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Q&A with Dr. Allison Edwards

For Breast Cancer Awareness Month, we asked Sesame's Medical Advisor Dr. Allison Edwards your questions about breast cancer, risk assessment, mammograms, and more.

What you need to know this Breast Cancer Awareness Month.

Q: How often should I be screened for breast cancer?

Dr. Edwards: The US Preventive Services Task Force - the organizing body that provides general screening recommendations to doctors - recommends that a woman receives a mammogram (screening for breast cancer) every other year from the age of 50 onward. According to the USPSTF, screening before the age of 40 is an individual decision based on health history and family history of breast cancer.

Other organizations, such as the American College of Obstetricians and Gynecologists, the American Cancer Society, and the National Comprehensive Cancer Network recommend women begin screening for breast cancer biannually between the ages of 40-45. These organizations, however, also note that this is a decision for the individual.

It’s important to remember that these are screening guidelines: they apply to women who don’t have a personal history of breast cancer and who aren’t actively concerned about a lump or any other breast concern that anything needs to be checked out.

Q: Should I get a 2D or 3D mammography exam?

Dr. Edwards: The FDA approved the use of digital breast tomosynthesis in 2011 but studies haven’t definitively shown that 3D is always going to be better for everyone. There are a lot of factors going into this. 2D mammography is lower cost, widely available, and has a lower radiation dose than 3D mammography. 3D mammography has been found to decrease the risk of needing to re-screen or call a woman back to the office for further imaging but does run at a higher price. It’s still unclear which modality is better at preventing death from breast cancer, which is the whole point of breast cancer screening! Stay tuned for more as time goes on.

Q: How do I determine my risk of breast cancer?

Dr. Edwards: With the advent of new technologies and sciences, we are learning more and more about the genetics that play into breast cancer. The genetic mutations that are most widely studied and linked to breast cancer are BRCA1 and BRCA2, which cause 5-10% of breast cancers. With 90-95% of breast cancers not attributable to these mutations, we have to revert back to simply examining the family history of a woman to provide the best recommendations for breast cancer screening.

Most breast cancers are not linked to a hereditary (I.e. inheritable) mutation. Because of this, even if you have a family member who has had breast cancer, your clinician will likely recommend screening with mammograms just like any other woman with average risk. That said, if you feel you have a strong family history of breast cancer, are at higher risk, or are experiencing any concerning symptoms, you should consult with your clinician about how to best move forward in your women’s health journey.

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