What is a mammogram? When should you get the exam? Experts weigh in on breast cancer screening

At 63, Louise Bajorek discovered a family member carried the BRCA gene mutation and quickly made an appointment for genetic testing. She remembers feeling a flood of relief when the results came back negative.

She thought she was in the clear because she didn’t inherit the harmful mutation that increases the risk of several cancers, notably breast.

Days later, however, Bajorek underwent a scheduled mammogram, and the images showed an area of concern prompting further testing. After an ultrasound that same day, there still wasn’t a definitive answer. The radiologist ordered a biopsy.

A week later, the findings revealed the unexpected — Stage 1 breast cancer.

The next month-and-a-half would be a series of treatments: a lumpectomy and 15 radiation sessions. She has been cancer-free for the past two years.

“There were a myriad of emotions,” Bajorek, of southwest suburban Burbank, said. “I was numb and terrified at the same time.” Yet, she also felt grateful.

Bajorek, now 65, credits diligent annual mammograms since age 30 for discovering her cancer early. Since her 2022 diagnosis, she has traded fear for courage: “I’ve never appreciated life more, and have been more of an advocate for early detection.”

In Illinois, breast cancer is the most common cancer among women, according to the state’s Department of Public Health, making mammograms important tools in finding early signs of cancer. Yet, some women aren’t getting the potentially life-saving exam. In 2022, about 1 in 4 women ages 50 to 74 years had not received a mammogram in the past two years, according to the Centers for Disease and Control Prevention.

While Breast Cancer Awareness Month is winding down, with one in eight U.S. women having a chance of developing breast cancer, according to the American Cancer Society, this conversation is an important one year-round. Here’s what else the experts want you to know — whether it’s your first mammogram or you’re preparing for the next.

What is a mammogram?

Mammograms, which are X-ray exams of the breast, “are the gold standard for screening,” according to Dr. Shikha Jain, a tenured associate professor at the University of Illinois Cancer Center and founder of the nonprofit Women in Medicine. Depending on the patient, ultrasounds and MRIs (magnetic resonance imaging) are also available screening options, she said. Doctors may also perform clinical breast exams during annual physicals. However, clinical and breast self-exams are no longer recommended as a screening tool by the American Cancer Society.

“Self-exams haven’t been found to impact or reduce breast cancer deaths; they’re often inaccurate and can lead to unnecessary procedures or biopsies — and anxiety. A lot of times, women who do these self-exams may feel like, ‘Oh, I did a self-exam. I didn't feel anything. So I don't need to get a mammogram,’ ” Jain explains.

When should you first get a mammogram?

Every woman should be getting an annual screening mammogram at age 40, based on the recommendations of the American College of Radiology and Society of Breast Imaging, or sooner depending on risk factors like a family history of cancer or in a high-risk group such as Black or Ashkenazi Jewish women, according to Dr. Sonya Bhole, director and physician lead of ambulatory breast imaging at Northwestern Memorial Hospital in Evanston.

However, recently, there has been a rise in younger women developing cancer. Because most women don’t begin regular breast cancer screening until they’re 40, younger women are also being diagnosed with later-stage tumors when the disease is more aggressive and more challenging to treat, according to a study published this year by the Washington University School of Medicine in St. Louis.

What is the difference between a screening mammogram and a diagnostic mammogram?

A screening mammogram is used to detect cancer in people who don’t have any symptoms, Jain said, while a diagnostic mammogram evaluates something potentially suspicious.“There’s already a concern for an abnormality,” she said. Another difference is a diagnostic may take more images and typically focuses on the area of concern.

Bhole adds that with a diagnostic mammogram, “You get the results the same day.”

Why do some women skip mammograms?

A fear of the unknown — especially about results — is a top concern Bhole hears from women about the exam.

Chris Joyce, 58, is one of them.

“Until I get that letter that it’s negative, you have that apprehension,” Joyce, who lives in western suburban La Grange Park, said.

Despite the underlying worry, she gets checked annually. She also eases her anxiety by taking time off on appointment days to do fun activities like shopping, going to the movies or getting her nails done. “It is my reward for going,” she said.

Still, factors such as cost, accessibility and time to prioritize their own health also play a role, Jain said. Women often juggle job responsibilities, manage the household and care for children or aging parents as part of the sandwich generation, she said.

Plus, not everyone lives in areas where it’s accessible to get a mammogram, and it can become expensive if additional testing is needed, Jain adds. “After a screening mammogram, for example, you may need an ultrasound or MRI based on your breast tissue or what they find,” she said. “Oftentimes, those become difficult to get covered with some insurance companies.”

Are mammograms painful?

For Jain, the most common questions she’s asked about breast exams and screenings are:

• Is it painful?
• Is it necessary?

To that, she responded: “Yes, it's definitely uncomfortable to get the mammogram. I tell patients it’s not only a potentially life-saving imaging that you will be getting, but it could also detect cancers before they even become cancers.”

Mammograms entail flattening and compressing the breasts between two plastic plates so X-rays can be captured. That part of the procedure, which takes seconds, can be uncomfortable or even painful, especially if multiple X-rays need to be taken. In general, mammograms typically take about 15 minutes.

I have dense breasts. Should I be worried?

Density doesn’t refer to breast size. Instead, Jain said it means there is more connective and glandular tissue than fatty tissue. Because dense breast tissue, and breast masses and cancer can also look white on a mammogram, it can be difficult to distinguish between the two, she said. “That’s why often women with dense breasts need to do extra screening tests like ultrasounds and MRIs,” Jain said.

What are the signs of breast cancer?

Many people have heard that a breast lump could signal breast cancer. But there are other, lesser-known potential warning signs. “Any sort of skin changes like dimpling of your skin or nipple discharge are some of the ways it can present,” Bhole said.

Jain pointed out that skin color changes on the breast, unintentional weight loss, overall fatigue and a lump or growth in the armpit area may be symptoms as well. She describes a condition called “peau d’orange,” where the breast starts looking a bit like an orange peels.

Should you worry if called back for an ultrasound after a mammogram?

Getting a callback after a mammogram doesn’t necessarily mean you have cancer; there’s just something that they want to look into further, Jain said. She advises to her patients: “Don't worry until there's definitively something to worry about.”