BREAST cancer is the most common cancer in women worldwide and is even more common in black women under 45 years.

Black women are more likely to die of breast cancer and as a result, it is recommended that breast cancer screening should start at 40 years old and be done yearly, especially since cancer can develop in patients with and without risk factors, making screening important for early diagnosis.

High-risk patients can start screening as early as 30 years, and men who are also at risk for breast cancers can and do get mammograms.

There are three main steps for maintaining good breast health — monthly self breast examination, yearly clinical examination by your doctor and yearly breast imaging.

A mammogram is an X-ray picture of the breasts. It is used to detect the early signs of breast cancer. The mammogram is most sensitive for breast cancer screening as it detects abnormalities when they are small and can find a cancer up to three years before it can be felt by you or your doctor. Earlier detection increases the chances that the cancer has not spread to other parts of the body and allows for more treatment options to be available increasing the likelihood of treatment success. It also decreases the likelihood of complications and death from the disease.

Breast imaging falls into two main categories:

1. Screening, which is imaging in a patient who has no symptoms.

2. Symptomatic, a type of imaging carried out when the patient or doctor feels that something is abnormal in the breast.

There are different ways to image the breast, and a woman may need more than one of these. Screening should start with mammogram. Other imaging methods of breasts include an ultrasound, MRI and/or others such as contrast enhanced mammography, ductogram, molecular breast imaging, positron emission mammogram.

When a mammogram is being done you will stand in front of the mammogram machine and a technologist will place your breast on a plastic plate one at a time. Another plate will firmly press your breast from above. The plates will flatten the breast and hold it in place while the X-ray is being taken. The baseline mammogram is two images of each breast. If the doctor reviews the images and has a concern, then additional views may be taken.

Mammograms are safe though it exposes the breasts to small amounts of radiation. But, our surroundings expose us to radiation naturally. The dose of radiation used for a screening mammogram of both breasts is about the same amount of radiation a woman would get from her natural surroundings over approximately seven weeks. If there’s any chance you might be pregnant, please let the mammogram technologist know. Screening mammograms are not routinely done in pregnant women who aren’t at increased risk for breast cancer. However, if the mammogram is required during pregnancy, the risk to the foetus is very small, and steps can be taken to shield the abdomen and foetus.

Below are tips to prepare for your mammogram:

1. If you still have menstrual cycles, we suggest that you do not schedule mammograms within the week before the menstrual cycle (period) as the breasts are usually very sensitive during this time.

2. Consider pain medication if you find that having a mammogram is uncomfortable. Taking an over-the-counter pain medication such as Panadol about an hour before your mammogram might ease the discomfort of the test. Always check with your doctor before taking any new medications.

3. Avoid using deodorants, antiperspirants, powders, lotions, creams, or perfumes under your arms or on your breasts.

4. If you have had a previous mammogram, please bring images and reports with you to your exam.

5. Wear a two-piece outfit so you will only have to remove your top and bra. You will be given a gown to wear, to feel less exposed.

6. Remove any neck or nipple jewellery for the test.

7. You can eat and drink as you normally would and take your medications as usual.

8. Mammogram pictures are taken with you in the standing position. If you are unable to stand the machine can be adjusted to a seated position.

9. Wear comfortable shoes. You will be standing for your mammogram and may be asked to lean forward or backward for best positioning.

If you have taken the COVID-19 vaccine the following should be noted when scheduling a mammogram.

1. Lymph nodes under the arm can become enlarged as part of the normal immune response following the vaccine.

2. If a mammogram shows that your lymph nodes appear enlarged, the radiologist may consider this an abnormal finding and request you return for further breast imaging such as ultrasound.

3. Screening mammograms should be scheduled before your first dose of a COVID-19 vaccination or four to six weeks after the second dose of the vaccine. This delay allows for your nodes to return to their normal size and reduces the chance of a call back for additional imaging.

After the radiologist has examined your mammogram images, a report is done that can either suggest:

1. This test is normal, and you continue regular screening.

2. The test is incomplete, and you will be recalled for additional imaging

3. The test shows an abnormality that requires a short interval follow-up of less than one year.

4. The test shows an abnormality and suggests that you have a referral for breast biopsy after consultation with your doctor.

If any concern arises in between your mammograms, for example, lumps in breast or armpit, nipple discharge or retraction, skin changes (itching, redness or dimpling), swelling and focal pain, please see your doctor to decide if your imaging needs to be repeated earlier than the scheduled screening time.

Dr Sherrian Leslie is a consultant radiologist and breast imaging specialist at Imaging and Intervention Associates located downtown Kingston at Shops 59-59 Kingston Mall, 8 Ocean Boulevard. She may be contacted at iiassocs.jm @gmail.com or @iiajamaica on Facebook and Instagram.