Ask the Expert: Breast Cancer Screening

Breast cancer is one of the most common cancers in women in the United States — 1 in 8 women will develop it in their lifetime. That number can feel overwhelming, and often brings a wave of questions. What raises your risk? When should you get a mammogram? And what happens if you find something that concerns you?

Natalie Jones, MD, a breast cancer surgeon at OhioHealth, answers your most common questions about breast cancer screening, diagnosis and risk factors. 

What factors increase a woman’s risk of developing breast cancer?

Breast cancer risk can be increased by a variety of factors. These include:

• If you got your first period before you turned 12.
• Having your first pregnancy after the age of 30.
• Atypical breast biopsy results.
• A family history of breast cancer in first and second-degree relatives.
• Alcohol use.
• Going through hormone replacement therapy for more than 10 years.

What should I do if I find a lump in my breast or underarm?

If you feel a mass during a self-check, you should first alert your primary care specialist or OB-GYN. The next step will be to have a bilateral diagnostic mammogram and ultrasound if you’re 30 years or older or, at a minimum, an ultrasound if you’re under the age of 30.

What does it mean to have dense breasts?

Having dense breasts is defined as having an increased amount of fibroglandular tissue compared to fatty tissue. It is very common for women to have dense breast tissue. The density of tissue is given a score by a radiologist when interpreting a mammogram. Patients determined to have dense breasts or extremely dense breasts sometimes qualify for additional imaging, including screening ultrasound or an abbreviated breast MRI, which will help to better identify any small masses in the background of dense breast tissue. This additional imaging is especially important if there are other risk factors already present like a strong family history of breast cancer or a personal history of biopsies showing abnormal cells.

Does hormone replacement therapy increase breast cancer risk?

Prolonged use of hormone replacement therapy — usually 10 years or greater — can increase breast cancer risk.

What kind of breast screening is needed after lumpectomy or mastectomy?

After a mastectomy, patients no longer require mammograms on the affected side, and if a patient has undergone a bilateral mastectomy, mammography is no longer required. If a patient has a lumpectomy, it is typically recommended to still undergo an annual mammogram. For those who have had a lumpectomy, additional imaging, like an ultrasound or breast MRI, is sometimes recommended alternating every six months with a bilateral screening mammogram.

Get to know the expert

What inspired you to become a breast surgeon?

I was initially inspired by my mom who is an oncology registered nurse and practiced for over 30 years. I shadowed many doctors from a young age and always knew that I wanted to go into medicine, but it was midway through my medical school years when I was rotating in surgery that I was drawn toward surgical oncology, particularly breast cancer and melanoma patients.

What do you find most meaningful about caring for breast cancer patients?

Taking care of breast cancer patients is very fulfilling in many ways, but as the surgeon, we are usually the first person to talk to a patient about their new breast cancer diagnosis and to walk them through many aspects of their treatment plan. Breast cancer surgery and treatment have become very individualized, and the discussions I have with patients are challenging and rewarding because I have learned you need to meet patients where they are and help guide them through a difficult journey that sometimes takes unexpected turns.

Is it time for your annual mammogram? Schedule a screening today.