Breast cancer screening is easy to put off. Between changing recommendations, unfamiliar medical terms and questions about insurance coverage, the process can feel overwhelming. To help make screening easier to understand, we spoke with Megan Pope, PA-C (Physician Assistant-Certified), from CU Medicine Breast Surgical Oncology – Highlands Ranch Specialty Care Center about what to expect, what the guidelines mean and how patients can make informed decisions about their care.

When Should I Start Getting Mammograms?

The average woman has about a one in eight chance of developing breast cancer in her lifetime. For most women at average risk, the recommendation is straightforward.

“General screening is an annual mammogram starting at the age of 40,” Pope said. “Standard screening also includes a breast exam at your primary care visit alongside the yearly mammogram.” 

An annual mammogram beginning at 40 is the guidance supported by the American College of Radiology, the American Society of Breast Surgeons and the American Cancer Society.

Women at high risk for breast cancer may need to follow a different schedule. Speak with your primary care provider about your risk and when to get started.

What Does Breast Density Mean?

One term that comes up often after a mammogram is breast density, and it can be confusing to know what it means for you.

There are four categories of breast density, ranging from fatty tissue to extremely dense tissue. Your mammogram report will identify your breast density category, which is standardized across facilities.

"Women with extremely dense breast tissue may need additional imaging, such as an ultrasound," Pope said. Dense tissue can make it harder to spot abnormalities on a standard mammogram, so additional imaging helps fill in the picture.

Depending on your facility, that additional imaging might include an automated breast ultrasound, sometimes used for heterogeneously dense tissue and above, or a newer option called contrast-enhanced mammography. Both are considered valuable tools for dense breast tissue, though availability varies by location since not every facility offers them yet.

What Happens If I Get Called Back for More Testing After a Mammogram?

This is often the most anxiety-inducing part of the process and it's also the part patients understand the least.

Your annual mammogram is considered preventive care and is usually covered by insurance without a separate bill. If something on that mammogram needs a closer look, you'll be called back for what's known as a diagnostic mammogram or similar test, which is billed differently through insurance.

A diagnostic mammogram isn't a different test so much as a closer look. "The radiologist is doing similar angles but extra magnification, looking closer at areas of asymmetry, masses or calcifications," Pope said.

One detail that surprises a lot of patients: you often get answers the same day. The radiologist reviews your mammogram while you're still in the office, so you'll typically know before you leave whether everything looks normal or whether more testing is needed

Does a Callback Mean I Have Breast Cancer?

Perhaps the most important thing Pope wants patients to know is that a callback does not automatically mean you have breast cancer.

"It can easily be benign tissue. Sometimes the way the images show up is layered tissue," she said. "We always want patients to follow through to make sure we're not missing anything malignant, but also, don't panic."

Following up on a callback is important and it's worth taking seriously. The vast majority of callbacks turn out to be nothing concerning. Understanding the difference between taking your health seriously and assuming the worst can make the process feel far less intimidating.

Breast Cancer Screening Simplified

Screening doesn't have to be a mystery. For most women, it starts with an annual mammogram at 40. Your results come with context, whether that's your breast density category or same-day feedback from your radiologist. If you do get called back for additional testing, remember that it is a common part of the screening process, not a diagnosis.

If you have questions about your own screening schedule or risk factors, talk with your primary care provider or schedule a consultation with CU Medicine Breast Surgical Oncology – Highlands Ranch Specialty Care Center.