Your Breast Cancer Screening Questions Answered
Throughout Breast Cancer Awareness Month we receive hundreds of questions about all aspects of breast cancer, including many about screening. We complied your top questions and asked board certified diagnostic radiologist and professor, Dr. Jocelyn Rapelya to answers some of the most asked-about questions from throughout the month:
1. I hear conflicting advice on when I am supposed to get my first mammogram, 40, 45, 50…but I also hear about women getting diagnosed with breast cancer earlier than these ages…when should I start screening for breast cancer?
Currently, there is no consensus on when to start screening for breast cancer. In order for a woman to maximize her benefit, mammographic screening should begin at the age of 40 and continue as long as a woman is in good health. These are the recommendations by the American College of Radiology and the Society of Breast Imaging. A woman who is considered to have a higher risk may need to start earlier and add screening exams such as a breast MRI. It is recommended you speak with your physician to discuss if you are at increased risk for breast cancer and if additional screening with breast ultrasound or breast MRI is needed.
2. What do I need to know before going for my first mammogram?
If you are having any symptoms, it is important to discuss this with your physician prior to going to your first mammogram. A diagnostic mammogram is ordered if a patient has symptoms. If you have decided to go to a new facility, it is important you get copies of your mammograms so the radiologist may review these exams along with the current study. On the day of the mammogram, patients are asked not to wear deodorant, lotion or powder as this can interfere with the interpretation of the examination.
3. What questions should I ask my radiologist when I receive my mammogram results? Are there any keywords I should be paying attention to?
What is my breast density and do I need any follow up?
4. Is a mammogram all I need? I have heard I might need another test?
Mammography remains the gold standard in terms of breast screening, but it is imperfect when it comes to women with dense breast tissue. Dense breast tissue appears white on mammograms, but so do cancers. This makes it more difficult to distinguish cancers from breast tissue and can therefore reduce the accuracy of the mammogram. To supplement mammography, ultrasound is recommended for women with dense breast tissue as cancers within dense areas of tissue appear black on these images and are more easily distinguishable from the breast tissue.
5. Can I feel if I have dense breast tissue myself, in a self-exam?
Breast density is not determined by looking or feeling the breasts. Rather, it is determined by a radiologist looking at images from a mammogram.
6. Am I at a higher risk for breast cancer if I have dense breast tissue?
Yes, but only a minimal increase in risk when compared to women with average breast density. Dense breast tissue can decrease the sensitivity of mammography, thus potentially masking breast cancers. Additional imaging with breast ultrasound or a breast MRI may be helpful tools in assessing an underlying cancer.
7. I am cancer-free but have continued pain in my breast, should I be concerned?
Breast pain can be very normal, however since you continue to have pain in one breast you should have it evaluated with your oncologist or breast surgeon. Depending on your physical exam and your history, they may advise that you have a mammogram and ultrasound. It is always important to discuss any breast symptoms with your doctor prior to screening with mammography.
Jocelyn Rapelyea, MD, is board-certified in Diagnostic Radiology and a professor at The George Washington University School of Medicine & Health Sciences. Dr. Rapelyea also serves as the associate director of Breast Imaging and the program director of the Radiology Residency Program. She specializes in diagnostic radiology and breast imaging. She was first introduced to Automated Breast Ultrasound (ABUS) as a sub-investigator in the somo-INSIGHT Study, a prospective, multi-center clinical study that compared the sensitivity of FFDM alone to that of ABUS combined with FFDM for screening asymptomatic women with dense breasts.
Dr. Rapelyea earned her medical degree from the New Jersey Medical School. She completed a research fellowship with the University of Maryland Medical Systems, Neuroradiology Department followed by a radiology residency at The George Washington University Hospital. Dr. Rapelyea pursued further training in breast imaging and intervention as a fellow at The George Washington University Hospital. She has received numerous honors and appointments throughout her career, including appointments to Chief Resident at The George Washington University Hospital, the National Executive Council for the American College of Radiology’s Resident Physician Section, Who’s Who in Medical Services Education, the Society of Breast Imaging Patient Care and Delivery Task Force, and is a Castle Connolly Top Doctor and Top Radiologist.
Dr. Rapelyea has published abstracts, articles, and chapters and has made various national and international presentations, including a congressional briefing on “Imaging the Patient with Implants.” Her published pieces can be found in various journals, including Radiology, Journal of Women’s Imaging, The Breast Journal, and Clinical Radiology. Dr. Rapelyea’s chapters can be found in Computer Aided Detection and Diagnosis in Medical Imaging and Breast Imaging. Dr. Rapelyea’s professional memberships include the American College of Radiology, American Medical Association, Screening Leadership in the Society of Breast Imaging, and the American Roentgen Ray Society.