Who should have screening mammograms?Experts do not fully agree on when it is most efficacious for women at average risk to begin annual screening mammograms. To summarize the current guidelines by medical organization, the American College of Radiology (ACR), the Society of Breast Imaging (SBI) and the American Congress of Obstetricians and Gynecologists (ACOG) recommend starting your yearly mammogram (if you are at average risk) at age 40. The American Cancer Society recommends starting annual mammograms no later than age 45, but they also advocate having a conversation with your doctor at age 40 to discuss the benefits of annual mammograms for you.
Women with certain risk factors (such as family history, prior mantle radiation, or high risk genetic mutations) should discuss an appropriate screening program with their clinician. If you are pregnant or think you may be pregnant, talk to your clinician before scheduling a mammogram.
Even if you are breastfeeding, you can have a mammogram. Just remember to pump or nurse right before imaging. A mammogram will not affect your breast milk.
How can I practice good breast health?Good breast health involves three parts: getting annual screening mammograms, doing your own breast exam every month and having a yearly breast exam by your clinician. Call your clinician if you notice any breast changes: lumps, thickening, swelling, nipple discharge or nipple retraction. Avoid alcohol, exercise regularly, and maintain a healthy weight.
How should I prepare for a mammogram?If you have had mammograms in different facilities, call those facilities in advance and arrange to have your previous mammograms, reports and any other treatment reports forwarded to the radiology department prior to your mammogram appointment.
Do not wear antiperspirant, powder or cream under your arms because these may interfere with the quality of your mammogram. Wear a two piece outfit since you will be asked to undress from the waist up.
How is digital mammography performed?After undressing from the waist up, you will be given a gown to wear during the mammogram.
You and a technologist will be the only people present during the mammogram. The technologist will position each breast, one at a time, on the mammography equipment. Each breast will be compressed and images obtained.
Although it can be uncomfortable for some people, compression is important as it helps spread the breast tissue, improving visualization for the radiologist.
Are digital mammograms painful?Breast compression may cause some discomfort for a brief time during each x-ray. Any discomfort experienced after the exam should be relieved with ibuprofen or Tylenol (as your clinician permits). If you have sensitive breasts, schedule your mammogram at a time of the month when your breasts will be less tender. In general, the week after your period is when breasts are less tender.
How will I get my results?Your digital screening mammogram will be checked by the technologist and then by the board-certified radiologist (a doctor who reads the images). The radiologist reviews your films and compares them with any prior mammograms. The radiologist then dictates a report that is sent to your ordering clinician.
The radiology/mammography department will notify you by letter of your results. If further follow-up is required, our department will call you to discuss next steps.
What Does Having “Dense Breasts” Mean?
Breast tissue is made up of milk glands and ducts as well as some combination of fatty tissue and supportive tissues. There are four categories of breast tissue density. The first two are fatty and scattered. These categories are considered “not dense.” Then there's heterogeneously dense and extremely dense, which together are considered as having “dense breasts.”
About 10% of women fall into the extreme categories of fatty and extremely dense, while the middle range categories each represent another 40% of the population. Therefore, about half of the population has “dense breasts” because they either have heterogeneously dense or extremely dense breast tissue.
The state requires us to inform women if they are considered to have dense breast tissue, so if you get a letter saying you have dense breast tissue, don't be surprised and also don’t be alarmed. Having dense breast tissue does not directly increase your risk for breast cancer, but it does have an indirect effect on your overall risk. It makes it harder for us to see through the tissue and for you or your doctor to feel through the tissue, making it overall harder to find cancer. Therefore, there may be a slight increase in breast cancer risk the denser your breast tissue is. The letter is intended to make sure women are informed and can make the right decisions about proper screening technique.
What is the difference between 2D and 3D mammography?
Knowing whether you have dense breasts becomes important when you are scheduling your mammogram. If you do have dense breasts, you should schedule a 3D mammogram, also known as tomosynthesis. 3D mammography allows a doctor to examine your breast tissue by layers because the machine takes multiple images of the breast to create a 3D picture. 3D mammography does have a few downsides, like longer compression time and therefore slightly more radiation.
That’s not to say everyone needs to have a 3D mammogram – those with non-dense breasts, for example, can have 2D mammograms after their first mammogram.
What does it mean if I get called back for additional views from a screening mammogram?You may be called to come back for additional views that are requested by the radiologist. This is called a diagnostic study and may also include an ultrasound. A diagnostic study helps better evaluate specific areas of the breast. Most additional views do not reveal any underlying abnormalities. The radiologist will direct the additional images and look at your images while you wait. Your results will be communicated to you before you leave the department. The radiologist then dictates a report that is sent to your ordering clinician.
The good news is that most times when we find something it’s benign. We still may decide to do a follow-up diagnostic exam (and often a few follow-ups, meaning we will want to schedule diagnostic exams for the next 2-3 years) to document stability over time. Sometimes we will want to schedule a biopsy. If that happens, the doctor will explain that procedure to you.
What is the Difference between a Screening and a Diagnostic Mammogram?A screening mammogram is meant to be used if you have no issues – you haven’t felt anything unusual in your self-exams and you’re not being followed for anything. You come in and you leave, and you get your report as discussed above.
A diagnostic study is when you have a concern – if you or your doctor feel something OR if the radiologist saw something in your screening mammogram and calls you back.
If you feel something, it is very important to schedule a diagnostic appointment through your doctor’s office as soon as you can. Again, you should be scheduled for a diagnostic study and NOT a screening study if you have an area of concern. This way you will be able to talk to the radiologist and have the proper imaging done, which may include an ultrasound.
The good news is that most times when we find something it’s benign. We still may decide to do a follow-up diagnostic exam (and often a few follow-ups, meaning we will want to schedule diagnostic exams for the next 2-3 years) to document stability over time.
Sometimes we will want to schedule a biopsy. If that happens, the doctor will explain that procedure to you.
What training do the technologists and radiologists receive to perform and review this exam?Our technologists are certified and registered by the American Registry of Radiologic Technologists (ARRT) and licensed by the Massachusetts Department of Public Health (DPH). Our radiologists are all board certified in radiology and meet state requirements. Many of our radiologists also have had additional training in breast imaging.
How is the digital mammography equipment maintained to ensure accuracy?
A licensed physicist performs annual tests on the equipment. Equipment service personnel perform maintenance checks of the equipment twice a year. Technologists run quality assessment metrics daily on each machine.