More than Mammograms: Proactive Care for Breast Health

October is Breast Cancer Awareness Month, and while most women know how important annual mammograms are for screening and catching breast cancer early, preventive care is not one size fits all. Breast health needs are different for every woman, and factors such as age, health history and individual risk can influence screening recommendations. A trusted healthcare provider can help you understand the care that’s right for you. Here are four important things to keep in mind as you take a proactive approach to your breast health.

1. Breast density is an important part of the conversation. “Density” describes the amount of fibrous and glandular tissue compared to fatty tissue in the breast. Breast density is classified into four levels – from A, non-dense, to D, extremely dense – with over 40% of women over age 40 having dense breasts. Dense breast tissue can make a mammogram more difficult to interpret because both dense tissue and cancers can appear white on a mammogram. Breast density is also independently associated with an increased risk of developing breast cancer. Depending on your density combined with other risk factors, your provider may recommend additional screening to supplement mammography, such as ultrasound or MRI. Each of these imaging methods see breast tissue differently, allowing providers to get a full picture.
    
2. Your family history can change when – and how – you are screened. Knowing your family history can help your healthcare provider identify if you are at increased risk before you develop cancer. It’s also important to know that it isn’t just your close family history of breast cancer that is relevant – ovarian, pancreatic, prostate, and other cancers can also factor into elevated risks, including the ages at which relatives were diagnosed. Certain family histories warrant genetic testing and counseling, which can help determine if you have an elevated lifetime risk and would benefit from beginning screenings earlier in life and/or adding additional screenings such as MRI. 

It’s also important to note that having no family history of breast cancer does not mean you won’t get breast cancer. Most breast cancers are not attributable to an inherited cancer-predisposition gene – only about 5-10% are thought to be hereditary. Family history is an important piece of the puzzle, but it is not the whole picture, which is why routine screening remains important even for women who don’t have breast cancer in their family.

3. Most screening callbacks are not cause for alarm, especially if it’s your first mammogram. Being called back for additional imaging can feel frightening, but a callback does not necessarily mean you have a cancer diagnosis. This is especially common after a first mammogram because your provider does not have previous images for comparison. In many cases, the radiologist simply needs additional images to get a closer look at a specific area or may recommend an ultrasound for further evaluation. 

The opposite is also important – a normal mammogram doesn’t mean you should ignore a new or unusual change in your breast. Regular self-exams are always encouraged, because you know your body best. If you had a normal mammogram, but notice a new lump, skin dimpling or thickening, nipple changes, or another new, persistent change, you should let your provider know. Screening is for women without symptoms – a new symptom deserves its own evaluation.

4. Breast pain usually does not mean breast cancer. Pain is one of the most common reasons women call their doctor. Fortunately, most breast pain is not cancer, but can be related to hormonal changes, medications, cysts, exercise, or even pain originating in the muscles and chest wall beneath the breast. That said, new or persistent pain, particularly if it is very localized or associated with another new change, should be evaluated. It is important to know that breast pain is common and is most often caused by benign conditions. While generally not a reason to assume the worst, it’s important to discuss any new or persistent paint with your healthcare provider.