• Review your mammogram report. Know your breast density and ask what it means for your individual screening plan.

• Know your family history. Find out which cancers have occurred in your family and at what ages. This information can help your provider better understand your risks.

• Encourage someone you care about. Remind a sister, friend, mother or daughter who is due for screening to make her appointment too.

Your Breast Health Matters

Breast cancer awareness matters most when it leads to action.

Take the next step:

➡️ Schedule your well-woman exam or mammogram today.