Make sure your doctor knows that just because you don't want a mammogram, it doesn't mean you don't want your breasts checked. You can tell your doctor you want a physical examination and to be taught how to do it yourself. If he is unwilling or has limited experience of physical examinations, you might ask to be referred to a clinic where these are routinely carried out, or find a doctor with a less rigid approach.

If you do decide to have a mammogram, shop around. Find out if the equipment to be used is dedicated that is, specially designed for mammography and therefore able to give the best image with the least radiation. Ask how many mammograms the lab does. The American College of Radiology recommends using a facility where each radiologist reads at least 10 mammograms a week. When was the machine last inspected and calibrated to check it is giving out the intended dose of radiation? Machines should be tested at least once a year.If a lump is found, either through mammography or self examination, you need to establish whether or not it is malignant. Some harmless cysts can be identified as such through a physical examination. If your doctors tells you it's a cyst but still suggests sending you for a biopsy (see main text), find out if it's really necessary. Is he just sending you off unnecessarily because he thinks it will put your mind are rest? A benign lump often changes with your cycle, becoming more tender before a period; a cancerous one won't.

If a lump is benign, returning each year for mammograms "just in case", is likely to serve only to create a problem where none existed.

Dr Ellen Grant, author of The Bitter Pill, warns that a benign lump indicates that your anti-oxidation systems aren't working properly. (The anti-oxidant defence system acts like a fire brigade to snuff out the combustion that goes on in cells when oxygen is used to burn food for energy or foreign germs. Without adequate anti-oxidants, these little "fires" can damage cells and, eventually, the immune system.) Radition from repeated x-rays will deplete your body's supply of anti-oxidating nutrients further, making cancer more likely.