What Is A Mammogram?
A mammogram is an x-ray image of the breast that shows changes in the tissue, new lumps, or tiny clusters of calcium that can be the first signs of cancer that cannot be felt or seen on MRI, Ultrasound or breast self-exam. Mammography is the most effective method for detecting cancer in the early stages, and are often the first line of early detection. Generally, mammography is separated into 2 categories, Screening Mammograms and Diagnostic Mammograms. Bedford Breast Center is a state of the art facility equipped to perform the best diagnostic and screening mammogram Beverly Hills breast centers can offer.
Why Do I Need A Mammogram?
Mammograms can show breast lumps before they can be felt by breast self-exams or clinical breast exams. They can also show tiny clusters of calcium. These specks of calcium can be caused by cancer, fatty cells or other things like cysts. Additional screening methods may be needed to find out if abnormal cells are present. Routine screening mammograms can find the presence of cancerous cells before it grows or spreads which can greatly increase survivability.
What’s The Difference Between Screening and Diagnostic Mammography?
Screening mammograms look for signs of cancers. “Screening” mammogram implies that there is nothing wrong, that there are no symptoms, no problems or complaints of breast disease – that neither you nor your doctor feel anything out of the ordinary. A screening mammogram normally is taken with 2 x-ray views of each breast. Although, for some women with larger breasts, additional images may be necessary. The goal of a screening mammogram is find breast cancer when it’s too small to be felt. This is a once-a year check done to make sure that subtle unsafe findings are not present. Yearly screening mammograms are recommended for all women starting at the age of 40 as well as a yearly clinical breast exam by your healthcare professional. If you have a higher risk for breast cancer your doctor may recommend a mammogram at an earlier age. Finding breast cancer as early as possible before it has grown or spread greatly improves a woman’s chance for a successful treatment.
Diagnostic mammograms investigate possible problems and involves additional views of the breast. These images are the same images as a screening mammogram, the difference is that we are focused on an area that was raised by you, your doctor or as indicated from a previous screening that showed an area standing out as abnormal from the surrounding tissue. It needs to be evaluated by a doctor on site while you are present. We will give you a clear understanding on what we need to do next. Sometimes diagnostic mammograms will be used for women who were previously treated for breast cancer.
What is Digital Mammography?
Both conventional and digital mammography use x-rays to produce an image of the breast. Conventional mammography stores the image directly on film. Digital mammography is an electronic image stored as a computer file. The digital image can be enhanced, magnified and or manipulated for further evaluation much more easily than the film counterpart.
Digital mammography allows doctors to adjust, store and retrieve the digital images electronically with offers some advantages over conventional mammography.
- Healthcare providers can share files electronically making long distance consultations, second opinions, and consultations with breast surgeons much easier.
- Subtle difference between normal and abnormal tissues may be easily examined.
- Fewer repeat images may be needed, reducing the exposure to more radiation.
- Fewer follow-up procedures may be needed.
Digital mammography can be done in facilities that are certified to practice conventional mammography. The procedure for having a mammogram whether it’s digital or conventional is the same.
A Diagnostic Mammogram Is Usually Interpreted In 1 Of 3 Ways:
1. What is seen or felt is likely attributable to healthy things.
- We may want to check that area again in six months, to be extra safe. (This does NOT mean you need a mammogram every six months FOREVER)!
- We may feel completely confident that it is safe and feel that you can return to your regular screening schedule without any additional images or intervention.
2. It requires additional imaging to get more advanced views and a clearer understanding on whether or not it is safe or unsafe; either Dr. Memsic or Dr. Richardson can provide this additional order, if you are under their care, if not, your referring physician will need to provide the order for this additional imaging.
3. It requires a tissue sample (biopsy) to discern the nature of the area.
- This can sometimes be done during the same visit, if it is seen on ultrasound.
- If it requires mammogram guidance, this may need to be done at a later time as it requires more preparation than an ultrasound biopsy.
- Surgical removal is not usually the first line of investigation before a core needle biopsy has been done, but it can be a good choice for specific situations. Let us know if you think you may fall into this category.
You MUST have an ORDER from a doctor to have a diagnostic mammogram. If you have an order for a mammogram in Beverly Hills, we can help you with this. If you have seen Dr. Memsic or Dr. Richardson at our Breast Care Center, we can sometimes provide this order for you.
