Mammography

Over the past 15 years, the technical advancements in mammography have greatly improved both technique and results. Today, dedicated equipment, used only for breast x-rays, produces studies that are high in quality with negligible radiation risk.

To schedule an appointment for a mammogram, call 919.731.6013.

Why Are Mammograms Important?

Annual mammograms can detect cancer early – when it is most treatable. In fact, mammograms show changes in the breast up to two years before a patient or physician can feel them. Mammograms can also prevent the need for extensive treatment for advanced cancers and improve chances of breast conservation. Current guidelines from the American College of Radiology, the American Cancer Society, and the Society for Breast Imaging recommend that women receive annual mammograms starting at age 40 – even if they have no symptoms or family history of breast cancer.

How Is Breast Cancer Detected?

Methods for breast cancer detection include breast self-examinations, clinical examinations by a healthcare professional, and mammography. In most cases, mammography can identify an abnormal breast mass as much as two years before it can be detected by touch. Although breast cancer is the second leading cause of death in women, after lung cancer, the rate of deaths from breast cancer has declined in recent years. It is believed that early detection and treatment of breast cancers is the key to successful treatment and survival.

The American Cancer Society recommends the following guidelines for detecting breast cancer:

  • All women aged 20 or older should perform breast self-examination every month.
  • Between the ages of 20-39, women should have a clinical breast exam by a healthcare professional every 3 years.
  • Women 40 and older should have a screening mammogram and a clinical breast exam by a healthcare professional every year.

What is a mammogram?

A mammogram is an x-ray examination of the breasts, used to detect and diagnose breast disease. The results are recorded on x-ray film or directly into a computer for a doctor called a radiologist to examine.

A mammogram allows the doctor to have a closer look for changes in breast tissue that cannot be felt during a breast exam. It is used for women who have no breast complaints and for women who have breast symptoms, such as a change in the shape or size of a breast, a lump, nipple discharge, or pain. Breast changes occur in almost all women. In fact, most of these changes are not cancer and are called “benign,” but only a doctor can know for sure. Breast changes can also happen monthly, due to your menstrual period.

There are two types of mammograms:

A screening mammogram is used as a preventive measure for women who have no symptoms of breast disease. A screening mammogram usually involves two views of each breast. As long as you are not having any problems with your breasts and you have an established doctor (a primary care physician or OB-GYN whom you have seen within the past year), you can schedule a mammogram yourself.

A diagnostic mammogram involves additional views of the breast from various angles and is used when an abnormality is found during screening, or in women who have breast complaints such as a breast mass, nipple discharge, breast pain, or skin irritation. A diagnostic mammogram requires you to have a doctor’s order, this way we know they are aware of your problems and you can receive the best possible care.

How is a mammogram performed?

During your mammogram, you will stand in front of a special x-ray machine. The person who takes the x-rays, called a radiology technologist, places your breasts, one at a time, between an x-ray plate and a plastic plate. These plates are attached to the x-ray machine and compress the breasts to flatten them. This spreads the breast tissue out to obtain a clearer picture. You will feel pressure on your breast for a few seconds. It may cause you some discomfort; you might feel squeezed or pinched. This feeling only lasts for a few seconds, and the flatter your breast, the better the picture. Most often, two pictures are taken of each breast — one from the side and one from above. A screening mammogram takes about 20 minutes from start to finish.

A radiologist will read the exam and results of the mammogram will be forwarded to your doctor. Then you will receive a letter by mail to inform you of the results.

If I have breast implants do I still need to have a mammogram?

The guidelines for screening mammography for women with implants are the same as for women without them. Breast implants create a unique situation, because some breast tissue will be covered by the implant and cannot be seen on x-rays. To compensate for this, the number of films taken for each examination for a woman with implants is greater to allow as much breast tissue as possible to be imaged.

Is a mammogram painful?

