Some rights of passage are more significant than others, and one of the most important for women is having their first mammogram.

Most physicians and several national medical organizations, including the American Cancer Society, recommend age 40 to begin having annual mammograms for women who are considered at average risk for breast cancer. Women who are high-risk, including those who have a strong family history of the disease and those who test positive for certain genetic mutations, may be advised to begin screening mammograms at an earlier age.

Although the U.S. Preventive Services Task Force recommended in 2009 that women begin screening mammograms at age 50, most breast specialists remain convinced that women benefit from beginning mammography a decade earlier.

One of the reasons they cite is the importance of early detection. “When breast cancers are diagnosed early, there is often the potential of not needing chemotherapy or being able to do a smaller lumpectomy with a better cosmetic outcome, rather than mastectomy or a wider lumpectomy that may be required for a larger tumor,” says Dr. Stephanie Schnepp, a breast surgeon and medical director of SSM Breast Care at St. Mary's Health Center.

No matter how old you are when you have your first mammogram, knowing what to expect is helpful. “The first thing to do is to find a facility that does a lot of mammograms. These facilities often have both technologists and radiologists who specialize in mammography,” advises Dr. Catherine Appleton, a radiologist and chief of breast imaging with Washington University Physicians. “In addition, try to find a facility you can return to year after year, because we do a better job when we have the benefit of the comparison from year to year.” She also recommends avoiding mammograms right before or during your period, when breasts are more tender.

A typical screening mammogram involves compressing the breast tissue between two flat plates. A digital image is taken from two angles for each breast. “The time in compression is very short, and the vast majority of women do not experience pain during the exam. Tylenol can be taken before the mammogram, if desired,” says Dr. Diane Radford, a breast surgeon with Mercy Clinic St. Louis Cancer & Breast Institute.

“Tell your doctor if you have any symptoms, such as a lump, nipple discharge, etc. In that case, the exam ordered should be a diagnostic,  not a screening mammogram. Screening exams are for women without symptoms,” she adds. Diagnostic mammograms involve additional angles and views of the concerning area.

“Most women who come for a mammogram are going to get a letter saying that everything is just fine,” Appleton says. “While there’s a little bit of an increase in the chance of being called back after your first mammogram, it’s only because we don’t have any previous images to compare. If a women gets a letter saying we need her to come back, she shouldn’t panic. Statistically, she’s likely to end up with good news after a second look.”

Schnepp reinforces Appleton’s words of encouragement: “Even in the category of women for whom biopsy is recommended based on mammogram and/or ultrasound, most of them will not result in a cancer diagnosis. So, most of the time it will turn out not to be anything to worry about; but often, additional films--and at times, a minimally invasive biopsy--will be needed to clarify the situation.”

Talk with your physician about your breast cancer risk and remember that mammograms are simply another right of passage as we travel through womanhood.

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