What you should know about breast cancer screening

It’s October, which means you can’t get through this month without seeing a pink ribbon or hearing about breast cancer awareness. So, naturally, it’s time to address breast cancer screening.

When to Start

Most guidelines recommend starting mammograms at age 40, then repeating every year or every other year for women at average risk. If you have a family history or other risk factors, ask your doctor when to start screening.

Some organizations say every other year is fine, but I usually suggest yearly screening. I’ve seen too many cases where someone had a normal mammogram one year and a new cancer show up the next.

Mammogram Myths Busted

• Myth #1: I don’t need a mammogram because no one in my family has had breast cancer.False. Over 75% of women who develop breast cancer don’t have a family history.

• Myth #2: Mammograms expose you to too much radiation.False. The radiation from a mammogram is about the same as what you’d get on a flight from New York to LA.

• Myth #3: Thermography is a safer, effective alternative.False again. Thermography measures temperature changes in breast tissue. The theory is that tumors have increased blood flow and higher metabolism, so they will show up as warmer areas on thermography. It doesn’t work. The results are inconsistent and can cause false alarms or miss cancers altogether.

Can’t I Just Get an Ultrasound or MRI Instead?

No! A mammogram is a vital part of breast cancer screening. But…MRI and US may play a role too.

Mammograms are best at finding early changes like microcalcifications and DCIS (stage 0 cancer).

MRI is best for detecting invasive cancers, especially in high-risk women with dense breasts. Not great for those early subtle changes.

Ultrasound is great for checking lumps and cysts. When used with a mammogram, it improves cancer detection in dense breasts. When used alone, it’s not enough.

What to Look for on Your Mammogram Report

1) Breast DensityThere are 4 types:

• A: Almost entirely fatty

• B: Scattered fibroglandular tissue

• C: Heterogeneously dense

• D: Extremely dense

A & B = not denseC & D = dense

Dense breasts are totally normal, but they can make mammograms harder to interpret, and they increase your risk for breast cancer slightly. If you have dense breasts, your doctor may recommend an ultrasound or MRI in addition to your mammogram.

2) BIRADS ScoreThis is the rating system radiologists use:

• 1–2: All clear

• 3: Probably benign, follow-up may be needed

• 4: Biopsy recommended

• 5: Highly suspicious for cancer

• 0: Not enough information; more images needed

3) Risk AssessmentSome reports include your lifetime risk of breast cancer. If yours doesn’t, you can calculate it using one of these tools:

• NCI Breast Cancer Risk Assessment Tool

• Tyrer-Cuzick model

A lifetime risk above 20% is considered high risk. This means you may need:

• Additional testing like MRI

• A conversation with your doctor about preventive options (like low-dose tamoxifen)

What You Can Do

Good news! Lifestyle changes really do make a difference. You can reduce your breast cancer risk by 20–30% with regular exercise, maintaining a healthy weight and limiting alcohol.

Get your mammogram. Ask about your breast density and your risk score. If you’re high risk, talk with your doctor about next steps.