Mammography: Frequently Asked Questions

by Dr. Mason “Gage” Hicks, Radiologist
As seen in the Odessa American Medical Matters at: http://www.oaoa.com/people/health/medical_matters/article_6a3aea48-b692-11e7-9190-137b296bd2ab.html

Why do women need to have yearly screening mammograms?

It reduces a woman’s risk of dying from breast cancer. Studies have shown that mammography screening cuts the risk of dying from breast cancer nearly in half.

When should a woman start having mammograms?

There are conflicting recommendations from different societies. We follow the American College of Radiology and Society of Breast Imaging guidelines which recommend yearly screening mammograms beginning at age 40 for women at average risk for breast cancer (most women). Studies have shown that this is how we will save the most lives.

Why yearly and not every other year?

It’s simple … yearly screening results in more lives saved than screening every other year.

Should a woman ever start having screening mammograms before age 40?

There are certain situations where a woman should start mammography screening before age 40 … women who are considered high risk. If you are unsure, then talk to your doctor. The American College of Radiology and Society of Breast Imaging never recommend screening mammograms before age 25.

What are some reasons a woman would be considered high risk for breast cancer?

Women with certain genetic mutations (BRCA1 or BRCA2), family history, women who received radiation to the chest at a young age (usually for treatment of Hodgkin’s disease) and women with a personal history of breast or ovarian cancer.

What is 3D mammography?

3D mammography, or breast tomosynthesis, is a breakthrough technology in breast imaging that allows a clearer, more accurate view of the breast (as opposed to the traditional 2D mammogram). It allows the breast radiologist to see through the different layers of tissue in the breast. This improves breast cancer detection.

What are the benefits of 3D mammography?

Earlier detection of small breast cancers

Clearer images of the breast tissue

Fewer additional tests or unnecessary biopsies

Greater accuracy

Greater likelihood of detecting multiple cancers

What does it mean if my doctor says I have dense breasts?

It has to do with the way you are made. It doesn’t mean that anything is wrong with you, though it can increase your breast cancer risk. Every breast has different amounts of fatty tissue versus glandular and connective tissue. When you look at a mammogram, the black/darker parts of the breast are the fatty tissues and the white/lighter parts of the breast are the glandular and connective tissues. When you have dense breasts, it means that there is more of the white/lighter tissues relative to the black/darker tissues.

What is the significance of having dense breasts when it comes to mammograms?

Most cancers also look white on the mammogram. So when you have dense breasts (more of the white/lighter tissues), it sometimes makes it harder for the radiologist to detect cancers. The dense breast tissue can sometimes obscure cancers (particularly smaller cancers) and make them difficult, or even impossible, to see.

What should I do if I have dense breasts?

It’s something to talk to your doctor about. DON’T stop having mammograms. Certain types of cancers, particularly those that present as tiny calcifications in the breast, can easily be detected on mammograms … even in dense breasts. Your doctor may recommend additional screening depending on your overall breast cancer risk. Additional screening with breast MRI can be a valuable tool in certain patients.

Do I need a “screening mammogram” or a “diagnostic mammogram”? What’s the difference?

Generally speaking, if you are not having any breast problems and it’s time for your yearly mammogram, a screening mammogram is recommended. Diagnostic mammograms are generally performed on patients that either had an abnormality detected on their screening mammogram, or are having some kind of breast problem (lump, pain, discharge, etc.)

If the patient had a potential abnormality on a screening mammogram, a diagnostic mammogram is performed for further evaluation. This usually involves specialized mammogram views and possible ultrasound of the area to determine the nature of the abnormality and determine if a biopsy is needed.

The diagnostic mammogram is not better pictures or better image quality than the screening mammogram. It is just performed in a way that allows the problem or potential abnormality to be fully evaluated with the necessary imaging while the patient is in the department. Personally, I like to talk to every patient that has a diagnostic mammogram so that they leave our department with peace of mind and understanding of what my recommendations are.

October is Breast Cancer Awareness Month. Please make your mammogram a priority in your life and encourage your loved ones to do the same. Early detection saves lives.