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Mammograms are one of the most effective ways to detect breast cancer early, when it¡¯s most treatable. MD Anderson recommends that women at average risk of breast cancer start getting mammograms every year beginning at age 40.

But there may be situations that make you second-guess your annual screening. ¡°Don¡¯t skip your mammogram. It could save your life,¡± says breast imaging radiologist ¡°With the right tools and our expertise, we can personalize our screening approach to your individual needs.¡±

Here, she shares seven situations when you might think it¡¯s OK to skip a mammogram ¨C but shouldn¡¯t.

1. Don¡¯t skip a mammogram if you have breast implants.

If you have breast implants, you may be hesitant to get a mammogram due to fear of damaging the implant. ¡°We take special care not to damage implants during mammograms, so the risk here is really low,¡± Omofoye says.? She adds that women with breast implants should be more inclined to get an annual mammogram. That¡¯s because beyond screening for breast cancer, in some cases, mammograms can help check that an implant is still intact.

¡°Sometimes with silicone implants, you may not know they¡¯ve ruptured. Mammograms are one way to tell that¡¯s not too invasive,¡± Omofoye says.

Since implants can obscure breast tissue during imaging, your care team may reposition the implants with their hands to temporarily to get a better look. They may also suggest additional imaging techniques, like an MRI or ultrasound, that don¡¯t require putting pressure on the breast.

¡°Before your appointment, let us know about if you have breast implants so we can plan ahead and cater to your specific needs,¡± Omofoye says.

It¡¯s also important to share your breast implant history with your care team because certain types of breast implants also increase your risk?of breast-implant associated anaplastic large cell lymphoma.

2. Don¡¯t postpone a mammogram while you¡¯re pregnant or breastfeeding.

¡°In general, being pregnant or breastfeeding reduces your risk of breast cancer, but it¡¯s not a guarantee,¡± Omofoye says.

Sometimes changes to your breasts during pregnancy or breastfeeding can mimic breast cancer symptoms. If you notice a lump, unusual discharge, rash, skin discoloration or nipple changes, you should not ignore these symptoms, Omofoye says. If you experience these for two weeks or longer, tell your doctor.

If you have a mammogram scheduled while you¡¯re breastfeeding, your care team may ask you to pump right before your exam to express as much breast milk as possible. ¡°This can make the procedure more comfortable and help us get a clearer image,¡± Omofoye says.

You may also be eligible for an ultrasound or other imaging that could reduce potential discomfort.

Depending on how long you plan to breastfeed, you may opt to delay a mammogram for a month or two. But, Omofoye says, it¡¯s important to maintain your regular screenings, especially if you plan to breastfeed for a year or more.

3. You still need an annual mammogram after breast cancer surgery.

Cancer can occur in any part of the breast tissue and can be found in nearby lymph nodes, Omofoye says.

Even though all breast tissue is removed during a mastectomy, you¡¯ll still need to work with your care team to determine which preventive screenings are right for you.

If you¡¯ve had a lumpectomy, you should still be getting mammograms, since you¡¯ll still have some breast tissue.

Especially if you¡¯ve only had one breast affected, you should be screening the other breast to monitor any abnormalities.

4. ?Mammograms are still needed during gender transition.

Since all humans have breast tissue, anyone can develop breast cancer. In fact, 2,650 men are diagnosed with male breast cancer each year in the United States, according to the .

Individuals going through gender transition may be at increased risk of hormone-driven breast cancer because of hormone therapies. ¡°When you adopt hormones, you adopt the risk that comes with them,¡± Omofoye adds.

No matter your gender identity or transition status, it¡¯s important to keep up with preventive health care. For example, if your assigned gender is female and you¡¯re transitioning to male, you may still need breast cancer screening. Similarly, biological males transitioning to female may need mammograms to keep an eye on their breast health.

Part of that means partnering with a care team you trust to make sure you¡¯re getting the right screenings for you. ¡°Our job is to be a part of your team to help you achieve your health goals,¡± Omofoye says.

5. Don¡¯t skip your mammogram because you¡¯ve had a history of normal results.

¡°Even if you¡¯ve always had normal mammograms, you should still get them regularly to be sure we¡¯re not missing anything,¡± Omofoye says. Breast tissue changes over time, and cancer can develop at any time.

Studies show cancer found between yearly mammograms tends to be smaller and responds better to treatment than cancers found later.

6. It¡¯s safe to get a mammogram during the COVID-19 pandemic.

Fear of contracting COVID-19 shouldn¡¯t keep you from getting your annual breast screening. ¡°The longer you wait in between mammograms, the more opportunity for something potentially serious to grow, which could make treatment more challenging,¡± Omofoye says.

But it¡¯s important to time your mammogram carefully because the COVID-19 vaccines can cause lymph nodes to swell, which could lead to an abnormal mammogram result. If you haven¡¯t received your COVID-19 vaccine or booster yet, schedule your breast screening first. If you¡¯ve had a recent vaccine, let your care team know so they can watch for any potential vaccine-related changes.

