For many people, the Obstetrician-Gynecologist (OB/GYN) acts as the primary physician for preventative care, making them the first point of contact for questions about breast health and cancer screening. While the OB/GYN is responsible for managing a patient’s overall breast health and determining their need for screening, they typically do not perform the mammogram procedure itself. The physical performance of this specialized medical imaging test requires specific equipment and personnel found outside the standard gynecological office setting.
The OB/GYN’s Role in Breast Health Screening
The OB/GYN plays a central role as the coordinator for a patient’s breast health screening process. During a routine annual exam, the physician performs a Clinical Breast Exam (CBE), which involves a physical inspection and palpation of the breasts and underarm areas. Although the value of the CBE in average-risk women is debated, it remains a common part of the visit, especially for women aged 40 and older.
The OB/GYN conducts a detailed breast cancer risk assessment. This involves reviewing personal and family medical history, including any history of breast or ovarian cancer among close relatives, and personal risk factors like breast density or genetic mutations. This assessment informs the physician’s recommendation for the age to begin screening and the frequency of future mammograms.
Based on the individual risk profile, the OB/GYN determines whether a patient should follow standard screening guidelines or require a more intensive surveillance plan. If a mammogram is deemed necessary, the physician provides the prescription or referral needed for the patient to schedule the imaging test elsewhere. This coordination ensures the patient receives the appropriate level of screening at the correct time.
Where Mammograms Are Performed
Mammograms are not typically performed in an OB/GYN’s office because the procedure relies on specialized, expensive imaging technology and a specific medical team. The equipment used is a dedicated mammography machine, often capable of performing three-dimensional (3D) imaging (digital breast tomosynthesis). These machines use low-dose X-rays to capture detailed images of the breast tissue, requiring a dedicated space and trained personnel.
The imaging is performed by a licensed radiologic technologist trained in positioning the breast correctly for optimal image capture. The resulting images are then interpreted by a board-certified radiologist, a medical doctor specializing in medical imaging. The radiologist looks for subtle signs of cancer, such as microcalcifications or masses, and issues a formal report to the referring OB/GYN.
Patients are generally directed to specialized imaging centers, hospital radiology departments, or dedicated breast health clinics to have the procedure done. These facilities are equipped with the appropriate machinery and staff to handle the entire imaging process, from the initial X-ray to the final interpretation. The logistics involve the OB/GYN submitting an order, and the patient scheduling the appointment at the designated imaging facility.
It is important to differentiate between a screening mammogram and a diagnostic mammogram, both of which take place at these imaging centers. A screening mammogram is a routine check for women without symptoms. In contrast, a diagnostic mammogram is a follow-up test for a suspicious finding, such as a new lump or an abnormal screening result, and often includes additional, targeted views.
Understanding Screening Guidelines
The recommendation for when to start and how often to get a mammogram varies slightly among major health organizations, but the consensus points toward screening beginning in the 40s. The American College of Obstetricians and Gynecologists (ACOG) suggests that women at average risk should be offered the option to begin annual screening mammography starting at age 40. This recommendation allows for a shared decision-making process between the patient and the physician.
The American Cancer Society (ACS) offers the option for women to start annual screening between the ages of 40 and 44, and then recommends annual screening for those aged 45 to 54. For women aged 55 and older, the ACS suggests continuing with either annual or biennial (every two years) screening. These guidelines apply to women at average risk, meaning they lack a strong family history, a known genetic mutation, or a history of chest radiation.
For women identified as having a higher-than-average risk, screening may need to begin earlier and include other imaging modalities, such as a breast MRI. The decision to continue screening past age 75 is based on the patient’s overall health and life expectancy, as determined through a conversation with the OB/GYN. General breast self-awareness is also encouraged, meaning patients should know the normal look and feel of their breasts so that any new changes can be reported immediately.