Dear Doc,

I try to practice self-care, but sometimes I’m not as focused on myself as I am on my service duties and making my family’s hectic schedules work. How often should I be checking my breasts for lumps and bumps, and what’s the current recommendation for getting a mammogram? Didn’t it change? I’m 40.

— U.S. Army Chief Warrant Officer 3 Winnie No

Dear Chief No,

Those are good questions. The U.S. Preventive Services Task Force recently changed its guidance, and now recommends mammograms every other year beginning at age 40. Other national organizations also recommend starting mammograms at age 40 annually or every other year.

U.S. Navy Capt. (Dr.) Monica Lutgendorf is an expert on breast health and when you need mammograms. She’s an OB-GYN and the department chair for Gynecologic Surgery and Obstetrics at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Lutgendorf recently filmed a video about the importance of mammograms and new guidelines. Here’s what she had to say:

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It's really important, even as busy mothers and family members, to take time for our health and to take care of ourselves.

Breast self-awareness is important. You should be familiar with your breasts, so you understand what's normal and promptly report changes or concerns such as new lumps, bumps, pain, a mass, new onset of nipple discharge, or redness in your breasts.

If you notice new breast changes, I recommend discussing these with your doctor. Although most breast changes detected as part of breast self-awareness have benign causes, some changes may signal something serious, such as breast cancer.

Cancer medical organizations say health care provider breast examinations may be offered every 1–3 years for individuals between the ages of 25–39 and annually for individuals 40 and older.

It's especially important for all individuals between the ages of 40 and 74 to get a mammogram every other year or annually. If you use TRICARE, the process through the Military Health System is pretty approachable. Just call to get an appointment. The appointments are pretty quick as far as getting the imaging done. The results are available in the MHS GENESIS patient portal, so it's very easy to schedule the follow up.

The actual mammogram is not a very painful procedure, in my opinion. If you're concerned about the discomfort, I would say that although that can vary from one person to the next, in general, it's a relatively quick and painless procedure.

The most important thing is to identify breast cancer at its earliest stage so you and your health care provider can arrange appropriate treatments. It's a very preventable and treatable cancer if caught early.

It’s really important to get screenings every other year for average-risk people to make sure we’re able to identify and detect breast cancer at an early stage. If you're somebody who has increased risk factors for breast cancer in your family, your screening recommendations may change. Risk factors include family members who are diagnosed with:

• Breast cancer at an early age (under 50)
• Tumors in both breasts
• Male relatives with breast cancer

If you’re at higher risk, talk to your doctor about the timing and frequency of breast cancer screening and the imaging modality recommended, as earlier, more frequent, screening and different screening modalities (such as magnetic resonance imaging) may be recommended.

Family history is important, as individuals with a concerning history for hereditary breast and ovarian cancer syndromes should be counseled and offered genetic screening-testing. For example, you should be counseled as to your options if your family has a history of the BRCA gene mutation or you are of Ashkenazi Jewish descent. Additional risk factors include:

• Prior breast biopsy with specific diagnosis
• Early menstrual cycle onset
• Late menopause
• Did not give birth
• No breastfeeding
• Menopausal hormone therapy
• Increasing age
• Dense breasts on mammography
• Prior exposure to high-dose therapeutic chest irradiation when ages 10–30

I also recommend that people maintain a healthy weight, limit their alcohol consumption, and complete their regular screening. It will only take about an hour for the appointment, and it's something that can easily be worked into a busy schedule.

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Chief,

I hope this answers your questions. Here’s some more information on breast cancer. Also, you should know that TRICARE’s well-woman exams annually cover breast exams, pelvic exams, and Pap smears as needed for women under age 65. There’s no cost-share or co-payment. Take care of yourself because you matter.