‍There’s a thick cloud of confusion around guidelines for breast cancer screenings. Turn on the news or tap into a credible online source, and it seems like there’s always a new twist or wrinkle in recommendations. It’s enough to throw women for a loop, and even leave providers scratching their heads about which guidelines to follow.  

What age should women start getting mammograms? How often should they get them? Are self-breast exams still “a thing?” What about how to cope with anxiety before, during, and after screenings?  

Let’s look beyond the pink ribbons and generalized “shoulds” when it comes to being proactive about breast health.

Fishing for a place to start mammograms 

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Maybe you’re a woman in your 40s who has diligently researched breast cancer screening guidelines. If so, you’ve seen that The U.S. Preventive Services Task Force, the American Cancer Society (ACS), and the National Cancer Network all provide different recommendations for when to start getting mammograms (ranging from age 40 to age 50) and how often to get them (every year vs. every other year). 

These recommendations consider potential benefits, such as early cancer detection/treatment and lower mortality rates. And, they weigh potential harms, such as false-positives and unnecessary biopsies, and needless surgeries or radiation for cancer that if left alone would never have caused symptoms or problems. 

All to say, the emotional toll could be steep. Anxiety-provoking tests, waiting for results, having to return for additional tests, and recovering from procedures can feel all-consuming and stressful for anyone. That’s why the American College of Gynecologists (ACOG) and Obstetricians champions a shared-decision making approach for women aged 40 to 50 who are at average risk for breast cancer (source). 

All about shared-decision making 

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Think of shared-decision making like a commercial airplane. It takes communication and coordination between the pilots and the control tower to get a plane safely from point A to point B.  The same is true of communication between patients and doctors. 

Shared-decision making is an approach to care in which patients and doctors work together to agree on a personalized plan for keeping up with their breast health. The patient provides their medical history, concerns, goals, and priorities while the doctor assesses potential benefits and risks for that individual. 

Just because someone is a certain age shouldn’t inform how soon or how often a mammogram should be. That would be like a pilot assuming that just because a plane was built recently, it’s not necessary to assess the controls in the cockpit before each flight. 

So, what should go into deciding whether to start breast cancer screenings at 40? The following factors need to be considered with your doctor:

• A previous cancer diagnosis 
• Your risk due to previous exposure to radiation 
• Family history of breast cancer (first-degree relative, meaning a mother, daughter, or sister and the age at which they got cancer)
• Personal preference (e.g. maybe starting at 40 is comforting, maybe it’s distressing)
• Goals and priorities  

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A new spin on the self-breast exam 

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It’s been long-standing advice to check your own breasts for lumps systematically every month in the shower or in front of a mirror. However, research suggests that there’s no evidence that self-exams improve survival rates. In fact, they are no longer recommended for women at average risk of cancer because they have high rates of false positives, and often cause unnecessary testing and anxiety. 

Instead, experts believe breast awareness is important. This is a general awareness of your own breasts (no specific technique or set time to check them). Reach out to your doctor if you notice any of the following changes to your breasts:

• Swelling/redness
• Pain in one particular area
• Nipple discharge 
• Skin Dimpling
• Visible/palpable lumps     

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Your path to easy breast health care 

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It can be challenging to find an imaging center or appointment time that fits into your schedule. Factor in navigating insurance, and the path to a mammography isn’t exactly the easiest. Completing the scan is one thing, waiting for results is another. And, follow-up testing or care after that is a whole other world to traverse, logistically, financially, and emotionally. 

That’s where Visana’s women’s health clinic can help. No matter where you are on the path to screening for breast cancer, we’ll help you get the care you need. 

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• Schedule an appointment with a provider to discuss your options
• Let care coordinators find you an in-network imaging center, schedule your imaging appointment, and provide you with reminders
• Receive results and clear direction for follow-up care and future screening recommendations

You deserve to feel empowered to discuss your goals and treatment preferences with doctors you like and trust.   

Tackling anxiety before, during, and after mammograms 

Numbers related to prevalence of breast cancer sound chilling, no doubt. Breast cancer makes up about 30 percent of all new cases of cancer diagnosed in women. In the U.S., a woman’s lifetime risk of developing breast cancer is roughly 12 percent (one in eight) – but that is over an entire lifetime – not in the next year or two!

However, breast cancer is also highly treatable and survival rates are impressive with 90 percent of people still living five years after diagnosis. 

With those statistics, it’s still common to experience anxiety before, during, and after mammograms. Try some of the following to settle your nerves:

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• Speak with your doctor and mammography technologist about your concerns.
• Seek out support from loved ones, especially those who have had a mammogram before.
• Bring someone you trust with you to the appointment. 
• Be selective about how you want your results delivered. Maybe a phone call feels better. Or, maybe a virtual face-to-face visit does.
• Speak with a therapist about techniques you can use during the scan (e.g. breathing exercises, mindfulness-based practices).
• Choose a mantra you can repeat during the scan (e.g. “I’m brave for doing this” or “I’m proud of myself for taking charge of my health”).
• Stay away from “Dr. Google.” Internet searches surface false information and scary results. 
• Reward yourself for completing the scan (e.g., watch a favorite show or grab coffee with a friend).
• Go to therapy consistently if the long-term effect of the scan or its related care causes distress.

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Remember, you’re just as much of an expert in your health and mammogram needs as your doctor is. It takes a team—you and your doctor—to identify what your mammogram journey should look like.   

_{Sources: Breast Cancer Risk Assessment and Screening in Average-Risk Women. (n.d.). Breast Cancer Risk Assessment and Screening in Average-Risk Women | ACOG. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/07/breast-cancer-risk-assessment-and-screening-in-average-risk-women}

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