7. Mammograms are needed even as you age.

While women at average risk of breast cancer should start getting mammograms at age 40, there¡¯s no age recommendation for stopping them. ¡°People are living longer, and living well longer, so there¡¯s really no reason to stop your regular health screenings due to age,¡± Omofoye says.

She also points out that it¡¯s important to build a relationship with your care team and discuss your health goals. When breast cancer is diagnosed early, most patients need much less invasive treatment, so no matter your age, getting regular screenings can reduce your chances of having to go through grueling treatment.

¡°Our goal is to help you achieve the greatest health possible, no matter where you are in life,¡± Omofoye says.

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You may already know that MRIs and CT scans are two of the imaging methods doctors use to diagnose and stage cancer.?

But do you also understand what the difference is between them? And, how physicians decide which one is most appropriate for you?

To answer these and six other questions, we went to , a neuroradiologist who specializes in the diagnosis of brain tumors and head and neck cancers.

What are MRIs and CT scans?

A CT scan is like a series of X-rays taken very quickly in a circle around you. When combined and looked at together, they provide a detailed, three-dimensional image of your body.

MRIs use a large, powerful magnet and radio waves to create a similar picture. The radio waves cause the molecules in your body to line up in a certain way, and they send out signals when they revert to their normal positions. This gives us information about the different types of tissue in your body.

Both scans require patients to lie on a movable table that passes through a big, donut-shaped machine.

Is one type of scan better or more detailed than the other?

No. That¡¯s like comparing apples to oranges. They¡¯re both great, just in different ways. I think of them as complementary, because they give us different types of information.?

Generally, CT scans are better at spatial resolution, while MRIs are better at contrast resolution. That means CT scans are good at showing us where the edges of things are ¡ª where this structure ends and that other one begins. MRIs are good at showing us the differences between various parts of the body and can help cancer tissue stand out from normal tissue.

How do doctors decide which scan to use?

That depends on the patient, their particular type of cancer and what question the doctor is trying to answer. Everyone¡¯s case is unique.

If your doctor wants to assess a bony structure, for instance, then a CT scan could be good for that. But if they¡¯re trying to distinguish between normal tissue and cancerous tissue, an MRI is probably a better choice. If someone has a lot of ascites, though, or fluid-filled pockets, they can distort an MRI and make it difficult to get a good, clear image.

So, often, it boils down to: what¡¯s the best picture I can get based on the patient¡¯s condition?

What are some of the advantages and disadvantages of MRIs and CT scans?

A CT scan is much faster than an MRI. It¡¯s super-quick. The preparation usually takes longer than the scan itself, which lasts a minute or less. If someone is in a lot of pain, or if they find it hard to hold still for long periods of time, then a CT scan is often your best option.

We can see things more clearly sometimes with an MRI, but those take anywhere from 30 minutes to an hour to obtain, depending on how much of your body is being scanned. If someone moves during the scan, the images will be distorted.

Still, if doctors see something on a CT scan they¡¯re unsure about, they may order an MRI to get a better look at it and figure out what it is. That¡¯s why I think of MRIs as more of a problem-solving tool.?

Are CT scans or MRIs ever the preferred scan for a particular cancer?

Yes. CT scans are really good at showing lung cancer, for instance. But you¡¯re going to want an MRI for anything related to the spinal canal. MRIs are also the preferred scan for looking at brain tumors.

Is there any reason why someone should not?have an MRI or a CT scan?

Yes. Since a very powerful magnet is involved, let your doctor know if you have any metal implants, pacemakers or prosthetics before having an MRI. Also let them know if you have a history of metal-working (like welding) or have any type of foreign body embedded in your tissues, such as bullet fragments, metal flakes or shrapnel.

If something is ferro-magnetic (iron-based), it could become dislodged and move around inside your body during an MRI.

Why does the room tend to be cold when you get an MRI or CT scan?

A lot of patients comment about how cool it is in the room while they¡¯re getting an MRI. That¡¯s because MRI machines have a special cooling process, and we have to keep the room cold to prevent them from overheating. We offer patients heated blankets to stay warm.

Should patients be concerned about radiation from scans?

Some patients worry about exposure to ionizing radiation, which is used during X-rays, mammograms and CT scans. But we do everything we can to minimize the amount of radiation being used, while still obtaining the level of detail we need in an image. And, we wouldn¡¯t recommend a particular scan if we weren¡¯t totally convinced that the benefits of having it far outweighed any risks.

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If you¡¯ve never heard of double-hit lymphoma or you¡¯re unfamiliar with the specifics of the disease, you¡¯re not alone. This rare and aggressive subtype of diffuse large B-cell lymphoma (DLCBL) was first classified as a specific diagnosis in 2016.

But what sets it apart from other lymphomas, especially other types of diffuse large B-cell lymphoma? How is it diagnosed, and how is it treated?

