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Receiving a Mammogram

A Mammogram is an X-ray image of your breasts used to screen for breast cancer. Mammograms play a key role in early breast cancer detection and help decrease deaths by breast cancer.

During a mammogram, your breasts are compressed between two firm surfaces to spread out the breast tissue. Then an X-ray captures black-and-white images of your breasts that are displayed on a computer screen and examined by a Radiologist, a Doctor who looks for signs of cancer or abnormalities.

A Mammogram can be used either for Screening or for Diagnostic purposes. How often you should have a Mammogram depends on your age and your risk of breast cancer.

Why It's Done

Mammography is X-ray imaging of your breasts designed to detect tumors and other abnormalities. Mammography can be used either for Screening or for Diagnostic purposes in evaluating a breast lump or other symptoms:

Screening Mammography

Screening Mammography is used to detect breast changes in women who have no signs or symptoms or new breast abnormalities. The goal is to detect cancer before clinical signs are noticeable to the patient or referring Doctor.

Diagnostic Mammography

Diagnostic Mammography is used to investigate suspicious breast changes, such as a new breast lump, breast pain, an unusual skin appearance, nipple thickening or nipple discharge. It is also used to evaluate abnormal findings on a Screening Mammogram that require more information and includes additional Diagnostic Mammogram images and/or Diagnostic Breast Ultrasound.


When to begin Screening Mammography

There is no set age to start Screening for breast cancer. Further, experts and medical organizations don't agree on when women should begin regular mammograms or how often the tests should be performed. Talk with your doctor about your risk factors, your preferences, and the benefits and risks of Screening. Together, you can decide what Screening Mammography schedule is best for you.

Doctor looking down at mammogram

Some general guidelines for when to begin Screening Mammography include:

Women with an average risk of breast cancer and no known symptoms usually begin Mammograms at age 40 and have them every one to two years. Women with a high risk of breast cancer benefit by beginning Screening Mammograms before age 40. Talk to your doctor about evaluating your individual risk of breast cancer. Your risk factors, such as a family history of breast cancer, a history of precancerous breast lesions or a confirm Gene Mutation of BRCA1/2 or sequencing related Gene Mutation, may lead your doctor to recommend Magnetic Resonance Imaging (MRI) in combination with mammograms.

Screening Mammograms can only be done EVERY 12 months due to the low-dose of radiation exposure and keeping within California’s regulations of “as low as reasonably achievable” (ALARA). If during these 12 months you notice a new symptom as listed above, see your regular Doctor to see if Diagnostic Mammogram Imaging is needed on the effected side.

Risks and limitations of Mammograms include:

Mammograms expose you to low-dose radiation. The dose is very low, though, and for most women the benefits of regular Mammograms outweigh the risks posed by this amount of radiation.

Mammograms aren't always accurate. The accuracy of the procedure depends in part on the technique used and the experience and skill of the Radiologist. Other factors — such as your age and breast density — may result in false-negative or false-positive mammograms.

Mammograms in younger women can be difficult to interpret. The breasts of younger women contain more glands and ligaments than do those of older women, resulting in dense breast tissue that can obscure signs of cancer. With age, breast tissue becomes fattier and has fewer glands, making it easier to interpret and detect changes on mammograms.

Having a Mammogram may lead to additional testing. Among women of all ages, about 10 percent of mammograms require additional testing, including additional imaging tests such as, specialized Diagnostic Mammogram Imaging, Ultrasound, and a procedure (Stereotactic or Ultrasound guided biopsy) to remove a sample of breast tissue for laboratory testing.

However, most abnormal findings detected on mammograms aren't cancer. Patients with Dense Breast may benefit from additional Imaging with 3D Tomosynthesis, Ultrasound or MRI. Your Radiologist will determine if you fall into this category based on your Mammogram Images.

