This campaign is designed to help men and women understand their personal risk of breast cancer and screening recommendations.
What is screening?
Screening is looking for signs of disease before a person has symptoms. The goal of screening mammography is to find cancer at an early stage when it can be treated and cured.
Mammograms
A mammogram is a low-dose x-ray that allows doctors called radiologists to look for changes in breast tissue. A screening mammogram is used to look for signs of breast cancer in women who don’t have any breast symptoms or problems. X-ray pictures of each breast are taken, typically from 2 different angles.
Getting a mammogram — A mammogram (“mammography”) is a breast X-ray. It is the best screening test for detecting breast cancer at an early stage.
Before the mammogram, you will be asked to undress from the waist up and wear a hospital gown or cape. Each breast is X-rayed individually. The breast is flattened between two panels. This can be uncomfortable, but it only takes a few seconds. If you still get a monthly period and your breasts are sensitive before or during your period, try to avoid scheduling your mammogram during that time if possible. Also, do not use underarm deodorant or powder on the day of your appointment; if you forget and do apply deodorant, you can request a special wipe to remove deodorant before the mammogram.
Mammogram results — A radiologist will review and interpret your mammogram. After the radiologist reviews your mammogram, you should get a phone call or letter with your results within 30 days. If you do not hear back about your results, call the office or hospital where you had the mammogram, or your doctor or nurse’s office, rather than assuming that your mammogram was normal.
What if my mammogram is abnormal? — If your mammogram is abnormal, you will likely need further testing. In fact, in the United States, about 1 in every 10 people who are screened will have an abnormal mammogram requiring follow-up. Most often when this happens, you will need to have more images taken (either mammogram or ultrasound images). Needing more images is common and does not usually mean that you have cancer. Knowing that this is common may help to reduce your anxiety if this happens to you. The extra images help the radiologist to have the most accurate and clear view of your breast tissue. Occasionally, additional testing such as a breast biopsy (in which a small amount of tissue is removed for examination) is needed to follow up on an abnormal screening mammogram result.
What if my mammogram is normal but I feel a lump? — Some breast cancers cannot be seen on a mammogram. So it is possible to still have breast cancer even if your mammogram comes back “normal.” For this reason, it’s still important to let your health care provider know right away if you notice a lump in your breast or have any other concerns about your breasts.
Ultrasound is not typically used as a routine screening test for breast cancer. But it can be useful for looking at some breast changes, such as lumps (especially those that can be felt but not seen on a mammogram). Ultrasound can be especially helpful in women with dense breast tissue, which can make it hard to see abnormal areas on mammograms. It also can be used to get a better look at a suspicious area that was seen on a mammogram.
A breast ultrasound is also not recommended as a routine screening test for people at average risk for breast cancer. Studies have shown that people who are screened with both mammograms and ultrasound tests are more likely to be referred for unnecessary breast biopsies, and so the benefit of adding ultrasound to mammography is not clear.
MRI uses a strong magnet (rather than X-rays) to create a detailed image. Breast MRI may be recommended, in addition to mammography, to help find breast cancer in people with a very high risk for developing breast cancer (such as those with a very strong family history of breast cancer, or a genetic mutation like BRCA1 or BRCA2).
However, breast MRI is not recommended for routine screening in people who do not have a high risk of breast cancer. Compared with mammograms, breast MRI is associated with more “false-positive” findings (changes that turn out not to be cancer), may lead to more unnecessary biopsies, requires intravenous contrast (dye injected into the veins), and is more expensive.
Information as of March 2022, courtesy of UpToDate
How to get screening?
The essential information so you don’t miss out on this important exam.
Before being able to schedule a mammogram, you might need a referral from a doctor if you are under the age of 40, have already received your annual screening mammogram for the year, have an abnormal breast symptom, or have had breast cancer in the past.
If you are 40 years or older and simply seeking a screening mammogram without any of the exceptions mentioned, it’s unlikely you will be asked for a doctor’s referral.
Screening mammogram: If you don’t have any symptoms or pain, and just need your yearly mammogram.
Diagnostic mammogram: If you have continuous and persistent pain, redness, a lump, discharge, or other concerns that need to be evaluated. Diagnostic mammograms are also done after irregular findings in a routine screening mammogram.
Mammograms are often performed at the hospital, breast center building or an imaging center. You can also look to see if there is a mobile mammography unit (“mammovan”) that might be coming to a location near your home or work.
Call the breast center or the hospital’s main number. Ask to be transferred to the breast center or women’s health center. Once you are transferred, ask who you should speak with about scheduling a free mammogram. If the receptionist doesn’t know, ask to speak to a patient or nurse navigator.
Use the following phrases to help you get connected to the correct department:
“Hello! I am calling to schedule my mammogram.”
“I was referred to you about free or low-cost mammograms. Can you help me find out how I can qualify and how I can get that scheduled?”
For those with insurance, please note that plans might cover each type of mammogram differently. For example, a yearly screening mammogram will be fully covered but you might be responsible for co-pays or deductibles if additional diagnostic mammograms or exams are required.
For those without insurance or difficulty covering the cost of a mammogram, a hospital may have funds or a charity care program where they provide the mammogram for free or at a low cost. Call the hospital near you and ask to speak with a financial counselor who can explain the program and qualification requirements. You can also contact local charities that might pay for the mammogram. Be sure to check first with the organization to see if you qualify and what they will require of you.
We have provided a list of resources below that may assist you if you have difficulty covering the cost of your mammogram.
“We don’t offer free mammograms here. The cost is going to be $400.”
Ask if they have a partner facility that might offer free or discounted mammograms.
If you are not interested in exploring a payment plan with this facility, consider this a great time to view the resources linked below.
