Although National Breast Cancer Awareness Month is drawing to a close, it is still important to maintain good breast health through annual mammograms and monthly self-exams.According to the American Cancer Society annual mammograms and monthly self-exams can lead to early detection and early treatment of breast cancer.Maj. Sara Michael, Blanchfield Army Community Hospital diagnostic radiologist and section chief of mammography and ultrasound, said women should begin having mammograms after their 40th birthday.A mammogram is a X-ray of the breast that is taken with a device that compresses and flattens the breast."There are multiple reasons why it is good to get a mammogram," Michael said. "One is that it's our only proven, population-based way to screen breast cancer. While it's not a perfect exam it is the best one that has been found over a whole population in order to detect breast cancer at an early stage."From mammograms, physicians can diagnose breast health issues including abnormalities."A lot of what we see on mammograms we can explain by seeing that same area on a mammogram from several years ago, so by having several images to look at it becomes easier and easier to detect sudden abnormalities that may indicate a tumor is growing," she said.Michael said having a mammogram annually gives the physician more content to analyze to determine the issue and quickly resolve it."If we only have a mammogram from every other year, we've already reduced our chances by 50 percent," she said. "It becomes a little more difficult to tell if what we are seeing on the most current mammogram is something that really is new or it's just because we have positioned the breast a certain way that now something looks a little bit more apparent that it has in the past."Many of these issues stem from taking a 3D object -- a breast -- and making it into a 2D image, Michael said. She said there will be some superimposition artifacts because of that.Patients can be called back for more imaging if their mammograms are not clear.In 2013, 66.8 percent of women 40 years old or older had a mammogram in the past two years, according to the Centers for Disease Control and Prevention. Michael said some women don't get mammograms regularly because of the pain and awkwardness associated with the procedure."[Having a mammogram] during the first part of your menstrual cycle can make it less painful because your breasts are less sensitive then," she said. "Also just having the mental knowledge that it's only for a couple of seconds can sometimes get you through the pain."Michael said to alleviate the pain patients can take pain relievers about 30 minutes before their appointment. She said to eliminate any awkwardness between the patient and the radiologist, the patient can always ask to meet them before the procedure."I know it can be very awkward, but please know that the vast majority of our technologists here at BACH are female so they themselves are also getting mammograms and they often have empathy and know exactly what you are going through."She said many of BACH's mammographers spend their entire day helping women through the mammogram process."That's what they do all day long," she said. "So not only have they seen breasts of all shapes, sizes and types, they also don't really care. They are medical professionals. It's not as sensitive to them in terms of the social stigma."In addition to annual mammograms, women are also encouraged to conduct monthly self-exams of their breasts. Michael said while this is completely supplementary to mammograms, they are still an important part of breast health."The No. 1 thing we suggest is that you do monthly self-exams around the same time of the month and same time of your menstrual cycle from month to month," she said. "Your breasts do undergo changes during the menstrual cycle so sometimes those changes can be misconstrued as a mass when it's just your body changing through the cycle."Michael said women who are starting to do their self-exams should seek guidance from a primary care physician or a gynecologist."Do it at the same time, in the same place and in the same manner," she said. "Learn how to do it in the correct manner, because it is somewhat difficult. It's not easy."Recently, a few women at BACH have been diagnosed with breast cancer because they noticed abnormalities during their monthly self-exams."It happened even though they had a normal mammogram a couple months earlier," Michael said. "Even when we retrospectively look at their mammograms, knowing where that cancer is, we look at it and we still can't see it."Although there are several different ways to complete a self-exam, Michael said it is important not to forget the first part of the exam -- looking in the mirror."In addition to feeling, looking is important so don't neglect that," she said. "It may seem trivial, but in fact that's how one woman we recently diagnosed presented was that she looked at her breasts in the mirror and noticed that they weren't 'hanging' appropriately and noticed there was some slight dimpling."During self-exams women should be aware of skin changes, specifically skin thickening, new nipple retraction, any redness without signs of infection and nipple discharge, Michael said."The type of nipple discharge we are concerned with in anything that is spontaneous. Something that is happening on its own, not by you pressing on it or anything," she said. "Clear or bloody coming from one duct on one breast. We don't get too concerned if it's yellow, milk colored, green or even shades of white. Dried blood though, like a bronze color, we do worry about that too."Michael said women can reduce their risk of getting breast cancer by maintaining a good weight, eating healthy and exercising. BACH's radiology department does screening mammogram, diagnostic mammograms, needle localization, biopsies and ultrasounds for targeted reasons."We are here to support any decisions that are made to ensure our patient's health," Michael said. "We are here to help with the decision making process so we can get things done quickly and efficiently."