What Are Doctors Looking For On A Mammogram?
A mammogram is the first in a series of tests that will help reveal a bigger picture. While they’re looking for possible cancer, your doctors may also come across masses or structures in the breast that deserve further investigation, including:
Even if you have a lump in only one breast, pictures will be taken of both breasts. This is so the breasts can be compared and so that the other breast can be checked for abnormalities. If you’ve had a mammogram before, the radiologist should compare your old mammogram to the new one to look for changes.
Your mammogram report will also contain an assessment of breast density. Breast density is based on how fibrous and glandular tissues are distributed in your breast, vs. how much of your breast is made up fatty tissue. Dense breasts are not always abnormal, but they are linked to a higher risk of breast cancer. We know that dense breast tissue can make it harder to find cancers on a mammogram, sometimes additional tests may be needed to determine if a woman is at risk for having or developing breast cancer.
Calcifications: are tiny mineral deposits within the breast tissue that look like white spots on a mammogram and can sometimes indicate the presence of an early breast cancer. Depending on how they’re clustered, their shape, size, and number, your doctor may want to do further tests. There are 2 types of calcifications.
- Macrocalcifications: are large calcifications, usually not associated with cancer and are most likely due to changes in the breast caused by aging breast arteries, injuries, or inflammation. These are usually found in women over 50 years old.
- Microcalcifications: are small calcifications, tiny specks of calcium in the breast. Doctors are more suspicious about microcalcifications, but they do not always mean that cancer is present. The shape and layout of microcalcifications help the radiologist judge how likely it is that cancer is present. Groups of small calcifications, called “clusters of microcalcifications,” are associated with extra breast cell activity. Most of the time this is non-cancerous extra cell growth, but sometimes clusters of microcalcifications can occur in areas of early cancer. In some cases a biopsy might be needed to determine if it is cancerous.
Masses: which is an area of the breast tissue that looks abnormal. Masses can be caused by a number of things like cysts or solid masses.
- Simple Cyst: are fluid filled sacs. Cysts are very common and are rarely associated with cancer. A cyst and a tumor can feel alike on a physical exam. They can also look the same on a mammogram. To confirm that a mass is really a cyst, a breast ultrasound is often done. Another option is a Needle Aspiration which removes the fluid from the cyst with a thin, hollow needle.
- Fibroadenomas: are movable, solid, rounded lumps made up of normal breast cells. While not cancerous, these lumps may grow. And any solid lump that’s getting bigger is usually removed to make sure that it’s not a cancer. Fibroadenomas are the most common kind of breast mass, especially in young women.
- Lump or mass: If a mass is not a simple cyst (that is, if it is at least partly solid), then you may need to have more imaging tests. Some masses can be watched with periodic mammograms, while others may need a biopsy. The size, shape, and margins (edges) of the mass help the radiologist determine if cancer is present. 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.
What Should Women With Breast Implants Do About Screening Mammograms?
Women with breast implants should continue to have mammograms. (A woman who had an implant following a mastectomy should ask her doctor whether a mammogram of the reconstructed breast is necessary.) It is important to let the mammography facility know about breast implants when scheduling a mammogram. The technician and radiologist must be experienced in performing mammography on women who have breast implants. Implants can hide some breast tissue, making it more difficult for the radiologist to detect an abnormality on the mammogram. If the technician performing the procedure is aware that a woman has breast implants, steps can be taken to make sure that as much breast tissue as possible can be seen on the mammogram.
A woman having a mammogram must undress from above the waist. You’ll remove your top and bra and put on a gown (which will be provided to you by the mammography facility) in a changing room. Our nurse will bring you to the mammography room, where our mammography technician will help position your breast between two flat panels that are used to gently compress the breast to flatten and spread out the breast tissue.
While compression can be uncomfortable for some women, it’s also very important. Compressing the breast thins and evens the breast tissue and is necessary to obtain clear x-rays images. The mammography technician will then leave the room or go behind a screen and begin taking the x-rays. This process of positioning and imaging is repeated for additional views of the same breast or the other breast.
The entire procedure should take between 10 – 20 minutes for conventional mammography and a shorter 5 – 10 minutes for digital mammography. This time might increase for diagnostic vs screening mammography due to the additional views needed for diagnostic mammography.
