What to expect at your first routine breast cancer screening

With Ontario lowering the age threshold for publicly funded breast cancer screenings for people with average risk by an entire decade, thousands more will be eligible for their first mammogram come fall, 2024.

Starting at age 40, people will be able to self refer for the screening every two years, which means an additional 130,000 mammograms will be completed in the province annually.

What is a mammogram and how is it conducted?

A screening mammogram is a test conducted usually on asymptomatic people to check for breast cancer and ideally detect it early if present.

“It’s a test that uses an X-ray beam to take a picture of a compressed breast,” explains Dr. Supriya Kulkarni, breast radiologist at Princess Margaret Cancer Centre.

The breast needs to be compressed in order to minimize any movement.

“Every breathing movement can cause movement of the breast. So we don’t want that to happen,” says Kulkarni.

When a patient arrives, they are given a loose gown that can be removed easily when it’s time for the test.

The breast is placed on a platform on the X-ray machine and a plastic plate is lowered to compress it. The X-ray beam is then activated, which goes through the plate and breast, into a receptor contained in the platform.

“[The receptor is] like a photographic film basically. And whatever goes through [the breast] gets recorded on this receptor and automatically gets transferred to the workstation where we actually look at the mammogram … to find changes which indicate early breast cancer.”

Those changes could look like a calcifications in the breast tissue or small masses.

“Sometimes in the breast tissue you can see distortion — the breast tissue is kind of moved around by the cancer — and we may pick that up as one of the early signs of breast cancer,” adds Kulkarni.

The screening takes about 30 seconds and is performed twice on each breast to get an oblique view and a transverse view.

Does a mammogram hurt?

Kulkarni says some people may find the compression uncomfortable, but tolerance levels vary and each person may experience discomfort in different ways based on their anatomical structure.

“I’ve had multiple mammograms myself, and the hardest part I find is what it does to your rib cage … but it’s very transient. We do many uncomfortable things — this is I think the least of them. It’s like walking in a tight shoe,” she says.

She adds that some women whose breasts tend to be more sensitive during their menstrual cycle may experience increased tenderness during that time.

“But it’s a screening test — it’s like going for a blood test. You are going to get a poke. The benefit outweighs the mild discomfort,” she says.

What to do before and what to expect after a mammogram

Kulkarni says there’s not much preparation required for a mammogram.

“You don’t need to be fasting or empty stomach or anything at all. You just need to have an appointment and come to the breast imaging department — wherever you decide to go,” she says.

However, there is one thing she says you shouldn’t do.

“The only thing we ask is not to have any creams or any kind of perfumes or deodorants because deodorants and creams tend to have metal particles such as zinc. That shows up on the mammogram because [it] picks up anything that is metal or anything that’s dense,” explains Kulkarni.

“[It will] produce what we call artifacts — [meaning] something which we don’t want to see, and they can obscure what we really are looking for.”

Kulkarni says for a majority of women, the results of a screening mammogram are normal. But if it’s your first one, you may be called back for additional testing like an ultrasound — which is not a cause for alarm.

“The idea of mammography is to have it sequentially at the given interval … and that helps us to understand how that person’s breast looks. And then we know that ‘oh yeah, she has this calcification and it’s been there for 10 years.’ So when we have prior comparisons it’s easier for the radiologist to interpret,” she says.

“When a person comes for the very first mammogram, which is called the baseline mammogram … we don’t have anything to compare with … [so] the likelihood of recall is a bit higher.”

The benefits of earlier access to mammograms

Kulkarni says 17 per cent of breast cancers are seen in women aged 40 to 50 years old.

She feels that as the goal of routine breast cancer screenings is early detection, it only makes sense to make it a public health policy to screen at a younger age as well.

“The definition of screening is to detect cancer before it becomes clinically obvious. So you don’t want to find cancers when patients can feel it … where the patient may feel a lump. That’s already much advanced,” she says.

Prospective PhD student Vina Mohabir found herself in that situation at age 28, when she was diagnosed with Stage-3 ductal carcinoma.

“My breast cancer journey started this March. It was quite a big shock,” she says, given that she has no family history or genetic predisposition to cancer.

“I had some weird symptoms and part of that was bleeding and my doctor thought maybe bleeding from the breast could be an infection. So she sent me into the E.R. and … it was actually like an ER visit I’ve never had, which is how I knew something was going on.”

Mohabir was referred to the Princess Margaret Cancer Centre for further testing and tests at the hospital’s Gattuso Rapid Diagnostic Centre revealed the cancer was already in her lymph nodes — indicating that it could spread anywhere in her body.

“Within two weeks I was started on chemotherapy,” she says.

 Since then, it’s been a rapid succession of treatments and surgery.

“I finished chemotherapy in August. I finished my surgery in September, which was a double mastectomy. And then I had radiation, which I actually just rang [the completion gong] last Friday,” says Mohabir.

“I actually have a break for the first time since March after back-to-back, just like kind of losing everything. But right now my hair is growing back, my energy’s coming back. I feel like I’m turning a corner.”

Being diagnosed only after showing physical symptoms, Mohabir says the Ontario government’s decision to make screenings available to younger people is a huge step forward and will be life saving. But she feels access to regular mammograms should be expanded even further.

“What’s tricky about breast cancer is that my blood work was completely normal. It was really the physical exam, ultrasound and mammogram that got me the treatment I needed,” she says. “I fully, fully believe everyone should be accessing it, just like going for a regular blood test.”

Mohabir’s surgical oncologist, Dr. Tulin Cil, adds that early screening has numerous advantages.

“We know that with localized breast cancer, survival is excellent and so it would be amazing to catch a breast cancer, if it does exist, at that very early, localized stage,” she says.

“The earlier stage we see things, the better the treatment and the more limited the treatment can be — so hopefully a smaller surgery and not as much need for other therapies like chemotherapy and other adjuvant medical treatments.”

Kulkarni encourages Ontarians to take advantage of the earlier screenings being offered and reiterates that the process will be easy and hassle free.

“I think it’s very critical for everybody to understand that there’s nothing to be afraid of having a mammogram … and we are going to be able to literally walk in and have a mammogram at any facility that’s close to your house … it’s easy,” she says.

“And I just feel that everybody should take their health in their own hands. Things are rapidly changing in the world, so the more you can be proactive about your health the better it’s going to be.”

“Because I work in healthcare, I know quite a few youth who’ve been diagnosed with cancer, but you never think it’s going to be you,” adds Mohabir.

“I think we really do have a fallacy that we are invincible … and it’s really easy to brush off something like cancer screenings, but it’s so important to do that and we have access to it … stop putting it off.”