If you have had Mammograms performed elsewhere, your Radiologist will ask for your permission to have them sent to our Radiology center so that they can be compared with the current Mammogram. Your Radiologist will want to compare your current Mammogram Images with previous Mammograms to look for abnormal changes. If any are seen, your Radiologist could ask for additional imaging as stated above.

Screening Mammography can't detect all cancers. Some cancers detected by physical examination may not be seen on the Mammogram. A cancer may be too small or may be in an area that is difficult to view by Mammography, such as your armpit. Mammograms can miss 1 in 5 cancers in women.

Not all of the tumors found by Mammography can be cured. Certain types of cancers are aggressive, grow rapidly and spread early to other parts of your body.

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How you prepare for your mammogram:

Choose a certified Mammogram facility. Schedule the test for a time when your breasts are least likely to be tender. If you haven't gone through menopause, that's usually during the week after your menstrual period. Your breasts are most likely to be tender the week before and the week during your period.

Bring your prior Mammogram images. If you're going to a new facility for your Mammogram, request to have any prior Mammograms placed on a CD. Bring the CD with you to your appointment or send it in before, so that the Radiologist can compare past Mammograms with your new images.

DO NOT use deodorant before your Mammogram. Avoid using deodorants, antiperspirants, powders, lotions, creams or perfumes under your arms or on your breasts. Metallic particles in powders and deodorants could be visible on your Mammogram and cause confusion or unnecessary further imaging.

Consider an over-the-counter pain medication if you find that having a Mammogram is uncomfortable. Taking an over-the-counter pain medication, such as aspirin, acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others), about an hour before your mammogram might ease the discomfort of the test.

What you can expect

During the test:

At the testing facility, you're given a gown and asked to remove neck jewelry and clothing from the waist up. To make this easier, wear a two-piece outfit that day.

For the procedure itself, you stand in front of an X-ray machine specially designed for Mammography. The Technologist places one of your breasts on a platform and raises or lowers the platform to match your height. The Technologist helps you position your head, arms and torso to allow an unobstructed view of your breast. Your breast is gradually pressed against the platform by a clear plastic plate. Pressure is applied for a few seconds to spread out the breast tissue. The pressure isn't harmful, but you may find it uncomfortable or even painful. If you have too much discomfort, tell the Technologist.

Your breast must be compressed to even out its thickness and permit the X-rays to penetrate the breast tissue. The pressure also holds your breast still to decrease blurring from movement and minimizes the dose of radiation needed. During the brief X-ray exposure, you'll be asked to stand still and hold your breath.

After the test:

After images are made of both your breasts, you may be asked to wait while the Technologist checks the quality of the images. If the views are inadequate for technical reasons, you may have to repeat part of the test. The entire procedure usually takes less than 30 minutes. Afterward, you may dress and resume normal activity.

In the United States, federal law requires Mammogram facilities to send your results within 30 days, but you can usually expect to receive your results sooner. Ask the Technologist what you can expect.

In addition, many states have passed legislation requiring Mammogram facilities to inform you about the density of your breast tissue on the Mammogram.

Results

A Radiologist interprets the Mammogram images and sends a written report of the findings to your doctor. The radiologist looks for evidence of cancer or noncancerous (benign) conditions that may require further testing, follow-up or treatment. Your report will feature a BIRADS number. Doctors use a standard system to describe Mammogram findings and results. This system (called the Breast Imaging Reporting and Data System or BI-RADS) sorts the results into categories numbered 0 through 6. By sorting the results into these categories, doctors can describe what they find on a Mammogram using the same words and terms. This makes accurately communicating about these test results and following up after the tests much easier. Your mammogram report will also include an assessment of your breast density, which is a description of how much fibrous and glandular tissue is in your breasts, as opposed to fatty tissue. The denser your breasts, the harder it can be to see abnormal areas on mammograms. Radiologists use the Breast Imaging Reporting and Data System, or BI-RADS, to classify breast density into 4 categories. They go from almost all fatty tissue to extremely dense tissue with very little fat.

