Around 20% of women in the U.S. wait until after age 35 to have their first child, according to the National Institutes of Health. As a result, pregnancy may overlap with another important milestone: the start of annual screening mammograms at age 40 or earlier, depending on your breast cancer risk. That may leave mothers-to-be wondering about mammogram guidelines during pregnancy.
“If you’re expecting a baby, you may feel like you have a million things to do, but maintaining breast health shouldn’t get lost in the shuffle,” says Dr. Stephanie Morgan, M.D., board-certified radiologist at Charlotte Radiology. “It’s safe to get your annual mammogram while pregnant. Doing so is the key to detecting breast cancer early and increasing the likelihood of successful treatment. We strongly encourage women to make breast health a priority throughout their pregnancy and post-pregnancy. That’s important for you and your growing family.”
Mammogram Guidelines During Pregnancy
The National Comprehensive Cancer Network (NCCN) and the Cancer Intervention and Surveillance Modelling Network (CISNET) recommend — and what Charlotte Radiology follows — says that women should start screening mammograms every year beginning at age 40 if they’re at average risk for breast cancer or as early as age 30 if they’re at higher risk.
“For pregnant women, the NCCN mammogram guidelines for screening mammography are largely the same as for those who aren’t pregnant, recommending women continue with annual screening mammograms and clinical breast exams during pregnancy,” Dr. Morgan says. “Maintaining breast health throughout is important, as a woman’s body is going through a lot of changes during this reproductive phase. Remaining vigilant about annual screening and early detection is still important.”
Experts consider mammograms safe during pregnancy. The advanced imaging technology used in 3D screening mammography ensures the lowest possible radiation exposure, concentrated in the breast area. Additionally, during the exam, the mammography technologist will cover your belly with a lead shield to reduce the risk of radiation reaching your developing baby.
“If you’re nervous about getting a mammogram while pregnant, talk with your primary care physician or OB-GYN,” Dr. Morgan says. “They can help you decide whether having the exam during pregnancy or waiting until after your baby is born makes the most sense for you. Your health history and any risk factors for breast cancer, like family history or genetics, should factor into the decision-making about annual screening.”
Breast ultrasound, a different imaging technology that uses sound waves instead of X-rays, is considered safe during pregnancy. However, Breast Ultrasound should not take the place of annual screening mammography. For some other forms of breast imaging, however, waiting until after pregnancy is best. Breast MRI, which you may need each year starting before age 40 if you’re at high risk for breast cancer, requires contrast material that can cross the placenta. As a result, experts typically recommend waiting until after you give birth for a breast MRI.
Read More: Breast Cancer in Young Women: Risk Factors and Early Detection
Breast Health and Normal Changes While Pregnant
“Like other parts of your body, your breasts may change during pregnancy due to shifting hormone levels,” Dr. Morgan says. “They may feel lumpy and more sensitive to touch. Your breast tissue may become more dense than usual. This can make breast cancer more difficult to see on a mammogram, although still detectable.”
The pregnancy-related changes that may affect your breasts underscore the importance of knowing how they normally look and feel. Each month, including during pregnancy, perform a breast self-exam. Use your fingers to gently check for lumps, nipple discharge, or other changes that may warrant further evaluation. Examine your breasts in a mirror to look for changes in skin texture or nipple shape.
Tell your primary care physician or OB-GYN about any breast changes you notice. Your physician may order mammographic imaging to further evaluate and characterize the change.
Read More: Navigating Varicose Veins During Pregnancy
Breastfeeding and Postpartum Mammogram Guidelines
Breastfeeding is good for your health and the health of your baby — and it shouldn’t affect the timing of your annual screening mammogram.
Clinical studies support that women who breastfeed have a lower risk of breast cancer than women who don’t breastfeed. The NCCN mammogram guidelines call for breastfeeding mothers to have annual screening mammograms and clinical breast exams. One key difference: Although a breast MRI isn’t recommended during pregnancy, it may be OK to have one while breastfeeding if it’s part of your high-risk screening regimen and your physician agrees the benefits outweigh any risk to you or your baby.
Just like during pregnancy, you may experience changes to your breasts during breastfeeding and with hormonal fluctuations post-pregnancy. Lactating women may notice lumps and discharge, but in most cases, these are related to breast milk production. Full milk glands, for example, may cause your breasts to feel lumpy and tender. Breastfeeding mothers may develop dense breast tissue, which can mask early-stage breast cancers in mammography. In addition to mammography, supplemental screening with breast ultrasound may be added to further characterize changes in breast tissue that require attention.
“If you breastfeed, mammograms are safe for both you and your baby,” Dr. Morgan says. “Breastfeeding or pumping right before your mammogram to empty your breasts of milk can help you stay comfortable during the exam. Mammograms don’t harm your breast milk, so you can nurse or pump afterward as soon as you need to. You don’t need to pump and dump your milk.”
Adjustments to Prioritize Your Comfort
When you schedule your annual screening mammogram, let the scheduler know you’re pregnant so they can notify the mammography technologist in advance. The upfront notification gives the technologist time to prepare accommodations for your comfort and safety, such as a shield for your belly.
Preparing for a mammogram while pregnant isn’t much different than before pregnancy. Avoid wearing lotion, perfume, deodorant or antiperspirant. Be sure to wear comfortable clothes, including a top and bra and separate bottoms so you can easily remove your top clothing to put on a robe for the exam.
“At Charlotte Radiology, we take pride in ensuring a positive patient experience for all patients, including those expecting a baby,” Dr. Morgan says. “When you arrive for your mammogram, let the technologist know if your breasts are feeling tender so they can take extra care to make positioning for the exam as comfortable as possible. Your technologist will advise you when to stay still during imaging and talk to you throughout the process so you know what to expect.”
Breast compression will last just a few seconds and shouldn’t be painful. Before you know it, the exam will be over, and you can get back to focusing on becoming a mom.
