Your 40-year-old patient wants to put off her first mammogram. Your healthy 80-year-old patient believes she no longer needs a mammogram. If your advice to both is to move ahead and schedule their screening mammograms, you could be saving a life, no matter your patient’s age.
In 2025, approximately 375,000 cases of breast cancer are expected to be diagnosed in the U.S., according to the American Cancer Society. With the incidence continuing to rise, particularly among younger women, physicians were stunned when a national study published recently in the Annals of Internal Medicine revealed that more than one-third of women eligible to begin breast cancer screening mammograms at age 40 prefer to wait until age 50.
“Mammograms are the gold standard for screening for breast cancer,” said Jane Mendez, M.D., chief of breast surgery at Baptist Health Miami Cancer Institute. “And we know that it’s extremely effective. By the time we feel a lump, it is usually already further advanced.”
Whether it’s a patient’s first or 31st mammogram, it’s normal to be a bit apprehensive before the exam, doctors say. But they warn against letting fear or busy schedules interfere with making a screening appointment.
“Women tend to be taking care of everybody else: their kids, their moms, their parents, their jobs. But if you could take a little bit of time and once a year go get your screening mammogram, it could potentially save your life,” said diagnostic radiologist Juliette The, M.D., with the Eugene M. & Christine E. Lynn Cancer Institute at Boca Raton Regional Hospital, part of Baptist Health.
The newest guidelines by the American College of Radiology and the American Society of Breast Surgeons recommend that women at average risk for breast cancer start screening at age 40 and continue annually.
It’s easy to schedule a mammogram at a Baptist Health Outpatient Services location from the Keys through Palm Beach County. Appointments are available online at BaptistHealth.net/Mammo or through the PineApp.
What to expect at a mammogram
Your patients may balk at making an appointment, particularly if they’ve never had a mammogram before, but the process is quick and simple, said Christina McDonald, a Baptist Health Outpatient Services mammography clinical specialist. “I think nervousness comes more from the exam itself and it being uncomfortable rather than the results,” she said. “I would say it’s not as bad as anybody thinks. It’s 10 seconds a picture and typically four pictures.”
Women who come to a Baptist Outpatient Services location for a mammogram, first check in with registration. A mammography technologist gives them a gown to change into. They’ll remove just their shirt and bra. The technologist will review some information, risk factors and health history, and then, after positioning the patient properly for the test, the images will be taken.
“It shouldn’t be painful. A little bit of pressure and discomfort is normal, but all of the techs who do this have great compassion. They make patients feel extremely comfortable,” Ms. McDonald said.
If patients have very dense breasts, which make it harder to see abnormalities, it may be recommended that they have additional studies that might include an ultrasound, CT or MRI.
Dedicated breast radiologists review the images, looking for particular shapes or patterns that could indicate cancer, Dr. The said. Artificial intelligence also helps pinpoint areas of concern that are impossible to see with the naked eye so that radiologists can take a closer look.
Patients and their doctors are sent a report, indicating the findings. Patients are also told if they have dense breasts so that the need for additional testing can be discussed. If all is well — and for the majority of women it is — they’ll be advised to schedule their next mammogram a year later, unless a problem warrants immediate attention.
When something “suspicious” is going on
Being consistent year after year also allows physicians to compare images to see if a problem is new or developing. Typically, a diagnostic mammogram is advised if a patient or physician feels a lump upon a breast exam, or a patient comes in after a screening mammogram identifies a potential abnormality.
“If it warrants a workup, we’ll generally get additional mammographic views — other views that we don’t do routinely,” Dr. Mendez said. “During a diagnostic mammogram, our radiologists are reading those images in real time because we need to come to a conclusion and give a final recommendation. We’ll do as many images as necessary and an ultrasound, if needed. At the end of the day, that patient leaves with a final recommendation. Is it something that we don’t need to worry about because the additional imaging shows it’s nothing? Or do we need to perform some type of biopsy?”
As we age
The risk of breast cancer goes up with age, and for that reason, Dr. Mendez reminds physicians that if their patients are otherwise in good health and they are willing to receive treatment should something be found, they should continue yearly mammograms irrespective of age.
“Today women are living longer lives and healthier lives,” she said. “The oldest patient I’ve ever treated, 99 years of age, had surgery and went home the same day.”
Baptist Health facilities feature the most sophisticated breast imaging technology in the hands of experts. And the cancer institutes also offer genetic testing, a full range of support services, advanced therapies and clinical trials, as well as nurse navigators who help those diagnosed with cancer handle the complexities of their health journey from diagnosis to treatment to survivorship.
