Breast surgeon Laura Pearson wants more Georgia women to understand something important about breast cancer: Your screening schedule may need to be different from someone else’s.

For women at average risk, the U.S. Preventive Services Task Force recommends starting mammograms at age 40 and getting screened every other year through age 74. But those guidelines don’t necessarily apply to women with factors that increase their risk, Pearson said.

“A lot of the recommendations are based on strictly average risk patients and it’s unfortunate because that gets lost. If you have dense breast tissue, which is pretty common, any sort of family history or had a biopsy, that all puts you at higher risk of developing breast cancer and so those every other year recommendations really don’t apply.”

A family history of breast cancer can increase a woman’s risk, but most women who develop breast cancer don’t have a known family history of the disease. About 80% of breast cancers develop in women with no breast cancer risk factors other than being female and over 40, according to the World Health Organization.

In Georgia, breast cancer is the most commonly diagnosed cancer among women and the second-leading cause of cancer death among women, after lung cancer, according to the Georgia Department of Public Health.

Breast surgeon Dr. Laura Pearson, medical director of Wellstar Comprehensive Breast Health Program, encourages women to be screened annually instead of every other year. (Tom Mileshko Photography/Courtesy of Wellstar Health System)

“A lot of the recommendations are based on strictly average risk patients and it’s unfortunate because that gets lost. If you have dense breast tissue, which is pretty common, any sort of family history or had a biopsy, that all puts you at higher risk of developing breast cancer and so those every other year recommendations really don’t apply.”

A family history of breast cancer can increase a woman’s risk, but most women who develop breast cancer don’t have a known family history of the disease. About 80% of breast cancers develop in women with no breast cancer risk factors other than being female and over 40, according to the World Health Organization.

In Georgia, breast cancer is the most commonly diagnosed cancer among women and the second-leading cause of cancer death among women, after lung cancer, according to the Georgia Department of Public Health.

With October marking Breast Cancer Awareness Month, it’s a good time for Georgia women to review their breast cancer screening schedule and learn more about what to expect from a mammogram.

Pay attention to changes

Mammograms are an important tool for detecting breast cancer, but women should also pay attention to changes in their breasts between screenings, Pearson said.

The most common sign of breast cancer is a lump in the breast or under the arm. Pearson recommends that women check their breasts with a self-exam once a month so they become familiar with how they normally look and feel.

“I tell my patients if they’re premenopausal to pick a day in their cycle, because not everybody is very regular, so it’s sort of at the same day in your cycle every month.”

A lump isn’t the only change to watch for. Changes in the shape or size of a breast, a difference in breast contour, or skin changes such as redness, flaking or inflammation around the nipple can also be signs of breast cancer.

“There’s a very common way that we find breast cancer,” Pearson said. “It can either be asymmetry where the breast contour is just different or one breast is a different shape or size from the other. That’s not usual.”

Worried about a mammogram? Here’s what to know

Pearson understands why some women dread mammograms, particularly the breast compression. But she said the feeling is brief.

“It’s definitely less than a minute of discomfort,” she said.

Women who tend to have breast tenderness may want to avoid scheduling a mammogram just before their menstrual cycle, when breast tissue can be more swollen and sensitive, she suggested.

She said some patients may find relief from taking an over-the-counter anti-inflammatory medication, such as ibuprofen, a couple of hours before their appointment, if they can safely take it.

Radiation exposure is another concern. But Pearson said the amount used in a mammogram is low, and the potential benefit of finding breast cancer early is significant.

“The risks of the radiation almost never outweigh the benefits of early detection.”

Understanding your options

For some, a mammogram alone may not be enough information to assess their breast cancer risk. Those with dense breast tissue or other factors that increase their risk of breast cancer may benefit from additional screening, such as magnetic resonance imaging, or MRI.

Three-dimensional mammography, also called digital breast tomosynthesis, has become increasingly common and can provide radiologists with more detailed images of breast tissue.

“A huge advance in the world is the adoption of 3D mammograms,” Pearson said.

MRI uses a magnetic field and radio waves to create detailed images of the breast. Pearson said it may be covered by insurance when a patient meets certain criteria, although it can be more complex and time-consuming than a mammogram.

Some doctors recommend screening every year

Dr. Amelia Zelnak, a medical oncologist with Northside Hospital Cancer Institute and managing partner of Atlanta Cancer Care, said she’s concerned about the vast majority of women having mammograms every other year instead of annually.

About 60% of women ages 40 to 49 and 80% of women 50 to 74 had a mammogram within the past two years, according to the Centers for Disease Control and Prevention. That means about 40% of women ages 40 to 49 and 20% of women ages 50 to 74 had not had one during that period, according to the CDC data.

While some organizations recommends a screening every two years for women at average risk, Zelnak recommends a yearly exam.

“There’s really a need to emphasize the importance of annual screening because you’re more likely to come in with a small, highly curable cancer if it’s detected super early as opposed to when you come in with a palpable mass,” Zelnak told The Atlanta Journal-Constitution.

Dr. Amelia Zelnak, a medical oncologist with Northside Hospital Cancer Institute's breast cancer program, said she’s concerned the vast majority of women are getting mammograms every other year instead of annually. (Courtesy of Northside Hospital)

About 60% of women ages 40 to 49 and 80% of women 50 to 74 had a mammogram within the past two years, according to the Centers for Disease Control and Prevention. That means about 40% of women ages 40 to 49 and 20% of women ages 50 to 74 had not had one during that period, according to the CDC data.

While some organizations recommends a screening every two years for women at average risk, Zelnak recommends a yearly exam.

“There’s really a need to emphasize the importance of annual screening because you’re more likely to come in with a small, highly curable cancer if it’s detected super early as opposed to when you come in with a palpable mass,” Zelnak told The Atlanta Journal-Constitution.