Breast compression may cause some discomfort for a brief time during each x-ray. However, breast compression is necessary to spread the tissue apart and allow the maximum amount of tissue to be imaged and to reduce radiation dose. If you have sensitive breasts try to schedule your mammogram at a time of the month when your breasts will be less tender. In general, the week after your menstrual period will be when your breasts are the least tender.

Is a mammogram dangerous?

Today’s mammography units use very low doses of radiation to produce high-quality x-rays, making this a very safe procedure.

In addition, in 1992 Congress passed the Mammography Quality Standards Act (MQSA). This act established a set of rigorous guidelines that assure mammography safety. To receive certification by the FDA, a mammography facility must conform to these guidelines that assure that mammography systems are safe and use low doses of radiation. These facilities should have a certificate posted and visible to patients.

What can mammograms show?

The radiologist will look at your x-rays for breast changes that do not look normal and for differences in each breast. He or she will compare your past mammograms with your most recent one to check for changes. The doctor will also look for lumps and calcifications.

  • Lump or mass. The size, shape, and edges of a lump sometimes can give doctors information about whether or not it may be cancer. On a mammogram, a growth that is benign often looks smooth and round with a clear, defined edge. Breast cancer often has a jagged outline and an irregular shape.
  • Calcification. A calcification is a deposit of the mineral calcium in the breast tissue. Calcifications appear as small white spots on a mammogram. There are two types:
    • Macrocalcifications are large calcium deposits often caused by aging. These usually are not a sign of cancer.
    • Microcalcifications are tiny specks of calcium that may be found in an area of rapidly dividing cells.

If calcifications are grouped together in a certain way, it may be a sign of cancer. Depending on how many calcium specks you have, how big they are, and what they look like, your doctor may suggest that you have other tests. Calcium in the diet does not create calcium deposits, or calcifications, in the breast.

Why was I called back for another mammogram?

If you have to return for a second mammogram, it means the radiologist needs more information. Approximately 1 in 10 women will be called back for further examination after a screening mammogram. Do not worry. The fact that you require additional imaging does not mean you have cancer. Most abnormalities found during a mammogram are not breast cancer. In fact, 80% of women re-called for a diagnostic mammogram have benign (non-cancerous) conditions. These conditions range from cysts (collections of fluid in the breast) to benign tumors known as fibroadenomas.

What if my screening mammogram shows a problem?

If you have a screening test result that suggests cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor may ask about your personal and family medical history. You may have a physical exam. Your doctor also may order some of these tests:

  • Diagnostic mammogram, to focus on a specific area of the breast.
  • Ultrasound, an imaging test that uses sound waves to create a picture of your breast. The pictures may show whether a lump is solid or filled with fluid. A cyst is a fluid-filled sac. Cysts are not cancer. But a solid mass may be cancer. After the test, your doctor can store the pictures on video or print them out. This exam may be used along with a mammogram.
  • Magnetic resonance imaging (MRI), which uses a powerful magnet linked to a computer. MRI makes detailed pictures of breast tissue. Your doctor can view these pictures on a monitor or print them on film. MRI may be used along with a mammogram.
  • Biopsy, a test in which fluid or tissue is removed from your breast to help find out if there is cancer. Your doctor may refer you to a surgeon or to a doctor who is an expert in breast disease for a biopsy.

How do I get ready for my mammogram?

Here are some general guidelines to follow as you prepare for your mammogram:

  • If you are still having menstrual periods, try to avoid making your mammogram appointment during the week before your period. Your breasts will be less tender and swollen. The mammogram will hurt less and the picture will be better.
  • If you have breast implants, be sure to tell your mammography facility that you have them when you make your appointment.
  • Wear a shirt with shorts, pants, or a skirt. This way, you can undress from the waist up and leave your shorts, pants, or skirt on when you get your mammogram.
  • Don’t wear any deodorant, perfume, lotion, or powder under your arms or on your breasts on the day of your mammogram appointment. These things can make shadows show up on your mammogram.
  • If you have had mammograms at another facility, have those x-ray films sent to the new facility so that they can be compared to the new films.

To schedule an appointment for a mammogram, call 919.731.6013.

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