A mammogram may be ordered as a screening test to look for any evidence of breast cancer in people who may or may not have any symptoms.

Mammogram

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A mammogram may also be done as a diagnostic test for those who have any signs or symptoms of breast cancer, such as

  • A breast lump or lump in the armpit (axillary mass)
  • Thickening or swelling of a breast or part of a breast
  • Dimpling of the breast skin
  • A change in the size or shape of the breast
  • A sense of heaviness in one breast
  • Nipple retraction (pulling in of a nipple)
  • Nipple discharge
  • Breast pain
  • Redness, scaling, a rash, or irritation of the breast or nipples
  • Itchy breasts

Age You Should Get a Mammogram

Different organizations, including the American Cancer Society, the U.S. Preventive Services Task Force, and the American College of Obstetricians and Gynecologists have somewhat different breast cancer screening guidelines.

The United States Preventive Services Task Force says women ages 50 to 74 should get a mammogram every two years. Some healthcare providers recommend mammograms for women age 40 and older.

Prior to that, women ages 25 to 40 should have an annual clinical exam of their breasts by their gynecologist.

These recommendations are intended for women at average risk only. Those with a family history, other risk factor, or an unusual symptom, may require earlier or more frequent mammograms or other screening tests, such as magnetic resonance imaging (MRI).

Talk to your healthcare provider to decide when is the best time for you to begin annual or biennial screening.

Do Men Get Mammograms?

A mammogram may be recommended for men who carry the BRCA1, BRCA2, or PALB genes.

Mammograms are an important screening test. They can sometimes detect breast cancer in its earliest stages before any symptoms are present. This is important because early diagnosis leads to better outcomes.

It’s recommended that most women start getting an annual mammogram starting around age 40.

Mammogram

When planning your yearly mammogram, talk to your doctor to see if 3D mammography could be a valuable addition to your screening.

Regardless of which type of mammogram you pursue, prepare for your appointment with these tips:

Wear a two-piece outfit since you’ll need to remove your top for the test.

Avoid deodorant, perfume, powder, creams or lotions on your breast or under arm area. Residue from the products may interfere with mammogram results.

Depending on the view of your breast to be taken, you will be asked to sit or stand. You may want to expect slight discomfort, but the procedure is not harmful and will not damage breast tissue.

Limitations

It is important to remember that mammograms cannot diagnose breast cancer but can only reveal suspicious findings. A breast biopsy (removing a sample of tissue for examination in a lab) would be needed to make a definitive diagnosis.

Also keep in mind that a mammogram has limitations in terms of how accurate its results are. Despite being highly valuable, mammograms can vary in their sensitivity (the ability to correctly identify people with the disease) and specificity (the ability to correctly identify people without the disease).

The sensitivity and specificity can be influenced by numerous factors, occasionally leading to incorrect, or false, and diagnoses.

False Negatives

A mammogram may not detect the presence of breast cancer when it is there. This is referred to as a false-negative result.

Women must be informed if they have dense breasts and may consider the option of additional screening, such as breast ultrasound or fast breast MRI (magnetic resonance imaging).

In early studies, fast breast MRI better detects breast cancer (especially more aggressive breast cancers) with fewer false positives (incorrectly indicates breast cancer is present when it is not) than the combination of mammography and ultrasound. Some studies suggest that fast MRI may be comparable to conventional MRI, which is the screening method of choice for women who are high risk.

Breast cancers such as inflammatory breast cancer and Paget’s disease of the breast are less likely than other types to be seen on a screening mammogram. In addition, most women who have inflammatory breast cancer also have dense breasts, which further reduces the chance of spotting these cancers

False Positives

Mammograms may also raise concern over harmless breast changes, particularly with regards to benign (noncancerous) breast lesions that can mimic breast cancer. These can lead to false-positive results, which can lead to more invasive testing and unnecessary treatment.

False-positive results are more common in younger women who have dense breasts, for those who have had previous surgery on their breast (such as a breast biopsy), for those who are using hormonal therapy, and for those who have risk factors for breast cancer.