To answer these questions, we spoke with lymphoma specialist

What is double-hit lymphoma?

Traditionally, diffuse large B-cell lymphoma (DLBCL) has been classified based on the risk of the cancer recurring. We considered a patient¡¯s age, the extent of the disease, lab results and the patient¡¯s overall health.

More recently, we¡¯ve been able to improve our prediction of high-risk disease by looking at the presence of oncogenes through molecular profiling. Oncogenes are the instructions for when cells die, when they reproduce and how they carry out their function. These genes are very regulated and have a specific order, but when they rearrange ¨C a process known as translocation ¨C it can result in cancer.

In diffuse large B-cell lymphoma, the most common abnormalities involve the oncogenes BCL2, BCL6 and MYC. When there is a translocation of the oncogene MYC with either the rearrangement of BCL2 or BCL6, the diagnosis is double-hit lymphoma. At times, the MYC gene is translocated with both BCL2 and BCL6 rearrangements; this can be referred to as triple-hit lymphoma. These abnormal chromosomal changes are what define the diagnoses and set them apart from other lymphomas.

What is double-expressor lymphoma?

Double-hit lymphoma and double-expressor lymphoma are sometimes lumped into one subgroup, but they¡¯re not the same. With double-expressor lymphoma, we¡¯re able to see overexpression of MYC, BCL2 or BCL6 proteins, but they may or may not have translocation. The chromosomes don¡¯t always rearrange like they do with double-hit lymphoma. That distinction is important because these diagnoses should be treated differently, too.

What are the symptoms of double-hit lymphoma?

This type of lymphoma usually makes people feel pretty sick. They may experience night sweats that require them to get up and change their bedding or lose weight without really trying. Often, patients?may lose more than 10% of their body weight. They also commonly report frequent fevers, fatigue and pain in areas of their body they hadn¡¯t previously experienced it.

Another sign to watch for is enlarged lymph nodes at the neck, under the arm or in the groin area. These swollen nodes are generally painless, but it¡¯s important to talk to your doctor if you experience these symptoms for longer than two weeks.

How is double-hit lymphoma diagnosed?

Like we do with other types of lymphoma, we look at a patient¡¯s blood cell counts and a bone marrow biopsy, as well as imaging results from PET scans and CT scans. To confirm the translocation of MYC with BCL2 and/or BCL6, we use a specialized technique called fluorescence in situ hybridization, commonly called FISH.

Double-hit lymphoma has an increased risk of spreading to the brain, so before starting treatment, patients often receive a lumbar puncture in the lower back to look for lymphoma cells in the fluid surrounding the brain.

How are double-hit and triple-hit lymphoma treated?

Although there are other chemotherapy options, the best and most commonly used one is an intensive regimen called dose-adjusted R-EPOCH. As with other regimens, patients need to be followed closely, but its side effects are manageable.

It¡¯s given as an infusion through a port or a PICC line over three or four days. You can receive this chemotherapy as an inpatient or outpatient procedure, depending on how well you¡¯re doing overall. As an outpatient, you¡¯ll receive a portable pump that¡¯s like a backpack, but you¡¯ll still have to come in every day to switch out the chemotherapy drug. It¡¯s also important to have a reliable caregiver who can call us or bring you in if something starts to feel off.

To help prevent lymphoma from spreading to the brain, you may also receive chemotherapy through a lumbar puncture. If we find lymphoma cells in the brain at diagnosis, we add different chemotherapy drugs to R-EPOCH to treat those cells.

Patients also used to receive an autologous stem cell transplant. But we¡¯ve seen that if patients have a complete response to the chemotherapy, the stem cell transplant isn¡¯t needed. Patients do just as well without a stem cell transplant if they receive the aggressive R-EPOCH therapy up front.

What are the treatment side effects?

With R-EPOCH, you¡¯re at an increased risk of infection. To help manage that risk, patients often receive additional medications, such as antibiotics or a growth factor shot, which helps boost your white blood cells and strengthen the immune system.

Other common side effects include hair loss, nausea, diarrhea and low blood count. Fortunately, we have good medications that can offer you relief from nausea and bowel changes. And two to three months after completing treatment, you can expect your energy level to return to normal and to see your hair grow back.

What if I have a relapse? How is it treated?

Unfortunately, if lymphoma comes back, it¡¯s hard to get under control again. If the disease has already responded once to chemotherapy, our first plan is usually more chemotherapy and an autologous stem cell transplant. But if that doesn¡¯t work, we have more options.

A newer treatment called CAR T cell therapy has changed the way that we treat lymphoma and can be an option that may provide a cure for a subset of patients. Several emerging therapies, including new chemotherapies as well as immunotherapies and targeted therapies, have also shown to be able to treat double-hit lymphoma.

Although double-hit lymphoma is rare, we¡¯ve come a long way understanding it better. I¡¯m hopeful for the future, and I want patients to be, too.

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