Approximately 252,710 American women will be diagnosed with invasive breast cancer in 2017. Breast cancer is the second deadliest form of cancer in women, and of those who are diagnosed around 40,610 are predicted to die. The good news is that early detection radically increases a woman’s chances of survival, and advanced screening techniques (including the mammogram procedure) combined with new, personalized therapies are creating stronger, more effective ways for doctors and their patients to fight the disease ([1] American Cancer Society).
You probably know that the mammogram procedure is one of the most common ways that doctors screen patients for breast cancer. But how do you know if you should get one? And what should you expect if you’ve never had a mammogram procedure before?
Don’t let fear of the unknown prevent you from utilizing this potentially-lifesaving measure. Here we’ll demystify some important facts about mammograms, and talk through what you need to know about standard mammogram procedure before you get one.
SHOULD I GET A MAMMOGRAM?
A mammogram is an X-ray of the breast that is used to screen for and diagnose cancers and other breast diseases that may not be visible from the outside or detectable by touch (Johns Hopkins).
Women over 40, women with a personal or family history of breast cancer, and women who have tested positive for certain genetic markers associated with an increased risk for the disease appear to derive the greatest benefit from mammograms. Age is an important factor in determining when a woman should begin to use mammograms as a method of screening: younger women tend to have a lower incidence of breast cancer, and tend to have denser breast tissue that makes mammography less reliable as a preventative strategy.(UpToDate).
You and your doctor must work together to determine if mammograms are an appropriate screening strategy for you. Your doctor may order a mammogram as part of a regular, precautionary regimen (a “screening mammogram”), or if a lump or other anomaly is discovered during a previous mammogram or breast exam (a “diagnostic mammogram”). If so, your doctor will refer you to a radiology facility or clinic that is equipped to perform the procedure. You may also get a referral for a mammogram through Planned Parenthood (Planned Parenthood).
Mammograms are often an outpatient procedure, though your doctor may also order one as part of your treatment while you are in the hospital (Johns Hopkins). Your doctor may recommend mammograms in combination with other screening and diagnostic methods such as clinical breast exams (palpation or examination by touch), ultrasound or MRI imaging, and genetic testing. Modern techniques mean the radiation exposure a woman receives from a mammogram is considered to be negligible (UpToDate).
MAMMOGRAM PROCEDURE: WHAT TO EXPECT
Mammogram procedure may vary slightly from facility to facility, and from woman to woman. That said, there are several basic steps that you should take in order to prepare for your mammogram no matter where you go.
If you are visiting a mammogram facility for the first time, always bring your medical records with you or arrange to have them delivered to the clinic. ([2] American Cancer Society). Always inform the facility if you’ve had any kind of medical procedure performed on your breasts in the past, including previous mammograms, biopsies, breast implants, enhancements, or breast reductions. Always inform your technician in advance if you have breast implants, if you are pregnant, or if you are currently breastfeeding. Women with implants can (and should) still receive mammograms, though your facility may need to take extra measures to in order to ensure the most accurate results. Silicone or saline implants will obscure part of the breast tissue that is visible on a mammogram, and so additional imaging is typically required for women who have them. ([3] American Cancer Society). You may need to arrange for a technician or facility experienced in screening women with implants, so don’t be afraid to ask questions when you make your initial appointment (Johns Hopkins).
Be sure to remove any nipple piercings or jewelry on or near your breasts prior to your visit. Don’t wear antiperspirant, deodorant, skin creams, or powders on or near your breasts the day of your mammogram: many of these products contain metallic substances (like aluminum) which may appear on the mammogram as a white spot or calcification (Johns Hopkins).
When you arrive, your technician (also called a radiologic technologist) will talk you through the details of the mammogram procedure. Be sure to mention any lumps, changes, or unusual symptoms you may have noticed at this time, in addition to any hormonal treatments you may be taking or changes (like menopause) you may be experiencing.
Before your mammogram, your technician will ask you to remove your bra and clothing from the waist up and provide you with a gown. The technician will then have you stand in front of a mammography machine, which compresses each breast between two plates in order to take an X-ray picture. “Flattening” the breast in this way allows your technician to obtain a more accurate image, and also reduces the amount of radiation required for the procedure. This compression may be uncomfortable, but it shouldn’t be painful; scar tissue or recent surgery may cause greater discomfort for some women, and many women find it helpful to avoid scheduling their mammograms immediately prior to or during menstruation when breasts are more likely to be tender. (Johns Hopkins). Don’t be afraid to speak up and tell your technician right away if something is painful!
Your technician will scan each breast one at a time, repositioning the breast on the X-ray plate between each image. Typically, he or she will take two images per breast for women without implants, and four images per breast for women with implants, though the exact number of images may vary from woman to woman ([3] American Cancer Society).
All in all, the whole procedure should take 20-30 minutes. (Johns Hopkins)
WHAT NEXT?
After a radiologist has read and analyzed the X-ray films, the mammography clinic will send the results to the doctor who referred you. The clinic will also mail a summary of these results directly to you ([2] American Cancer Society). You may be asked to go back in for additional imaging after your initial mammogram. Remember that getting called back is quite common, and does not necessarily mean you have cancer. As the American Cancer Society notes, “less than 10% of women called back for more tests are found to have breast cancer.” ([4] American Cancer Society).
You may have heard about instances of “false positive” results from mammograms, or read about the risk of “overdiagnosis” and “overtreatment” associated with mammograms as a method of screening: that is, sometimes a mammogram may detect a lump or other disease that would typically be benign if it went undetected, leading to unnecessary treatment. The good news is that more specific, “personalized” screening measures – like using genomic testing to determine if a woman is at increased risk for breast cancer, and thusly more likely to benefit from mammograms – are helping doctors to reduce the incidence of false positives, keep costs down, and make the best possible use of mammograms as a screening and diagnostic tool (STAT).
Remember that it is often difficult to tell how aggressive a cancer or other disease may be through mammography alone, so always talk to your doctor about your options for further testing and treatment if your mammogram does come back with abnormal results. Don’t be afraid to ask questions if you have trouble understanding something, or to get a second opinion if you have any doubts or concerns about your results or treatment.
Above all, remember that mammograms are just one of the many resources women have at their disposal to make better, more informed choices about their health. And in the fight against cancer, a little knowledge can be a lifesaving thing.
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REFERENCES
[1] American Cancer Society – How Common Is Breast Cancer?
https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html
Johns Hopkins Medicine Health Library – Mammogram Procedure.
UpToDate.com – Screening for breast cancer: Strategies and recommendations. Joann G. Elmore, MD MPH. Topic last updated: August 26, 2016
Planned Parenthood – Statement from Planned Parenthood Federation of America Senior Director of Medical Services Dr. Deborah Nucatola on Breast Health Services. October 17, 2012
[2] American Cancer Society – Mammograms: What to Know Before You Go.
[3] American Cancer Society – Mammograms for Women with Breast Implants.
[4] American Cancer Society – Getting Called Back After a Mammogram.
STAT – Mammograms plus personalized treatment are the best options to fight breast cancer. Dennis Citrin, February 16, 2017.
