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When Should I Start Having Mammograms?

“I tell my patients to begin annual mammograms at age 40 and continue as long as they are in good health,” says Claire Edwards, MD, breast surgeon, The Reinsch Pierce Family Center for Breast Health, VHC Physician Group. As a woman ages, her risk of getting breast cancer increases. According to Susan G. Komen®, the median age for breast cancer diagnosis in the United States is 62. To catch breast cancer early, having mammograms on an annual basis is the safest, most cautious guideline to follow.

If there is a strong family history, you should begin mammogram screening 10 years before the age when breast cancer affected your youngest family member. That means if your paternal aunt was diagnosed at age 45, you should begin having mammograms at age 35. Ethnicity is also a factor in determining when to be screened. Because breast cancer can be more aggressive in African American women and women of Ashkenazi Jewish descent, they should have a breast cancer risk assessment at age 30, and be screened subsequently according to their individual risk.

“Women who have genetic susceptibility or a family history of breast cancer should be screened with additional modalities, such as a breast MRI,” says Sarah Mezban, MD, a radiologist who is fellowship-trained in breast imaging. “We can test for a wide range of genetic mutations that increase breast cancer risk,” says Molly Sebastian, MD, FACS, breast surgeon, The Reinsch Pierce Family Center for Breast Health, VHC Physician Group. “Genetic testing is widely accepted and covered by most insurance.”

Mammograms have changed significantly with the advent of 3D (three-dimensional) mammograms (also called tomosynthesis), which take multiple images of the breast to create a 3D picture. “I highly encourage all women to get a 3D mammogram. It allows us to detect tumors earlier at smaller sizes. Because it is more accurate than a standard 2D mammogram, there are fewer false positive readings and callbacks for repeat imaging,” says Dr. Mezban.

Having dense breast tissue makes it harder to detect cancer on mammograms and is also a risk factor for developing breast cancer. Virginia law requires mammography facilities to disclose information about breast density in the written report sent to the patient after a screening mammogram. This helps women be better informed about whether to consider additional screening.

“Virginia Hospital Center has Automated Breast Ultrasound (ABUS), which obtains an ultra- sound image of the entire breast,” says Dr. Edwards. “ABUS is done as a supplement to a mammogram and can possibly detect a mass that was not seen on a mammogram because of dense breast tissue.” “Talk with your physician about your risk for breast cancer and the best screening plan for you,” Dr. Edwards advises.

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