- Two views are taken of each breast without implants
- Four views are taken of each breast with implants
- The amount of radiation exposure of a mammogram is less than flying from NYC to London and back, or less than the amount of radiation we are exposed to just living life in the US in a three month period
Preparing For A Mammogram
There are a number of steps that you can take in order to prepare yourself for your mammogram in Beverly Hills at the Bedford Breast Center.
- Schedule your mammogram just AFTER your period when the breast tissue is least tender and has the least amount of water retention. This will maximize accuracy and comfort.
- Bring previous mammography films or images on a CD – imaging centers can’t FAX or send images to us instantly or the same day – in order for us to have them, you must bring them with you or notify your former center 1-2 weeks before the appointment so that the images can arrive on time.
- Wear separates – (pants or skirt and a top), so that you can keep your bottoms on! Remember you will be undressing above the waist so if you wear a dress, you may feel more exposed once you remove it, we do provide a wrap for the exam, but most patients prefer to have a skirt or pants that they can keep on for the exam.
- Take Tylenol or Advil the morning of the study and avoiding salty food the day before to reduce discomfort.
- Notify the mammography facility when scheduling your mammogram appointment if you have breast implants.
- RELAX!! Stressing out can cause you to tighten up which may make positioning take longer and cause involuntary motion, which may mean having to repeat the images.
- Do Not Wear deodorant, powder or creams under your arms– metallic particles present in most deodorant can cause unnecessary spots on the images.
- Worry about results, don’t worry if we find something and have to redo the exam – or worry about being told that an abnormality is present; rechecking is common and there are lots of healthy reasons for us to look into taking additional pictures or wanting to investigate with another form of imaging such as ultrasound or MRI.
- Avoid wearing bulky jewelry that will have to be removed during the mammogram.
- You will be getting undressed and redressed – try not to wear complicated garments or that is difficult to take on or off.
Mammograms After Breast Cancer
If you have had surgery for breast cancer, such as lumpectomy or mastectomy, or you’ve had breast reconstruction after mastectomy, you’ll likely receive a different recommendation for having screening mammograms than women normally do.
Mammograms After Lumpectomy
If you had a lumpectomy, plus radiation therapy, you can expect to have a mammogram of the treated breast about 6 months after finishing treatment. Radiation can cause some changes in the breast tissue and skin. This 6-month mammogram will become the new “standard” against which future mammograms of the remaining breast tissue are compared to. From this point on, your doctor may say that yearly mammograms are sufficient. Or, he or she may recommend that the treated breast still get a mammogram every 6 months for the next few years. Talk to your doctor about the plan that is best for you.
Mammograms After Mastectomy
If you’ve had a single breast mastectomy, no additional mammograms are needed on that side because the breast tissue has been removed. You will however continue with your yearly screening mammograms as usual on the remaining breast. Those mammograms on the remaining breast are especially important, because having cancer in one breast raises your risk of developing cancer in the other. No mammograms will be needed if you had a double mastectomy, as there is no more breast tissue to look at.
Mammograms will be recommended if you had a special type of mastectomy called nipple-sparing mastectomy, also known as subcutaneous mastectomy. In this surgery, you keep your nipple and the tissue just under the skin. Enough breast tissue remains to warrant the continued use of screening mammograms.
Mammograms After Breast Reconstruction
If you have breast reconstruction after mastectomy, you may wonder if you should have mammograms on the reconstructed breast. In most cases, the answer is no, unless you had a nipple-sparing mastectomy.
- If you’ve had saline or silicone implants for reconstruction, you won’t need mammograms of the affected side as no breast tissue remains. With an implant, you and your doctor can still do a careful physical examination of the breast area.
- In general, if you’ve had reconstruction using tissue from another part of your body, typically you will not need mammograms of the affected breast. Again, this is because no breast tissue remains. Regular physical exams of the reconstructed breast will be performed. Under some circumstances, doctors may recommend mammography after this kind of breast reconstruction:
- if you’re at high risk for local recurrence
- if physical examination of the breast is difficult
- if there is a questionable abnormality
Breast MRI is another and possibly more effective way to screen women who have had breast reconstruction and are at high risk for recurrence.
The above are just general guidelines. Talk to your doctor about what he or she recommends for you, then contact Bedford Breast Center in Beverly Hills, to schedule the top screening mammogram Beverly Hills has to offer..