Monday, September 12, 2016

Relax it’s not that bad! Clearing Up the Confusion Surrounding Your Mammogram

By: Stamatia Destounis, MD, FACR, FSBI

It’s that time of year, and you need to make your screening mammogram appointment and anxiety begins!

There are many questions and misconceptions for women when considering scheduling their mammogram. This blog will discuss some of the questions women have asked me over the years and, hopefully my responses will offer a level of comfort and understanding of the mammography experience.

Why do I need to have a mammogram EVERY year? 

You probably have asked yourself this question: when should I have my first mammogram and how often thereafter? Your radiologist (the physician that interprets the mammogram) hears this a lot. The confusion around this question is understandable because there are conflicting opinions.

Here’s the thing: breast cancer, when found early, is curable (98% of breast cancer patients survive!).

Many national organizations, such as the American College of Radiology (ACR), the Society of Breast Imaging (SBI), the National Comprehensive Cancer Network (NCCN) and the American College of Obstetrics and Gynecology (ACOG), recommend that women get yearly mammograms starting at age 40. However, the U.S. Preventive Services Task Force (USPSTF) recommends against routine screening mammography in women 40-49 years. Instead the task force recommends mammography every other year starting at age 50.

Changing the intervals of screening in women 40 and older puts women’s lives at risk. Said screening mammography supporter Amy Robach, ABC Correspondent on Good Morning America, diagnosed at age 40 after receiving her mammogram on-the-air, “I’m lucky to be alive…. A year could have made a big difference.”

So what is the right decision? Take a look at the website “End the Confusion” and discuss your options and personal risk factors with your healthcare provider. Remember, yearly mammography SAVES lives!

How do I know where to go for a mammogram?

Choose a facility that is accredited to do mammography. On both the Food and Drug Administration (FDA) and the American College of Radiology websites, you can search for a facility near you that is accredited and certified.  

Why do I need to provide my medical history?

The medical history is very helpful as it gives me information regarding patients’ overall health, allergies, current medications and how these medications may affect the breast tissue.

Why is family history important?

A woman has a 1 in 8 chance of developing breast cancer over her lifetime, and women who have one or more first-degree relatives (mother/father, sister/brother, or daughter/son) diagnosed with breast cancer are at higher risk of developing cancer.

The age of your relative(s) at diagnosis can guide decision-making regarding when you begin screening mammography. For example: if your mother was diagnosed in her 30s, your first mammogram would most likely be recommended earlier than age 40.

Do I need to dress in any special way?

Not in particular. At most facilities, you will be called to the changing area to put on a patient gown. When changing into the gown, you need to undress from the waist up. So, a dress is not a great clothing choice for the day of your mammogram!

Jewelry, such as bulky necklaces and dangling earrings, can get in the way of positioning for the mammogram.

Can I wear deodorant?

Please do! Depending on the mammography facility, the technologist may ask if you have deodorant, powder or lotion on your breast. You may need to wipe this off if the technologist feels that it might be in the imaging field of view, as these products can appear as little white specks that may look like an abnormality on a mammogram.

Can I have a mammogram if I have breast implants?

Yes, you can have a mammogram. Patients with implants undergo screening mammography routinely without any problems. In addition to regular mammograms, there is a technique which displaces the breast tissue in front of the implant in order to see the tissue better. It is completely safe and will not damage your implant in any way.

Are there different types of mammograms?

Yes. Digital Mammography (DM) has replaced the traditional x-ray film mammogram. Most facilities in the United States have upgraded to DM. The most recent technology is

Digital Breast Tomosynthesis (DBT or 3D), which creates a 3-dimensional picture of the breast and offers advantages over DM. If you would like to have a DBT mammogram, you can ask your mammography facility if they offer this technology.

This is my first mammogram……what happens?

The technologist will bring you into the mammography room and go over some information, such as your date of birth, for what may seem to be the hundredth time! This is a good time to tell the technologist if you have any physical limitations, such as frozen shoulder or a back or neck problem that may limit the positioning technique.

Two views (x-ray images) of each breast are needed because the entire breast cannot be seen on one view. The CC view (cranial-caudal) takes a picture of the breast from top to bottom. The MLO view (medial lateral oblique) captures a side-to-side picture.

The technologist will guide and talk you through the positioning. Snug compression (lasting only seconds) is applied to hold your breast in place and spread the tissue out for a clear image. You may be asked to hold your breath or breathe very quietly during the x-ray.

Does compression hurt or cause cancer?

Compression doesn’t cause damage to your breast or cause cancer. In some rare instances, bruising might occur, especially if you are on blood thinners or aspirin. Compression can cause mild discomfort, but shouldn’t be painful. Communication with your technologist about your level of discomfort is very important. Remember that the compression is necessary because it gives a clearer picture of your breast. It prevents blurring from breast motion and helps spread out the tissues so that cancer is not hidden and that overlapping tissue doesn’t look like an abnormality.

Why do I need extra views?

Sometimes the technologist needs to repeat an image because not enough of the breast was included or the image is blurry. 

If you get called back for extra (so called additional) imaging, don’t panic! The need for extra views does not mean that there is a problem. In fact, the large majority of women (~80%) are normal and don’t need any other testing. Most extra views are due to an area of overlapped breast tissue, which is normal. Positioning the breast in another way (for the extra view) allows the radiologist to see this, letting you breathe a sigh of relief!

My breast density is mentioned on the mammography results; why do I need to know this?

Breast density is a measure of the amount of fatty tissue (fat) and fibroglandular tissue (glands, like milk ducts and milk lobules, and fibrous tissue) in the breast. This is evaluated by the radiologist interpreting your mammogram. There are four types of breast density: Fatty – totally made up of fatty tissue; Scattered – more fat than glandular tissue; Heterogeneously Dense – mostly dense tissue or areas of very dense tissue; Extremely Dense – almost all dense tissue.

Women who have dense breast tissue have a slightly higher risk of developing breast cancer than women with average dense breast tissue. Several states now have breast density laws that require each facility to let you know your breast density type. If you have dense or heterogeneous breast density, talk with your doctor about having additional screening tests, such as breast ultrasound.

In Conclusion:

Mammography can be intimidating. Hopefully, by reading my blog, you have a better understanding of what to expect. Call and get this life-saving screening test!

Stamatia Destounis, MD, FACR, FSBI is Managing Partner and radiologist at Elizabeth Wende Breast Care, LLC. and Clinical Professor of Imaging Sciences at University of Rochester School of Medicine & Dentistry, Rochester, NY.

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The Society of Breast Imaging‘s goal for its initiative End the Confusion is to provide evidence based information on breast cancer screening. We will continue to provide information and resources as well as our views on the latest breast cancer screening news so we encourage you to regularly visit the website, like us on Facebook and follow us on Twitter (@BreastImaging). Hopefully we have addressed and will continue to address any and all confusion you experience when it comes to breast cancer screening. 

*The Society of Breast Imaging welcomes contributions from guest bloggers. If you would like to be a guest blogger, please review the guidelines here and email your blog post to info@sbi-online.org.*

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