Breast cancer is the most common non-skin cancer in women and the second leading cause of cancer-related death. Mammography — an X-ray of the breast — has been proven to increase early detection and improve survival. While early mammograms used plain film, newer technologies like digital and 3D mammography offer greater accuracy and are now widely available.

This article focuses on screening recommendations for women at average risk—defined as having about a 1 in 8 lifetime chance of developing breast cancer. High-risk individuals will be discussed in next week’s article.

  1. Know your risk Before diving into screening plans, it’s helpful to understand your personal risk. You can calculate your risk using tools like the IBIS Risk Calculator.
  2. When to start? For average-risk women, most professional organizations recommend starting annual mammograms at age 40, though some suggest beginning at 45. Unfortunately, even on this fundamental question, doctors can’t agree.
  3. How often? Again, there’s disagreement. Government agencies — focused on cost-effectiveness — recommend screening every two years. Physician-led organizations, on the other hand, advocate for annual screenings, as they are the ones sitting across from patients facing real outcomes.
  4. Radiation exposure A standard mammogram delivers about 4 millisieverts of radiation — roughly equivalent to what you’d absorb from cosmic rays on a flight from Knoxville to California.
  5. What if it’s abnormal? An abnormal mammogram can lead to follow-up tests such as ultrasound, MRI, fine needle aspiration or surgical biopsy. These will be discussed in more detail next week.

Final thought on self-breast exams: Current expert guidelines no longer recommend routine self-breast exams (SBEs). Respectfully, I disagree. SBEs are painless, instantly available, universally accessible, inclusive and responsible for identifying up to 25% of breast cancers. That kind of tool should be recommended and not discouraged. But again, I’m not an expert.

Special thanks to Dr. David Forsberg of Mosaic Breast Imaging for generously sharing his expertise.

Dr. Charlie Barnett is a contributor at KnoxTNToday for a weekly column, DocTalk, providing his expertise on health and wellness management.

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