Having a baseline mammogram available to compare with has been found to significantly reduce the chance of getting a false-positive result. A baseline mammogram usually is a person’s first mammogram.

For women who have breast implants, images may not be as accurate without special views, as X-rays don’t travel well through either saline or silicone, the materials used to fill implants. With special views (two for each breast) however, the accuracy is greatly improved.

More than 50% of women who are screened every year for 10 years in the United States will likely get a false-positive result, according to the National Cancer Institute.

Risks and Contraindications

Mammograms expose women to a small amount of radiation, the amount of which rarely causes illness.

According to a 2016 study in the Annals of Internal Medicine, an estimated 125 of every 100,000 women who undergo an annual mammogram will develop radiation-induced breast cancer, of whom  (or 0.00016 percent) will die.

(By comparison, among the same group of women, 968 breast cancer deaths could be avoided as a result of the mammograms.)

The risk of radiation from mammograms is expected to be higher in those who receive higher doses of radiation and in women who have larger breasts, as they require additional radiation to accurately view all breast tissue.

For women who have breast implants, there is a small risk that an implant could rupture, and it’s important to let the technician know you have implants before the procedure.12

Cost and Health Insurance

Most health insurance plans cover screening mammograms, as well as mammograms that are done to evaluate symptoms. The average cost for a mammogram is around $100 but can vary by location and whether any special views are ordered.

For those who do not have insurance, there are a number of state and local programs that provide free or low-cost mammograms, and some employers also offer discounted mammograms. The National Breast and Cervical Cancer Early Detection Program, a program of the Centers for Disease Control and Prevention (CDC), also offers free or low-cost mammograms to women who need financial help.13

If you are unable to find free or low-cost mammograms in your area, you may receive a discount if you let the clinic know that you do not have insurance.

What to Expect

Before you have your mammogram, your healthcare provider will ask you about any risk factors you have, as well as any symptoms of breast cancer.

Before

Some women may find mammograms painful. For most, however, they are just uncomfortable.14 With this in mind, keep your menstrual cycle in mind when booking your mammogram. Scheduling it for 10 days after your period can be helpful, as your breast are less likely to be tender.

Your mammogram may be done in an outpatient clinic, hospital, or mobile mammography unit. If you had previous mammograms at another facility, you may be asked to bring copies of those images to your appointment. If needed, request them as soon as you make your appointment.

As for preparing for the test itself, there are minimal but important steps to take:

Pain relief: It may help to take an anti-inflammatory medication such as Advil (ibuprofen) or Aleve (naproxen) one hour prior to the test.

Caffeine: You may want to avoid caffeine during the week prior to your mammogram, as it can make breast tissue more sensitive.

Self-care products: Many personal care products contain metallic particles (such as aluminum) that can may end up looking like breast calcifications in mammogram images. On the day of your test, skip applying deodorant and body lotion.

Many clinics will have you complete a questionnaire before you have your mammogram. These forms usually ask about any risk factors you have for breast cancer, any symptoms you are having, and your medical history.

If you don’t have specifics memorized (like the date of a relative’s breast cancer diagnosis), you may want to jot them down ahead of time so you can bring the information with you.

  • Where to Find Low-Cost or Free Mammograms
  • What the Mammogram Itself Is Like
  • When you are ready for your test, a radiology technician will take you back into the mammogram suite. You may have markers placed on your breast. These are used for a number of different reasons, such as to mark nipples, moles, scars, and any lumps or areas of pain you have noticed.

The test is usually performed while you are standing. For those who are unable to stand, sitting mammography may also be done.

Your technician will help you place your breast between two plates. These plates are then compressed, squeezing your breast as the images are taken. Compression helps ensure a clearer image.10

You will be asked to take a deep breath and hold it for a few seconds while each image is made. During a standard screening mammogram, two images of each breast are usually shot: one from above and one from the center outwards.

Additional views, such as spot compression, cleavage view, and others may be done if needed to get an accurate image of your breasts. If you have breast implants, you may need special implant displacement views completed.10

If you experience any discomfort, let the technician know. In some cases, your breast can be repositioned without compromising the image. Even so, each image usually takes only a minute or less to complete.

