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YOU ARE SMART. Every woman is unique personalized risk

Women today are aware that one in eight of us will develop breast cancer during our lifetime. We're savvy about the need for screening, but recently debates about mammogram guidelines have left many of us confused.

When and how often should the average woman get a mammogram?

A lot of guidelines have changed but the American College of Radiology still recommends women begin annual mammograms at age 40. I always promote this unless I know of a patient's high-risk status. I would tell any woman this, and I would do it for myself.

How does a woman know her risk level?

At SMIL, we use five different models for a personalized risk assessment. You gill out a questionnaire, which asks questions about family history pertaining mainly to grandmother, mother, sister, daughter. Then we look at ovarian cancer history, personal breast cancer history, body mass index, menstrual cycle history and whether or not she's had any babies. This all factors into how our models determine risk level. Anything about 20 percent is high-risk status, 15 percent or lower is average risk, and between 15 and 20 percent in intermediate.What should a woman do if she's high risk?

She can talk to her provider about whether she could get annual MRI's along with mammograms. If she has a first-degree relative (daughter, mom, grandmother) who had breast cancer, we recommend she starts getting mammograms 10 years prior to the age when the relative got breast cancer. But we never want to start mammograms before age 25.

What about women who've been told they have dense breasts that are difficult to read on mammograms?

Half of the population of women have dense breasts. With the increase in breast density, the concern is that misses could be hidden within the dense breast tissue. A kit of patients with dense breasts talk to their providers about whether they should get a subsequent ultrasound in addition to a mammogram. You never want to replace a mammogram with an ultrasound because the mammogram is the gold standard and ultrasound can't pick up things like macrocalcifications. An experienced radiologist can tell the difference on a mammogram between macrocalcifications that are harmless, and which are associated with "carcinoma in situ" (pre-cancer), or even an invasive cancer. We also have 3-D mammography, which is a big help looking through dense breast tissue because it shows slices of the breast. This enables us to look through the slices and detect if there is a mass or a distortion. 3-D can also increase the detection of invasive cancers and decrease callback rates. I would recommend any of my friends and family consider it as an option.

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