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Finding breast cancer early when it hasn’t spread is the reason we’ve been getting annual mammograms. But guidelines have been updated in recent years, and women now have more options for breast health screenings that include an ultrasound and genetic testing.

“There are several recommendations by different medical organizations about how women should be screened,” says Akiva Novetsky, MD, associate professor, department of OB/GYN and reproductive health at Rutgers New Jersey Medical School and chief quality officer of the Rutgers Cancer Institute of New Jersey.

“You and your doctor should have a conversation about what’s best for you, as opposed to previous guidelines that said ‘this is what you’re going to do.’ The better informed you can be about your choices, the more comfortable you’ll feel.” Here’s what you should know and discuss with your doctor:

How often should I get a mammogram?
The decision about when to start having mammograms, based on your personal history and risks, should be discussed with your doctor. The American Cancer Society (ACS) says women ages 40 to 44 can start annual screenings, while women ages 45 to 54 should get yearly mammograms. The American College of Gynecology recommends women start screening every 1 to 2 years starting in their 40s.

“Research has shown that we’re not missing any cases of cancer with these intervals, and we’re avoiding false positives, which result in significant anxiety and follow ups such as biopsies,” says Novetsky. But if you feel more comfortable getting a mammogram every year, you can continue with annual screenings, she adds.

What should I do if I have dense breasts?
Breasts contain glandular, connective and fat tissue. Women with dense breasts have more glandular and connective tissue and less fatty tissue, making mammograms more difficult to read. Women with dense breasts also have a higher risk of breast cancer, so an annual screening may be preferred, says Novetsky. Some providers suggest an ultrasound along with a mammogram, but it’s unclear whether it’s helpful as a supplemental screening tool. An ultrasound can be useful for looking at uncertain areas on a mammogram; it often can tell the difference between a fluid-filled cyst, which is unlikely to be cancer, or a solid mass, which requires further testing.

breast health screenings
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What’s my personal risk of breast cancer?
You’re considered at high risk of breast cancer if you have a personal history of breast cancer or first-degree relatives, such as a mom, sister or daughter, with breast cancer. Risk also is increased by having a BRCA1 or BRCA2 gene mutation, or if you have first-degree relatives with this mutation. Women with a BRCA gene change also have an increased risk of other cancers such as ovarian and pancreatic cancers, according to the American Cancer Society. High-risk women need more frequent mammograms, such as every six months, or mammograms along with an MRI.

Should I have BRCA testing?
If you’re at high risk, ask your doctor about being referred to a genetic counselor for evaluation, says Novetsky. Risk factors include a family member with a BRCA gene mutation; a personal or family history of breast cancer; a personal or family history of ovarian, pancreatic or prostate cancer; or being of Ashkenazi Jewish descent (about 1 in 40 Ashkenazi Jewish people have one of these mutations).

Is 3D mammography better than digital?
In recent years digital breast tomosynthesis, or 3D mammography, has become available in some places. “Traditional 2D digital mammograms take two images from different perspectives of breasts, while the newer technology takes a series of images which computer software converts to 3D images,” says Susan Brown, a registered nurse and senior director of education and patient support at Susan G. Komen.

“There’s a hope this newer technology will save more lives, but we just don’t know yet.” Some studies have shown it finds slightly more cancers, and it may be better at detecting cancer in dense breast tissue.

A large clinical trial is ongoing comparing the two types of digital mammography. Until the results are available, both the American Cancer Society and National Comprehensive Cancer Network recommend either 2D or 3D imaging. “Talk to your doctor about if 3D screening is right for you, but call your insurance company before your appointment to ensure it’s covered,” says Brown.

What else can I do to ensure accurate screening?
“Use the same screening center or have your films transferred,” says Novetsky. “It’s helpful for the radiologist to be able to compare the new imaging to the old to help decrease false positives.”

And although an annual clinical breast exam by your doctor isn’t done any longer if you’re not having any issues, know your own breasts. If you notice any changes, call your doctor.

Should I put off my mammogram during COVID?
If you’re at average risk, it’s probably fine to delay a few months if your region is having an uptick in cases, says Novetsky. But you shouldn’t go beyond 2 years—and you shouldn’t put it off indefinitely because you’re nervous about coming in during COVID. “Don’t be embarrassed to call and ask questions about what to expect. That’s why we’re here,” says Novetsky. “We want to protect both our staff and the patient.”

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