Author: Mia Kazanjian, MD

When did you last have a mammogram?

Many women first deferred their annual mammogram in 2020 during the height of the pandemic. After the vaccine and with relaxed social distancing, we still have patients who have not yet returned for screening. And for those who did return and skipped a year or two of screenings, we’ve seen more cancers in shorter time periods, and at more advanced sizes or grades.

Breast cancer is one of the most common cancers in women. About 1 in 8 will receive a breast cancer diagnosis. And time is of the essence. The earlier the cancer is picked up, the lower the risk it has spread and the better the treatment options and outcomes.

That’s why it’s so important to know your breast cancer risk and make a plan with your doctor for breast cancer screenings.

Here are the breast cancer screening guidelines and prevention tips we recommend at Stamford Health’s Breast Center:

1. Start breast cancer screenings at age 40.

The two biggest risk factors for breast cancer are being a woman and aging. That’s why every woman should undergo annual breast cancer screening starting at age 40.

2. Go for screenings every single year.

As a radiologist, I follow the American College of Radiology (ACR) and Society for Breast Imaging (SBI) recommendations to screen for breast cancer annually. Some health organizations suggest screening every other year, but that can increase the chance of an ‘interval’ cancer developing between screenings. Breast cancer, once it grows, can spread from the breast ducts to the lymph nodes and become invasive. A yearly mammogram can save your life.

3. Quit smoking.

Smoking is a risk factor for breast cancer. When you smoke a cigarette, the chemicals within it cross to the bloodstream from the lungs. This circulates to the entire body, including the breast tissue.

4. Maintain a healthy weight.

Overweight and obesity also increase the risk of breast cancer because excess body fat brings higher levels of estrogen, which is related to breast cancer risk.

5. Determine your personal breast cancer risk.

To determine your breast cancer risk—and whether you’re in the 20% of women who should start screening before age 40—you should have a risk assessment at age 30. You should discuss this with your gynecologist at that point. In addition, the Tyrer-Cuzick Risk Assessment Calculator, which you can do online, asks questions about your personal and family history to determine your chances of developing breast cancer.

6. Meet with your doctor if you’re concerned about your family history.

If you have a family history of breast cancer, then your doctor may suggest that you undergo genetic testing to see if you carry an inherited mutation in the BRCA1 or BRCA2 gene, the most common cause of hereditary breast cancer. If you’re considered high-risk, you may also benefit from supplemental screening tests like magnetic resonance imaging (MRI) or ultrasound.

7. Consider the risks of hormone replacement therapy (HRT).

Many types of hormone replacement therapy (HRT), taken to offset the effects of menopause, elevate your risk for breast cancer, too. The risk is greater if the HRT has both estrogen and progesterone. Vaginal estrogen has not been linked to a higher risk. Talk to your doctor, as this is a risk-benefit situation. The life-improving benefits of HRT for some women outweigh the risks.

8. Discuss with your doctor when to stop screenings.

When to stop screening for breast cancer is up to you, your doctor, and your health. If you are in good health and have a number of years of life expectancy, then it makes sense to keep screening.