It all depends on your risk factors—for both breast cancer and COVID-19.

By Kasandra Brabaw
May 28, 2020
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Back in April, when COVID-19 was just starting to take hold of the US, the American College of Obstetricians and Gynecologists (ACOG) shared the message that, due to the virus, women's health care providers would possibly have to reschedule regular checkups or opt for telemedicine appointments instead.

While the ACOG still said that women should see their ob-gyns for urgent situations—a vaginal infection, symptoms of an ectopic pregnancy, severe vaginal bleeding, etc.—recommendations for routine screenings like mammograms weren't so clear-cut. "If you are due for routine mammography but do not have a high risk of breast cancer, your screening may be rescheduled," wrote the ACOG. And now that many states are beginning to reopen, the question of getting a mammogram has become even more blurry. “This is a complex topic because even though stay-at-home orders in many places are being relaxed or lifted, the pandemic is not over,” says Laura Makaroff, MD, senior vice president of prevention and early detection at the American Cancer Society. 

So what's your best move right now if you're due for a mammogram or you've recently had to push back your appointment due to the pandemic (and should it have been pushed back at all)? Here's what you need to know about routine breast cancer screenings during COVID-19, according to experts.

How safe is it to get a mammogram during COVID-19?

The COVID-19 pandemic has proven that nowhere you go is 100% safe, and there’s still a risk that you can catch the virus in any setting. But skipping an important cancer screening is risky, too. “As a breast surgeon, my concern is that people are not coming in and that we're going to see more advanced stages of breast cancer than usual because people are not getting diagnosed early,” Sarah Cate, MD, a breast cancer surgeon at Mount Sinai, tells Health. Delaying a mammogram for a month or two shouldn’t be a problem, but pushing it off for six months or waiting until next year allows a cancer that could have been caught early to progress. 

When it comes to choosing whether or not you want to postpone a mammogram, the answer is in weighing your risks, Dr. Makaroff says. Some things to consider: What is your personal risk for breast cancer, how common is COVID-19 in your area, and what is your risk for complications if you were infected with COVID-19? 

These questions should help you answer whether you should get screened ASAP or if it’s okay to delay a bit longer. If you’re at higher risk for breast cancer—say, if you know you have a mutation on a BRCA gene or you know you have a family history of breast cancer—or if you’ve felt a lump in one of your breasts, the chance of catching breast cancer at an early stage likely outweighs the risk of catching COVID-19 while you’re at the screening. If you’re at average risk for breast cancer, without anything in your or your family’s medical history to suggest greater risk, but at high risk for complications from COVID-19, it’s probably okay to delay a mammogram appointment until it feels safer to go out, as long as you clear that with your doctor. 

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On the subject of mammogram recommendations, there's something else you need to know: They're different than they once were. In 2015, the American Cancer Society updated its mammogram recommendations, and while the organization once said all women (or people assigned female at birth) should start getting mammograms at 40 and get one every year from then on, the ACS now says people at average breast cancer risk can wait until 45 to get their first mammogram. The organization recommends a yearly mammogram from ages 45-54, but says people can then transition to mammograms once every two years from age 55 onward. So if you’re over 55 and at average risk, skipping this year’s mammogram if you got one last year is likely totally fine, Dr. Makaroff says. 

Overall, skipping your mammogram or going in for an appointment is a personal choice, and there’s risk involved either way. “Cancer screening is always based on expert recommendations which take into consideration the benefits and harms of a particular screening test,” Dr. Makaroff says. “However, those recommendations do not account for the impact of COVID-19, which does in fact change that balance on a personal level.” 

If you’re on the fence about skipping a mammogram, make a call to your ob-gyn, who can help you parse the pros and cons based on your medical history. And if you do choose to make an appointment, know that the doctors there are doing everything they can to make the office as safe as possible. 

What exactly are doctors doing to keep patients safe during mammograms?

It's important to note that mammograms can be done at a few different places, including radiology or imaging centers, mammography clinics, and even some physicians' offices, according to the Susan G. Komen organization's website—and those places are taking every precaution they can to reduce the risk of catching COVID-19 for both patients and staff. 

“In general, I think it's perfectly safe to come to a facility like Mount Sinai where we're really taking a lot of measures to make sure that the facility is clean and safe,” Dr. Cate says. She adds that the hospital's cancer center isn’t close to parts of the hospital where COVID-19 patients are treated, and every patient who walks through the door is pre-screened with questions about whether they or someone in their household have been feeling sick within the last two weeks. Patients are also temperature screened before they come inside the office, to ensure no one has a fever. And as with other doctors’ offices, patients who come in without a mask are given one at the door, and hand sanitizer is set up at the doorway so they can sanitize their hands when they walk in.

Once patients make it inside, they’re kept at least six feet apart in the waiting room; the office has removed chairs to be sure patients keep their distance. Visitors are no longer allowed at appointments with patients. And the hospital, like many other cancer screening centers, has drastically reduced the number of appointments allowed per day, so there’s no chance of a crowded waiting room. “We have Saturday hours and we've extended into the evening so that we can still get people in and seen and imaged on time,” Dr. Cate says.

While the main concern with COVID-19 is that people can be asymptomatic—and therefore not know they might be spreading the virus—wearing masks, hand sanitizing, and keeping a six-foot distance severely diminishes the risk, Dr. Cate says. “All the doctors, the technicians, our nurses, and our staff are wearing masks and the patients are all wearing masks, so even if someone is asymptomatic the risk of transmission is exceedingly low,” she says. 

Columbia University's Department of Radiology, another location that performs mammograms, is also upping their safety standards in the wake of COVID-19. Those extra precautions include patient screenings as well, like temperature checks and questionnaires, extended hours to allow more social distancing, and increased cleaning practices to disinfect waiting rooms between patients, in addition to continued sterilization of equipment between exams.

Of course, there’s still the risk you’ll touch a surface with the virus or come in contact with someone who has it on your way to the office. To minimize that risk, follow the CDC’s guidelines. That includes avoiding public transportation, wearing a cloth mask to cover your nose and mouth, washing your hands as often as possible, and keeping your distance from anyone you pass by in the street or at the cancer center. 

Taking into account all of these precautions, the risk of catching COVID-19 at a mammogram appointment is low, and the benefit of a breast cancer screening could vastly outweigh the risk. It’s important not to neglect other parts of your health in an effort to avoid coronavirus.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDCWHO, and their local public health department as resources.

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