Mammograms and Small Breasts

QUESTION: Is it necessary for very small-breasted women to have mammograms every year after their 50th birthday? Is self-exam enough, or are there some cancers that cannot be felt by self-exam? I am 54 years old and I am overdue for a mammogram. I don't like the exposure to radiation if unnecessary. Please advise.

ANSWER: Let me address your concerns one at a time:

1. Guidelines for screening mammograms are for women with all sized breasts—large, medium, and small alike.
2. The risk of getting breast cancer doesn't depend on breast size.
3. Breast self-examination alone can usually discover just under two thirds of breast cancers. But roughly one third of breast cancers are only found on mammography—not on breast examination—and are usually "caught" in a relatively early stage.
4. The amount of radiation exposure with modern-day "film screen technique" mammography is very low, less than 1 rad per complete study. Thus, it does make sense to continue with yearly mammography, even though all of us dread this procedure.

—Marisa Weiss, M.D.