You Get Your Annual Mammogram. But Can You Answer These 5 Breast Cancer Questions?

We hear a lot about breast cancer every October, but knowing your breast density, lifetime risk, and whether your current screening plan is enough could make all the difference.

By Meghan Rabbitt

Every October, we’re surrounded by reminders about breast cancer. Yet despite the incredible (and important!) pink ribbon awareness campaign, too many of us don’t know some of the most important facts about our own breast health.

For example, do you know your breast density and what it means for your cancer risk and screening plan? Have you ever talked to your doctor about your lifetime risk of developing breast cancer? For an area of the female body that tends to get a lot of attention from the outside world, it’s pretty remarkable how little we’re taught about our breast health and how to protect it.

So, this Breast Cancer Awareness Month, we’re highlighting the life-saving information all of us need to know.

“Breast cancer is the most common cancer to affect women,” says breast oncologist Marisa Weiss, MD, founder and chief medical officer of Breastcancer.org. “It’s so common that within your life, it’ll impact you directly or someone you know or care about. The good news is that most people get the benefit of early detection, when it is found as early as possible and when it’s most treatable.”

Here, Dr. Weiss breaks down the essential questions all of us must ask—and answer—to better understand our risk, make sure we’re getting the screening we need, and know exactly what to ask at our next doctor’s visit.

 

Question No. 1: What category is my breast density?

If you’ve had a mammogram recently, you’ve probably been notified about your breast density. As of September 2024, mammography centers are required to include breast density information in the results they send to patients. However, being told you have dense breasts and understanding what that means are two very different things.

Here’s what you need to know: Breast density is a measure of the amount of fibrous and glandular tissue compared to fatty tissue in the breasts. Having dense breasts means you have more fibrous and glandular tissue and less fat. Radiologists classify breast density in four categories:

A: Fatty. Breasts are almost all fatty tissue. 

B: Scattered fibroglandular breast tissue. This means there is mostly fatty breast tissue with some scattered areas of dense glandular and fibrous tissue.

C: Heterogeneously dense breast tissue. This means there are many areas of dense glandular and fibrous connective tissue, with some areas of fatty tissue.

D: Extremely dense breast tissue. This means there is almost all dense glandular and fibrous connective tissue. 

Half of all women have dense breasts, category C (40 percent) or D (10 percent). If this is you, it means two things, says Dr. Weiss:

1. Your risk of getting breast cancer is higher—and the greater the amount of dense tissue, the higher your risk.

2. Dense breasts make it harder for doctors to see breast cancers on mammograms, which means you may need extra imaging (such as breast MRI and/or ultrasound) as part of your screening plan. “Dense breast tissue looks like white-out conditions in a snowstorm,” says Dr. Weiss. “Finding breast cancer in dense breast tissue can be like finding a polar bear in a blizzard.”

This is why it’s crucial to know your breast density and talk to your healthcare provider about what it means for you.

 

Question No. 2: What’s my lifetime risk of breast cancer?

Understanding your personal, lifetime risk of breast cancer is one of the most important steps you can take to protect your breast health, yet few of us have ever had a conversation with our healthcare providers about this. This is too bad, because if you’re at higher risk, you’ll likely benefit from enhanced screening (which can include imaging beyond mammography, such as breast MRI) and a screening schedule tailored to your risk.

So, how do you know your lifetime risk of breast cancer? You can calculate it right now using the Tyrer-Cuzick risk assessment model, which is a questionnaire that estimates your likelihood of developing breast cancer over the next 10 years and over your lifetime. Anything over 20 percent is considered high risk.

Once you know your number, use it as a starting point for a conversation with your doctor about your breast cancer screening plan, whether genetic testing is right for you, and risk-reducing strategies (more on those below). You can say something like, “I calculated my lifetime risk of breast cancer and here is my score. Do I need a breast MRI in addition to my annual mammogram based on my score?”

 

Question No. 3: Is an annual mammogram enough—or should I get additional screening?

Here’s the good news: If you’re at regular, average risk of developing breast cancer, an annual mammogram should be sufficient for early detection of breast cancer along with self-breast exams and your provider’s exam, says Dr. Weiss. If you are at elevated risk due to a significant family history, a moderate to high risk inherited genetic alteration, type C or D breast density, or other risks that can increase your lifetime risk of breast cancer, you would likely need extra screening.

“If you’re at elevated risk of developing breast cancer, annual mammogram screening alone is often not enough,” says Dr. Weiss. If this is true for you, talk to your clinician about alternating mammograms and breast MRIs every six months. This twice-annual surveillance can help detect an interval cancer—which is cancer diagnosed between annual mammograms—sooner. “Other forms of breast imaging, like contrast-enhanced mammography and ultrasound, may also have a role,” adds Dr. Weiss.

Question No. 4: What are the breast cancer risk factors I can change?

All of us have some risk of developing breast cancer. Some of the risk factors are simply part of your personal health history, such as being born female, having dense breasts, certain inherited genetic mutations, and a family history of breast cancer. (Though here’s a fact that may be surprising: Most women who develop breast cancer do not have a family history of the disease, and they don’t have an inherited gene abnormality either, says Dr. Weiss.)

However, while we talk a lot about these unchangeable risk factors, the modifiable risk factors don’t get enough airtime. These include limiting (or better yet, avoiding) alcohol; moving your body (aim for a minimum of 150 to 300 minutes of moderate activity or 75 to 150 minutes of vigorous activity each week); strength training two to three times a week; reaching and maintaining a healthy weight; consuming a nutrient-dense diet; managing stress; and staying socially connected.

“It’s good to know there’s a lot you can do to lower your risk,” says Dr. Weiss. “It’s hard work! But you have to start somewhere, and your best bet is to start in a place where you’ll make the biggest difference.”

 

Question No. 5: What symptoms should prompt me to call my doctor, even if my last mammogram was normal?

While most of us are trained to call our doctors if we feel a breast lump, there’s a chance you might feel or see another type of an abnormality—which is important to get checked out, too. Keep these signs in mind and call your healthcare practitioner if you notice any of the following new and persistent changes:

• Asymmetry (one breast becomes noticeably different than the other)

• Thickening or swelling of part or all of the breast

• Changes to the look or texture of the skin covering your breast, such as a bulge, an indentation, dimpling, or redness and swelling

• A pulling in of the nipple (retraction), pain, and/or nipple discharge other than breast milk

• Any change in the shape or size of the breast

• Pain in any area of the breast

• A lump in the armpit area

“Most of the things you feel turn out to be nothing,” says Dr. Weiss. “But you don’t want to miss anything. So, even if life is busy—and even if you’d rather not think about anything you don’t want to think about—get it checked out. If you see something, say something.”

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Meghan Rabbitt is a journalist and author of The New Rules of Women's Health.