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Category 0

Addtional imaging evaluation and/or comparison to prior mammograms are needed.

This means the radiologist may have seen a possible abnormality, but it was not clear and you will need more tests, such as another mammogram with the use of spot compression (applying compression to a smaller area when doing the mammogram), magnified views, special mammogram views, or ultrasound. This may also suggest that the radiologist wants to compare your new mammogram with older ones to see if there have been changes in the area over time.


Category 1

Negative

There’s no significant abnormality to report. Your breasts look the same (they are symmetrical) with no masses (lumps), distorted structures, or suspicious calcifications. In this case, negative means nothing bad was found.


Category 2

Benign (non-cancerous) finding

This is also a negative mammogram result (there’s no sign of cancer), but the radiologist chooses to describe a finding known to be benign, such as benign calcifications, lymph nodes in the breast, or calcified fibroadenomas. This ensures that others who look at the mammogram will not misinterpret the benign finding as suspicious. This finding is recorded in your mammogram report to help when comparing to future mammograms.


Category 3

Probably benign finding – Follow-up in a short time frame is suggested

The findings in this category have a very high chance (greater than 98%) of being benign (not cancer). The findings are not expected to change over time. But since it’s not proven to be benign, it’s helpful to see if the area in question does change over time.

You will likely need follow-up with repeat imaging in 6 months and regularly after that until the finding is known to be stable (usually at least 2 years). This approach helps avoid unnecessary biopsies, but if the area does change over time, it still allows for early diagnosis.


Category 4

Suspicious abnormality – Biopsy should be considered

Findings do not definitely look like cancer but could be cancer. The radiologist is concerned enough to recommend a biopsy. The findings in this category can have a wide range of suspicion levels. For this reason, some, but not all, doctors divide this category further:

4A: Finding with a low suspicion of being cancer

4B: Finding with an intermediate suspicion of being cancer

4C: Finding of moderate concern of being cancer, but not as high as Category 5


Category 5

Highly suggestive of malignancy – Appropriate action should be taken

The findings look like cancer and have a high chance (at least 95%) of being cancer. Biopsy is very strongly recommended.


Category 6

Known biopsy-proven malignancy – Appropriate action should be taken

This category is only used for findings on a mammogram that have already been shown to be cancer by a previous biopsy. Mammograms may be used in this way to see how well the cancer is responding to treatment.

Possible findings include:

  • Calcium deposits (calcifications) in ducts and other tissues
  • Masses or lumps
  • Asymmetric areas on the Mammogram
  • Dense areas appearing in only one breast or one specific area on the Mammogram
  • New dense area that has appeared since your last mammogram

Calcifications can be the result of cell secretions, cell debris, inflammation and trauma, among other causes. Tiny, irregular deposits called Micro calcifications may be associated with cancer. Larger, coarser areas of calcification may be caused by aging or by a benign condition such as Fibroadenoma, a common noncancerous tumor of the breast. Most breast calcifications are benign, but if calcifications are irregular in appearance, have increased in number or appear worrisome, the radiologist might order additional Diagnostic images with magnification and possibility of a Stereotactic or Ultrasound guided biopsy.

Dense areas indicate tissue that is more glandular than fatty, which can make calcifications and masses more difficult to identify or differentiate from normal glandular tissue. Dense areas can also represent cancer. Distorted areas suggest tumors that may have invaded neighboring tissues.

If the radiologist notes areas of concern on your Mammogram, further testing may include additional Mammograms, known as Compression or Magnification views, as well as Ultrasound imaging or a procedure (Stereotactic or Ultrasound guided biopsy) to remove a sample of breast tissue for laboratory testing.

Some situations require the use of Diagnostic Magnetic Resonance Imaging (MRI) in areas where the current imaging with Mammography or Ultrasound is negative and it's not clear what's causing a breast change or abnormality.

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