Breast cancer is the most common cancer in women and the second most common cause of cancer death in women in the United States. Annual mammography beginning at age 40 — the recommendation of the American Cancer Society and American College of Radiology — reduces breast cancer mortality significantly by detecting tumors at earlier, more treatable stages. Yet a substantial proportion of women are not current with recommended breast cancer screening, and many do not know whether their breast density or personal risk factors warrant supplemental imaging beyond standard mammography.
The gynecologist is often the clinician who identifies that breast cancer screening is overdue, who performs the clinical breast examination that may detect an abnormality warranting prompt referral, who recognizes that a woman with dense breasts may benefit from supplemental ultrasound or MRI, and who initiates the genetic counseling referral for women with a family history that suggests BRCA or other hereditary breast cancer risk. This coordination role is an integral part of well-woman care at Lapeer Women’s Health.
Mammography Screening Recommendations
Mammography recommendations vary somewhat between organizations but converge on the importance of annual screening beginning at 40 for average-risk women. The American Cancer Society recommends annual mammography from age 45 to 54, then every other year from 55 onward for average-risk women, with the option to start at 40. The American College of Radiology and the Society of Breast Imaging recommend annual mammography from age 40. The U.S. Preventive Services Task Force (2024 update) recommends screening mammography for all women beginning at age 40. At Lapeer Women’s Health, the recommendation at the well-woman visit is for annual mammography beginning at age 40 for average-risk women — which reflects the most screening-protective approach and aligns with the evidence that annual mammography from 40 provides the greatest mortality reduction.
Dense Breasts — When Supplemental Screening Is Recommended
Approximately 40 percent of women have dense or heterogeneously dense breast tissue, which reduces the sensitivity of mammography and is itself an independent risk factor for breast cancer. Women with dense breasts may benefit from supplemental screening with breast ultrasound or breast MRI. Michigan law requires that mammography reports notify women about their breast density results. At the well-woman visit, Dr. Andrei reviews breast density status from prior mammography reports and discusses whether supplemental screening is recommended based on density category and overall risk.
High-Risk Women — Enhanced Screening Protocols
Women with a lifetime breast cancer risk of 20 percent or greater — calculated based on family history, genetic mutation status, prior breast biopsy results, and other factors — are recommended to have annual breast MRI in addition to annual mammography. This enhanced protocol applies to women with BRCA1 or BRCA2 mutations, women with first-degree relatives with BRCA mutations who have not been tested themselves, women with a strong family history of breast or ovarian cancer, and women with prior chest radiation. Identifying which women meet the threshold for enhanced screening is a specific component of the well-woman visit at Lapeer Women’s Health.
Clinical Breast Examination
Clinical breast examination (CBE) by a trained clinician detects palpable abnormalities that may not yet be visible on mammography and provides a physical baseline for comparison at subsequent examinations. CBE is performed at well-woman visits at Lapeer Women’s Health. Findings that warrant further evaluation — a new lump, skin dimpling, nipple discharge, or lymph node enlargement — are referred promptly for diagnostic imaging and surgical evaluation as indicated.
Breast Self-Awareness
Monthly breast self-examination is no longer formally recommended in guidelines — but breast self-awareness is. Women who know what their breasts normally feel and look like are better positioned to notice changes and report them promptly. Unexplained breast lumps, skin changes, nipple discharge, or axillary lumps should be reported to your gynecologist without waiting for the next scheduled well-woman visit.
Contact our office promptly — do not wait for your next scheduled well-woman visit — if you notice:
- A new breast lump or thickening, particularly one that is firm, fixed, or growing
- Unexplained nipple discharge — especially if bloody, from a single duct, or spontaneous
- Skin changes over the breast — dimpling, puckering, redness, or changes in skin texture
- Nipple changes — new inversion, retraction, or scaling of the nipple or areola
- New axillary (armpit) lymph node enlargement that is unexplained
The evidence for annual mammography beginning at age 40 in reducing breast cancer mortality is substantial and consistent across large studies. The benefit is greatest for women who screen regularly — not for women who catch up after a long gap. If your mammography is overdue, or if you are unsure whether your breast density or family history warrants supplemental imaging, your well-woman visit at Lapeer Women’s Health is the right place to address that.
Both our Lapeer and Rochester Hills offices are here for that visit. No referral required.
Our team at Lapeer Women’s Health ensures your breast cancer screening is current and complete. No referral required.
Schedule a Gynecologic VisitEducational purposes only. Not medical advice. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.