Mammography

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A mammogram is an x-ray of the breast. A screening mammogram is used to look for breast disease in women who have no symptoms, that is, they appear to have no breast problems. Screening mammography usually involves 2 views (x-ray pictures) of each breast. For patients with breast implants, additional views may be needed to include as much breast tissue as possible. Women who are breastfeeding can get mammograms. They are asked to express their breast milk before coming in for their mammogram appointment. A diagnostic mammogram is used to diagnose breast disease in women who have breast symptoms. Additional views are taken of the breast with a diagnostic mammogram to more carefully evaluate your symptoms.

Strict governmental guidelines are in place to ensure that our mammography equipment is safe and uses the lowest dose of radiation possible. Many people are concerned about the exposure to radiation, but the level of radiation in modern mammography does not significantly increase the risk for breast cancer. We are exposed to radiation from natural sources all the time. So, to put the radiation dose into perspective, the dose of radiation that you are exposed to when having a mammogram is equal to the natural background radiation you receive in 3 months.

For a mammogram, the breast is pressed between two plates to flatten and spread the tissue. Although this may be uncomfortable for a few moments, it is necessary in order to produce a good image. The compression only lasts a few seconds and the entire procedure for screening mammography takes only about 20 minutes. This procedure produces a black and white image of the breast tissue that is interpreted (“read”) by a radiologist. Radiologists are doctors who have special training in diagnosing diseases by looking at images of the body produced by using x-rays, sound waves, magnetic fields and other methods.

The radiologist is looking for several types of changesInterpreting mammograms can be challenging. A mammogram is like a fingerprint. The appearance of the breast on a mammogram varies a great deal from person to person and some breast cancers may produce changes in the mammogram that are difficult to notice. It is very important for the radiologist to have the films from previous examinations (not just the report) for comparison. This will help to identify small changes and detect cancer as early as possible.

• A mass, which may occur with or without calcifications. Masses can be many things, including non-cancerous cysts and fibroadenomas, but they could be cancer and may need to be biopsied to find out for certain.
• A cyst is a collection of fluid in a small sac in the breast tissue. It can feel like a soft lump. Either a breast ultrasound or removal of the fluid with a needle (aspiration) is used to confirm that it is indeed a cyst. It is rare for a cyst to be cancer but if the cyst has characteristics that are suggestive of cancer the fluid removed will be sent to the laboratory to be examined under the microscope for cancer cells.
• Calcifications or microcalcifications are tiny calcium deposits in the breast tissue that appear as small, white spots on the film. They may occur singly or in clusters. They are a sign of changes within the breast tissue and can be benign or suggestive of cancer based on their appearance and/or arrangement. If they appear benign, careful monitoring of them with periodic mammograms is recommended. If they are suggestive of cancer, a biopsy is recommended so the tissue can be carefully examined under the microscope for the presence of cancer cells.

A mammogram cannot prove that an abnormal appearing area is cancer. To confirm whether cancer is present, a tissue sample must be obtained and examined closely by a pathologist (a doctor with special training in diagnosing diseases by looking at tissue samples under a microscope).

Both you and your primary healthcare provider will receive written results of your mammogram.

Mammography is imperfect at finding breast cancer. If you discover a breast mass, you should have a clinical breast examination, even if your mammogram is normal.

Tips For Having A Good Quality Mammogram

The following are suggestions for ensuring that you will receive a good quality mammogram.

• If you are coming to the Center for Breast Health for the first time, you should bring your previous mammograms with you, or have them sent to us prior to your appointment. By having your prior mammograms on the day of your appointment, the radiologist will be able to compare this mammogram with your previous ones to identify any changes.
• Do not wear deodorant, powder, lotion or creams on your breasts on the day of your mammogram. These preparations can interfere with the images and may appear in the film as calcium spots and could lead to an inadequate interpretation of your mammogram.
• You will be required to undress above the waist so it may be more convenient for you to wear a blouse and skirt/pants rather than a dress. A gown will be provided for you to wear during the procedure. Only you and one mammography technologist will be present during the mammogram. Our technologists are all women.
• You may feel some discomfort during the compression by the machine, but this should be tolerable. If you find the level of pain with compression extreme, ask the technologist about reducing the amount of compression. The compression will only last a few seconds and it is extremely important to obtain a quality image of your breast tissue.
• To help reduce the amount of discomfort, schedule your mammogram when your breasts are not tender or swollen. A suggested timeframe for scheduling your mammogram is 7-10 days after your period has ended.
• Be prepared to describe any pertinent medical history such as prior surgery, hormone use, family or personal history of breast cancer, age at first menstrual period, oral contraceptive use, number of pregnancies, age at birth of first child and any new problems you may be having with your breasts.
• The Mammography Quality Standards Act, under FDA regulation, requires mammography centers to notify you, in writing, about the results of your mammogram within 30 days. Your healthcare provider will also receive the results of your mammogram.
• If you do not hear from your healthcare provider within 10 days, do not assume that your mammogram was normal—call the Center for Breast Health or your healthcare provider’s office.
• If there is a concern or question with your mammogram, you will be contacted and arrangements made for additional evaluation.
• Of all mammograms performed, about 10% will require additional evaluation. The majority of these only need additional mammogram images. Do not be alarmed if this is requested of you. Only 2-4 mammograms out of every 1,000 lead to a diagnosis of cancer.