Breast health screening is a fundamental part of preventative care for women, as breast cancer remains one of the most frequently diagnosed cancers globally. Navigating the screening process, from initial risk assessment to the imaging procedure, can be confusing for patients. Your obstetrician-gynecologist (OBGYN) serves as a primary source for coordinating this preventative health strategy. Understanding your doctor’s specific responsibilities and the logistics of the screening process ensures you receive timely and appropriate care.
The OBGYN’s Role in Breast Health Screening
Your OBGYN is typically the provider who initiates the breast cancer screening process, acting as a gatekeeper to specialized services. During your routine annual visit, your doctor performs a clinical breast exam (CBE) to check for any palpable masses or abnormalities in the breast tissue and underarm area. They also conduct a thorough assessment of your personal and family medical history to determine your individual risk factors for breast cancer.
These risk factors can include a family history of breast or ovarian cancer, genetic mutations like BRCA1 and BRCA2, and having dense breast tissue. Based on this comprehensive risk profile, your OBGYN educates you on breast health and determines the appropriate age and frequency for your screening regimen. For patients who meet the criteria for screening, the doctor provides the necessary order or referral for the specialized imaging procedure.
The OBGYN’s office is not equipped with the machinery to perform a mammogram, which is a common misconception among patients. Instead, their primary role remains risk assessment, patient education, and performing the CBE. They coordinate with radiology specialists to ensure a personalized screening plan is in place, especially for patients identified as higher-than-average risk who may require earlier or supplemental screening.
The Logistics of Mammography
Mammography requires specialized equipment and is performed in dedicated medical settings, not a standard OBGYN office. These facilities are often found in hospital radiology departments, outpatient imaging centers, or specialized breast centers. Some areas also utilize mobile mammography units to increase access to screening services.
These locations must meet stringent federal quality standards and employ certified mammography technologists to perform the procedure. The technologist positions the breast and applies compression to flatten the tissue, which is necessary to obtain a high-quality image with minimal radiation exposure. The resulting images are then interpreted by a board-certified radiologist who specializes in breast imaging.
The procedure itself is relatively quick, usually taking about 10 to 15 minutes, though the compression can cause temporary discomfort. The use of 3D mammography, or digital breast tomosynthesis, is becoming more common. This technology provides the radiologist with multiple thin-layer images, which can improve cancer detection and reduce the likelihood of a false-positive result. Once the images are interpreted, the results are sent back to your ordering physician, your OBGYN, for discussion and follow-up.
Current Age and Frequency Guidelines
The recommended age to begin routine screening mammography and the frequency of the exams vary slightly among major medical organizations. It is important to discuss your specific situation with your doctor. The American Cancer Society (ACS) and the American College of Radiology (ACR) recommend that women at average risk have the option to begin annual screening at age 40, emphasizing this provides the greatest reduction in breast cancer mortality.
The U.S. Preventive Services Task Force (USPSTF) recently updated its guidance, recommending that all women begin biennial screening mammography—every two years—starting at age 40 and continuing through age 74. The American College of Obstetricians and Gynecologists (ACOG) suggests that women in their 40s should discuss the benefits and risks with their doctor to decide on annual or biennial screening. Despite the minor differences in frequency, there is a strong consensus on starting screening in the 40s for women at average risk.
Individual risk factors can significantly alter this standard timeline, often requiring earlier or more frequent screening. Women identified as being at higher-than-average risk, such as those with a BRCA mutation or a lifetime risk of 20% or more, are advised to begin annual screening with mammography or magnetic resonance imaging (MRI) as early as age 25 to 30. Women with dense breasts may also require supplemental screening beyond the mammogram, such as breast ultrasound or MRI, because dense tissue can obscure small tumors.