Is there a risk of radiation exposure from having regular mammograms?
You may want to ask your physician about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of X-rays, so that you can inform your physician. Risks associated with radiation exposure may be related to the cumulative number of X-ray examinations and/or treatments over a long period of time. Special care is taken to ensure that the lowest possible amount of radiation exposure occurs when you have a mammogram.
Mammography uses radiation to form images of the breast. The dose is extremely low, much lower than any other X-ray exam or CT scan. The amount of radiation from a mammogram is comparable to the amount you would receive on a cross-country flight.
The Women’s Diagnostic Center has lead aprons and thyroid shields available for all patients that may be concerned about radiation exposure.
Are mammograms painful?
Some women find the pressure of the plates on their breasts to be uncomfortable or even somewhat painful. Timing your mammogram when your breasts are not tender is important. In premenopausal women, this is usually one week after your menstrual period. If you do experience discomfort or pain, remember that each X-ray takes just a few moments and could save your life.
When should I have a screening mammogram?
We at the Women’s Diagnostic Center, along with the American Cancer Society and the American College of Radiology , recommend annual screening mammography starting at age 40. If you are high risk for breast cancer (if your mother or sister had breast cancer before the age of 50), then we recommend beginning screening 10 years before the age at which your mother or sister was diagnosed. For instance, if mom found out she had breast cancer at age 45, we would recommend starting screening at age 35.
How is it performed?
A screening mammogram consists of two views of each breast. In order to see through the breast tissues, it must be compressed. Our technologists are very experienced in positioning the breast as gently as possible, and the compression lasts only seconds while the mammogram is obtained, and the compression is released. It takes an average of about 10 minutes to take the four views. The technologist will then check the films to make sure they are of good quality. After that you are free to leave.
How is my mammogram read and who reads it?
When the technologist has finished your exam, the mammograms are placed through a computer-assisted detection system or CAD. The images are digitized and run through the CAD system and displayed for the radiologist to interpret.
All our radiologists read a large volume of mammograms and perform breast interventional procedures. We do not read your screening mammogram right when you are there. Why? Because we know that the best way to detect breast cancer is to read screening mammograms at a quiet time, with no interruptions. We read these studies the following day in batches with the aid of the CAD software. Because of this, we have the best chance of finding a cancer if there is one there.
What should I wear?
You will be asked to undress from the waist up for the exam. We provide robes to cover up. Any comfortable clothing is appropriate.
What preparation is needed?
We ask that you do not apply deodorant, lotions, powders or perfumes the morning of your mammogram, or that you wash this off thoroughly prior to your appointment. The flecks of deodorant can show up on the films and be confused for abnormalities.
How long will it take?
The exam should take less than 15 minutes.
When will I get results?
We read screening mammograms within 24 hours of your appointment. We send a letter to your home and to your doctor as soon as possible, always within three days of your appointment. If there is any finding on the films, we will call you immediately in addition to sending you a letter.
What if I have had mammograms at another facility in the past?
Prior exams are needed in order to compare changes within your breast tissue. It would be best if the exams could be sent to the Women’s Diagnostic center prior to your appointment. However, we would be happy to facilitate the process at the time of your exam. Please note that if your exams are not available at the time of your appointment, there will be a delay in your results until the prior exams are received.
What is the difference between a screening mammogram and a diagnostic mammogram?
A Screening Mammogram is a routine radiologic examination of both breasts performed on a woman who does not have symptoms of breast disease, is not at high risk for breast cancer, and has no present or recurrent breast-related problems, for the purpose of early detection of breast cancer. Screening mammograms are also performed on women who are at high risk for breast cancer, including those with a family history of breast cancer; women who gave birth after age 30 or who never gave birth; or women who have had a history of biopsy-proven benign breast disease.
Diagnostic Mammography is technically the same radiologic procedure as a screening mammogram. The main difference is that this procedure focuses on the signs or symptoms of breast disease – including pain, nipple discharge, masses or lumps, etc.; a personal history of breast cancer, endometrial cancer of unknown origin; or breast implants/augmentation that were presented in the screening mammogram or other doctor visits. Diagnostic mammography is used to evaluate women with suspicion of breast disease either because of physical changes noted by the patient or her physician or because of abnormalities detected on a screening mammogram.
In addition to the four views obtained in a screening mammogram, there are many specialized views that are possible to further investigate a finding. The most common view is called a “spot compression magnification” view. This is a magnified view of a particular area of the breast. The radiologist may also want to do an ultrasound.