“You need a doctor or doctor’s order to schedule this exam.”
If you don’t have a doctor and you are experiencing an abnormal breast symptom, try an internet search phrase like “Find a doctor near me.” Many healthcare systems have online databases that will allow you to easily search for doctors by criteria, such as specialty and zip code. If you don’t have insurance, you may try searching “free and low-cost clinics near me”. A family doctor or gynecologist can examine your breast symptoms and write an order for a diagnostic mammogram. If you are scheduling an appointment with a doctor for the first time, be sure to tell the scheduler that you have an abnormal breast symptom.
If you already have a doctor and the mammography facility requires a doctor’s order, be sure and let you doctor know that you need to schedule a mammogram, as well as any unusual breast symptoms that you are experiencing. Your doctor may want to examine you in the office before writing an order.
“We need your previous mammograms for this appointment.”
In certain situations, you may be required to obtain your past mammogram records, like images, films or cds, from a previous facility. If so, contact the previous facility where you had your mammogram and ask how you may obtain your prior mammography images and reports. They may ask for the mailing address of your new mammography facility.
Self Breast Exam.
Self breast examination isn’t recommended as a screening tool for breast cancer and should not replace screening tests such as mammography.
Visual inspection
With no clothing covering your chest, stand in front of a mirror. Put your arms down by your sides. Look for any changes in breast shape, breast swelling, dimpling in the skin or changes around the nipple. Next, raise your arms high overhead and look for the same things. Finally, put your hands on your hips and press firmly to make your chest muscles flex. Look for the same changes again. Be sure to look at both breasts.
Manual inspection while standing
With no clothing covering your chest, stand in front of a mirror. Put your arms down by your sides. Look for any changes in breast shape, breast swelling, dimpling in the skin or changes around the nipple. Next, raise your arms high overhead and look for the same things. Finally, put your hands on your hips and press firmly to make your chest muscles flex. Look for the same changes again. Be sure to look at both breasts.
Manual inspection while lying flat
When you lie down, your breast tissue spreads more evenly. So this is a good position to feel for changes, especially if your breasts are large. Lie down and put a pillow under your right shoulder. Place your right arm behind your head. Using your left hand, apply the same technique as step 2, using the pads of your fingers to press all parts of the breast tissue and under your arm. Finally, move the pillow to the other side, and check the other breast and armpit.
Tutorial
A video tutorial can be accessed at the link below for additional instruction.
Examples.
We have created examples of women to help you understand potential risk factors for breast cancer.
Elaine
Frequently asked questions.
We have answers to the most asked questions.
False-positive results are common with screening mammography, especially in younger women, leading to further imaging and radiation exposures and breast biopsies.
Yes, but your doctor might recommend not scheduling them close together.
Some people have had temporary swelling of lymph nodes in the armpit (“axillary”) area after getting certain COVID-19 vaccines. In some cases, this can make it harder for the radiologist to interpret your mammogram. For this reason, experts recommend trying to schedule your mammogram either before you get the COVID-19 vaccine, or at least four to six weeks after your last dose.
If you’re not sure when to schedule your mammogram, talk to your health care provider. They can help you make this decision based on your situation. While breast cancer screening is important, it is also very important to get the COVID-19 vaccine when you are able.
Certain ethnic groups are at higher risk of developing breast cancer. For example, African-American women are 42% more likely to die from breast cancer than non-hispanic white women despite roughly equal incidence rates.
Screening should continue through at least age 74, and beyond that based on overall health. Mammogram screening is recommended for all women with ≥ 10 year life expectancy.
Almost 50% of women 40 to 74 years of age have dense breasts, which is a risk factor for breast cancer and for false negative results on standard mammography. Ultrasound, MRI, and 3D mammography have been proposed as methods to detect breast cancer that might be missed on mammography.
The American College of Radiology recommends that women with a 20% or higher lifetime risk of breast cancer be offered annual mammography and magnetic resonance imaging, typically starting at 30 years of age. For high-risk women 25 to 29 years of age, ACOG recommends a clinical breast examination every 6 to 12 months and annual breast MRI with contrast.
Women with close relatives who’ve been diagnosed with breast cancer have a higher risk of developing breast cancer. If you’ve had one first-degree female relative (sister, mother, daughter) diagnosed with breast cancer, your risk is doubled. If two first-degree relatives have been diagnosed, your risk is 5 times higher than average.\nIn some cases, a strong family history of breast cancer is linked to an abnormal gene associated with a high risk of breast cancer, such as the BRCA1 or BRCA2 gene.
For those without insurance or difficulty covering the cost of a mammogram, a hospital may have funds or a charity care program where they provide the mammogram for free or at a low cost. Call the hospital near you and ask to speak with a financial counselor who can explain the program and qualification requirements. You can also contact local charities that might pay for the mammogram. Be sure to check first with the organization to see if you qualify and what they will require of you.
We have provided a list of resources below that may assist you if you have difficulty covering the cost of your mammogram.
The BRCA gene test is a blood test that uses DNA analysis to identify harmful changes (mutations) in either one of the two breast cancer susceptibility genes (BRCA1 and BRCA2).
People who inherit mutations in these genes are at an increased risk of developing breast cancer and ovarian cancer compared with the general population.
The BRCA gene test is offered to those who are likely to have an inherited mutation based on personal or family history of breast cancer or ovarian cancer. The BRCA gene test isn’t routinely performed on people at average risk of breast and ovarian cancers.
African-American women have a higher risk of BRCA1 and BRCA2 genetic mutations than women of Western European ancestry. People with BRCA1 or BRCA2 genetic mutations are at much higher risk of breast cancer (55% – 72% for those with a genetic mutation will develop breast cancer by 70 – 80 years of age).