With approximately 40 million mammograms performed in the United States each year, it might seem like every woman is “all in” for this lifesaving X-ray of the breast.1
Not exactly. To dispel any misconceptions about mammograms, breast radiologist Jibi Thomas, MD, director of Breast Imaging, Memorial Hermann Southeast Hospital, separates fact from fiction in mammogram myths.
Myth One: “I’m too young…” or “I’m too old to get a mammogram.”
FALSE: “Screening guidelines vary with age,” says Dr. Thomas. “Across the board, an absolute start date for women is age 40. African American and Black females are at higher risk, and they should start screening at age 30.”
Women with a first-degree relative with breast cancer—a parent, sibling or child—need to start 10 years before the age of diagnosis of that family member, with the earliest age being 30, he says.
“We usually don’t screen before then unless the woman is in a subset of very high-risk individuals with genetics-based, calculated lifetime risk of 20% or more, or who had chest radiation at a young age2. For those women, we may do an MRI instead of a mammogram.”
Breast cancer risk declines at age 80, he says. “The ‘peak’ age group is 60-69, but ages of diagnoses are getting younger, at age 28 or 29.”
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Myth Two: Family history is the most important predictor of breast cancer.
FALSE: “As we’ve said, family history, such as that first-degree relative, is indeed important,” Dr. Thomas says. “If you have a strong family history of ovarian and breast cancers in non-first-degree relatives, or your family has seen multiple cancers of the ‘female type’ in those relatives, there seems to be an increased association there.
“We used to say that up to 75% of patients who developed breast cancer had no family history connection, but now, that number, surprisingly, has increased to 90%,” he says.
Myth Three: Mammograms are very painful.
FALSE: “Having your breast compressed may not be a lot of fun but remember that you’re experiencing tolerable and temporary discomfort for between 25 and 45 seconds per image,” Dr. Thomas says. “Also, 3D mammography, available in all our Breast Care Center locations, has been with us for a decade and uses less compression because the machine is able to tilt instead of remaining static.”
“We want to use the lowest amount of radiation, and a denser breast does require slightly more,” he says. Making the breast as “flat” as possible helps eliminate errors caused by overlapping breast tissue.
“If you experience discomfort, please don’t blame the technician,” he says. “They’re trying to help you. They don’t want you to have to come back because you moved, and the image is unclear.”
Patients can control the amount of compression they receive at Memorial Hermann Imaging Center in Bellaire. At this location, the mammogram equipment has SmartCurve® technology , that fits the curve of a woman’s breast with uniform compression.
Myth Four: Sigh. Another year, another “regular, old mammogram,” right?
FALSE: First, you may already be having tomosynthesis 3D mammograms, says Dr. Thomas. “We can see the breast layer by layer, in much more detail than previous 2D mammograms, an advantage with dense breasts.”
Additional technology helps when a “second look” is needed, especially with dense breasts or high-risk patients, to help detect breast cancers that don’t show on mammograms. Ultrasounds are painless and noninvasive, without radiation. MRIs utilize powerful magnets, again, with no radiation, and involve contrast dye without iodine.
New contrast-enhanced mammograms also use contrast dye, quicker and less expensive than an MRI. “This delivers images at two different energy levels, low and high, on two different mammograms. They’re done with contrast, and allow us to detect abnormalities such as cancer,” he says. “This does require an intravenous or IV injection.”
“Be sure your breast MRI is done at a center with specialized breast MRI technology,” Dr. Thomas says. “No matter where you go at Memorial Hermann, know that we really care about our patients, and we’re always trying to improve how we do things to help them. That includes mammograms.”
1https://maps.cancer.gov/overview/DCCPSGrants/abstract.jsp?applId=10238778&term=CA237827
2https://www.jacr.org/article/S1546-1440(23)00334-4/fulltext