What is a call back?
In about 10% of cases, a question arises as a result of the screening mammogram. This does not mean that you have breast cancer. Most of these turn out to be entirely normal. But whenever there is a question, we will “call back” the patient for more views, and possibly an ultrasound. If this happens we will call you to arrange an appointment. We also send a letter to your home so that we will be sure to contact you.
Additional imaging may consist of:
- Additional orientations or "views" (images taken at different angles)
- Breast ultrasound which is frequently used to evaluate questionable areas such as suspected cysts seen at screening mammogram.
- Special mammography views, which may include magnification views or focal/spot compression views. Both are used to make a small area of breast tissue easier to evaluate.
Magnification views use a small magnification table which brings the breast closer to the x-ray source and further away from the film plate. This allows the acquisition of "zoomed in" images (2 times magnification) of the region of interest. Magnification views provide a clearer assessment of the borders and the tissue structures of a suspicious area or a mass. Magnification views are often used to evaluate micro-calcifications, tiny specks of calcium in the breast that may indicate a small cancer.
Spot compression is also known as compression mammograms, spot views, cone views, or focal compression views. All mammograms involve compression of the breast. Spot views apply the compression to a smaller area of tissue using a small compression plate or cone. By applying compression to only a specific area of the breast, the effective pressure is increased on that spot. This results in better tissue separation and allows better visualization of the small area in question. Spot compression views show the borders of an abnormality or questionable area better than the standard mammography views. Some areas that look unusual on the standard mammography images are often shown to be normal tissue on the spot views. True abnormalities usually appear more prominently and the margins (borders) of the abnormality can be better seen on compression views.
Please note that women who are recalled for additional or special views should not be alarmed. Eight out of ten patients (80%) that get recalled for additional views are subsequently categorized as "benign" or "probably benign" and receive follow up with mammography in 12 months or 6 months, respectively. Only about one out of ten women who are recalled for special views are determined to have carcinoma.
How do you know if you are at high risk for breast cancer?
High risk factors for breast cancer include:
- Family history of breast cancer - two or more first degree relatives with breast cancer, especially if they were diagnosed when premenopausal
- Personal history or family history of the breast cancer gene BRCA 1 or BRCA 2
- Personal history of radiation therapy to the chest between the ages of 10 and 30 years
- Lifetime risk of breast cancer scored at 20-25% or greater, based on one of several accepted risk assessment tools that look at family history and other factors. This category often requires consultation with a genetic counselor who can assess breast cancer risk using various computer models.
What happens if something suspicious is found on my mammogram?
If there is a suspicious finding on your mammogram, you will typically need to have additional views and/or ultrasound performed. The radiologist will consult with you in person and will recommend additional evaluation to make a diagnosis. This might be ultrasound-guided core biopsy, stereotactic breast biopsy, cyst aspiration, needle localization and surgical consultation, or MRI-guided biopsy. We will make every attempt to schedule and perform these procedures as soon as possible, so that our patients do not have to endure a long wait to find out whether or not they have breast cancer.
Are there new techniques being studied to improve the accuracy of breast screening?
There are many exciting technologies being investigated in the field of breast imaging. All of this work is in the hopes of detecting breast cancer at the earliest stage possible to allow patients the best chance for a cure.
One new technology being developed is Tomosynthesis, an adjunct to digital mammography. In conventional mammography, a 3-D structure (the breast) is evaluated with a 2-D image. A major drawback of mammography is that structures can be superimposed on a single image. This can result in cancers being hidden on the image or can cause the false appearance of cancer, leading to unnecessary biopsies, etc. Tomosynthesis is a 3-D digital technique that removes the effect of superimposed structures by taking multiple low dose exposures of the breast and processing the information into 1 mm thick slices. This shows promise in improving detection of breast cancers by mammography and decreasing the rate of false positive studies.
Breast-specific gamma imaging (BSGI) and Positron emission mammography (PEM) are developing nuclear medicine techniques which also show promise in detecting breast cancer at early stages. Rather than depending on the shape or appearance of cancer, these techniques depend on the metabolism or biology of the lesion for detection.
To schedule an appointment at the Eunice Q. Sorin Women's Diagnostic Center, please call the scheduling line at 410-641-9714. Schedulers are available Monday through Thursday, 8 a.m. to 5:30 p.m. and Friday, 8 a.m. to 4:30 p.m.