10 Things to Know Before Your Next Mammogram

Dr. Elizabeth Kagan Arleo, an attending radiologist at NewYork-Presbyterian/Weill Cornell Medical Center, on how to prepare for your annual screening.

A medical uniform with a pink stethoscope and pink lapel ribbon
A medical uniform with a pink stethoscope and pink lapel ribbon

If you don’t feel you’re prepared for your first mammogram, or you’re anxious about your annual visit to the radiologist, you’re not alone. The American College of Radiology and Society of Breast Imaging recommend that women of average risk start getting annual mammograms at age 40, and yet, only 65 percent in that age group have done so in recent years, according to the Centers for Disease Control and Prevention.

The reasons include concerns of discomfort, being exposed to radiation, and fear of contracting COVID-19. Here, Dr. Elizabeth Kagan Arleo, an attending radiologist at NewYork-Presbyterian/Weill Cornell Medical Center and a professor of radiology at Weill Cornell Medicine, discusses why it’s important to set aside those fears and offers ways to make the most of your annual visit.

1. It’s normal to feel nervous about a mammogram, but you should still go.
“The whole experience can be anxiety-provoking — before, during, and after. It can be helpful to acknowledge that, and then move on to focus on why do it in the first place. And that’s because annual screening mammography, starting at age 40, prevents the most deaths from breast cancer.”

While The American Cancer Society guidelines state that people can choose to begin getting mammograms starting at age 40 (recommending that women ages 45 to 54 get them every year), a study published in the journal Cancer in August 2017 and co-authored by Dr. Arleo, found that the greatest reduction in breast cancer-specific mortality is achieved with annual screening starting at 40.

Dr. Arleo adds that the American College of Radiology made new recommendations in 2018 that “all women, especially black women and those of Ashkenazi Jewish descent, should be evaluated for breast cancer risk no later than age 30, so that those at higher risk can be identified and can benefit from supplemental screening.” Women can be evaluated for breast cancer risk by having a conversation with their doctor, including ob-gyns, internal medicine or family medicine physicians, to discuss their family history and any additional known risk factors. If applicable, their doctor may recommend genetic counseling or testing.

2. Bring your medical history with you for the best care.
“A week to a month before a mammogram, if a woman’s not going to a radiology practice she’s been to before, she should locate her prior images [the actual images, not just the reports] and bring them to the new appointment. Having prior studies for comparison is really important because part of the evaluation is looking not only for masses and calcifications, but also for changes in the breast tissue pattern, and without any prior images, that part is missing. Having prior images can also minimize the need for additional imaging evaluation.”

3. Go au naturel the day of your test.
“Don’t wear deodorant to your appointment. It can appear on the mammogram as little white dots, which can look like calcifications, which in some cases can be the earliest sign of breast cancer. Also consider wearing a skirt or pants with a separate top, so when you get undressed you can remove your top without having to remove all your clothes.”

4. Team up with your technologist.
“Tell the mammogram technologist if you have any new lumps and then work with her to get the best possible images. The positioning and pressure may be uncomfortable; however, it lasts just a few seconds and enables optimal evaluation of the breasts. As much as possible, just try to relax the body and work with the technologist. It’s a team effort to get the best possible images.”

5. Stay ahead of scheduling.
“On your way out, book for next year to ensure that you actually get annual screening mammography.”

6. With annual screening mammograms, don’t let concerns about radiation dissuade you.
“A mammogram is an extremely low dose X-ray, and the risk of the minimal radiation exposure is far outweighed by the potential mortality benefit.”

7. You may not know your results right away, and that’s normal.
“Most women come in, have their test, it’s read within 24 hours, and then results are mailed to the patient and referring physician. The vast majority of women, the vast majority of the time have a truly normal mammogram, and this is very reassuring.”

Portrait of Dr. Elizabeth Kagan Arleo

Dr. Elizabeth Kagan Arleo

8. Family history counts.
“Women at high risk of breast cancer, defined mainly on the basis of a genetic mutation or family history, should start annual screening earlier. For example, if your mother or sister was diagnosed with breast cancer at 46, then you should start getting annual mammograms at 36 years old.”

9. You still need a mammogram, even with no family history.
“Even if you don’t have a family history or other risk factors, this doesn’t mean that you shouldn’t get screened. The fact of the matter is that 60 to 70 percent of women diagnosed with breast cancer have no known risk factors.”

10. Annual screening mammography saves the most lives.
“If you haven’t had a mammogram in the last year, then call your healthcare provider so they can help you to do so.”

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