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What to know about your mammogram

Mammography is the most successful screening imaging modality in breast health. Since the inception of routine, screening mammography, breast cancer mortality has significantly decreased. The purpose of breast imaging is to identify 'lesions' that require biopsy. Patient survival from breast cancer diangosed as a result of "routine screening mammography" is much higher than those patients who present with a physical finding, such as a lump/mass or nipple discharge. Screening mammogram is the crucial first step towards ensuring that early detection will increase one's chances of surviving breast cancer.

When should I start having mammograms?

Generally speaking, according the the American Cancer Society, American College of Radiology, American Society of Breast Surgeons, screening mammography, should begin at age 40 years, and, then yearly. This timing and frequency is changing, however, and, in the future, will likely be tailored to a patients risk.

Position Statement of Screening Mammography {The American Society of Breast Surgeons}

page1image31244416page1image31244672page1image31244992Summary of ASBrS Recommendations for Breast Cancer Screening*page1image31244864

Women with average risk
  • Women with non-dense breasts (A and B density)^
Annual mammography (3D preferred modality) starting at age 40, no need for supplemental imaging
  • Women with increased breast density (C and D density)^
Annual mammography (3D preferred modality), starting at age 40, and consider supplemental imaging
Women with higher-than- average risk
  • Hereditary susceptibility from pathogenic mutation carrier status
  • Prior chest wall radiation age 10-30
Annual MRI starting at age 25 Annual mammography (3D preferred modality) starting at age 30
  • Predicted lifetime risk >20% by any model
  • Strong family history
Annual mammography (3D preferred modality) and access to supplemental imaging (MRI preferred modality) starting at age 35 when recommended by their physician
Women with prior history of breast cancer age ≥50 with non-dense breasts#Annual mammography (3D preferred modality)
Women with prior history of breast cancer at age <50, or with dense breasts#Annual mammography (3D preferred modality) and access to annual supplemental imaging (MRI preferred modality) when recommended by their physician

*All women to undergo risk assessment at age 25-30 and updated at appropriate intervals

^Class A or 1 density = fatty; Class B or 2 density = scattered fibroglandular density; Class C or 3 density = heterogeneously dense; Class D or 4 density = extremely dense

#Women with prior breast cancer who did not undergo bilateral mastectomy

Recently, there has been some debate as to when mammograms should become routine, and, how often.  The American Society of Breast Surgeons is strongly opposed to the recommendations released by the United States Preventive Services Task Force (USPSTF) which cuts back on the frequency of mammograms. We believe there is sufficient data to support annual mammography screening for women age 40 and older. We also believe the breast cancer survival rate of women between 40 and 50 will improve from the increased use of digital mammographic screening, which is superior to older plain film techniques in detecting breast cancer in that age group.

While we recognize that more frequent mammograms will probably result in a larger number of benign biopsies, we also recognize that mammography is the optimal screening tool for the early diagnosis of breast cancer in terms of cost-effectiveness, practical use, and accuracy. To restrict mammography use will mean that breast cancers will go undiagnosed for a longer, more unacceptable period of time. This restriction of mammographic screening defeats the goals of early detection, which often allows for breast conserving surgery and avoidance of chemotherapy.

The USPSTF also does not make a recommendation for mammography screening for women age 75 and older. Women in this age group are at the greatest risk for breast cancer and at the point where mammography is most sensitive.  In general, women with a life expectancy of >10 years should consider annual screening mammogram.

We believe the USPSTF recommendations in effect turn back the clock to pre-mammography days by limiting the diagnosis of breast cancer to only when the tumor is large enough to be felt on a physical exam. The Society will continue to advocate for routine annual mammography screening for all women beginning at age 40. Mammography screening reduces breast cancer mortality and saves lives.

The American Society of Breast Surgeons, the primary leadership organization for general surgeons who treat patients with breast disease, is committed to continually improving the practice of breast surgery by being an advocate for surgeons who seek excellence in the care of breast patients. This mission is accomplished by serving as a forum for the exchange of ideas and by promoting education, research, and the development of advanced surgical techniques.


 

How are mammograms interpreted?

Your mammogram is viewed by a radiologist. Many radiologists, specialize in interpreting breast imaging, but, all learn this craft during their residency. Any finding on a mammogram is viewed with at least some level of suspicion, typically leading to additional imaging. The BI-RADS system is a standard method used by breast imagers, to signify the level of concern atypical findings may suggest. A screening mammogram may lead to early detection, which will lead to earlier treatment, which increases overall survival of those diagnosed.

Learn about BI-RADS