How Long Does a Mammogram Take?

The mammogram itself usually takes around 10 to 15 minutes to complete, but plan to spend at least an hour at your appointment to check in and give your radiologist time to review your images. If needed, a second round of images may be taken.

After

When your mammogram is completed, you may be asked to wait until the radiologist reviews your images. A report will be sent to your healthcare provider who will notify you of your results.

The discomfort of breast compression often improves rapidly when the test is done, but some women continue to feel aching in their breasts for a day or two after the test.14 If you do feel uncomfortable, wear a comfortable sports bra or camisole under your clothes.

Interpreting Results

After your mammogram, a radiologist will review your images and compare these with any previous mammograms you have had. The time it takes until your results are available can vary, and, with some clinics, it may take up to a month before a written report is sent to you.

Your mammogram report will include the following information

  • Patient information
  • Medical history
  • Procedures (such as previous biopsies)
  • Findings

Impression (referred to as a Breast Imaging Reporting and Data System, or BIRADS, classification)

Recommendation for further tests, if needed

It is extremely important to contact your healthcare provider if you have not received your results. Don’t assume that all is fine if you haven’t heard anything.

Findings

The findings section may simply say that your test was normal, negative, or benign. But if your radiologist sees anything that is suspicious or suggestive of malignancy, the report will describe the size of the finding, the location, and the shape or outline of the abnormal region.

There are a number of terms that may be used to describe findings, including:

Clustered breast calcifications or micro calcifications (calcifications appear as white spots on a mammogram, and their significance can vary)

A speculated mass (a lump that has spikey borders like a starfish)

An asymmetrical density of breast tissue

Skin thickening

Retraction (areas of skin or nipple pulling inward)

Focal distortion (something is pressing on tissue)

In all cases, the report may also include a description of the density of your breast tissue.16

 Normal and Abnormal Mammogram Images

BIRADS Classification

Your mammogram report will include a Breast Imaging Reporting and Data System number—the BIRADS classification—which is a number used to indicate your radiologist’s overall impression of your mammogram. This scale was developed to help standardize mammograms done across the country and at different institutions.

The scale for BIRADS goes from zero to five, with higher numbers indicating a greater possibility of breast cancer:

0: The mammogram report is incomplete, and an impression cannot be given until further views are done, other tests (such as an ultrasound) are performed, or the mammogram is compared with previous films.

1: Negative

2: Benign findings, such as benign calcifications or a benign fibro adenoma

3: Probably benign, with a 98% chance that it is not cancer. This usually means you will need earlier follow-up, such as a mammogram in six months.

4: Suspicious abnormality; a biopsy is often indicated. This can be broken down into 4A, 4B, and 4C, with 4A meaning a lower chance that it is cancer, and 4C indicating a higher chance of the disease.

5: Highly suggestive of malignancy; a biopsy should be done. Radiologists give a score of 5 when they estimate the chance that the findings mean cancer is 95% or higher.16

A BIRADS score of 6, meaning cancer, can only be made with a breast biopsy.

Follow-Up

Your radiologist may make some recommendations based on your mammogram results. In some cases, no other studies may be needed. But if so, they may include:

  • Follow-up imaging
  • Spot views
  • Magnification
  • Diagnostic mammogram

Breast ultrasound for lumps and masses: This test can often distinguish between solid masses and breast cysts, which you may get the same day as your mammogram.

Breast MRI: There are several differences between a mammogram and an MRI in the evaluation of breast tissue, and an MRI may be more accurate for those who have a family history, other risk factors, or dense breasts.

Breast biopsy: This conclusively diagnoses or rules out breast cancer.

If your mammogram is normal, and you have no symptoms of breast cancer, it’s important to continue to follow breast screening guidelines.

If any abnormalities are found, or if the mammogram is difficult to interpret, talk to your healthcare provider. The radiologist will be able to review your images, but your healthcare provider can also look at your risk factors, findings on physical exam, and your medical and family history,

Summary

Mammograms are incredibly important to rule out cancer and serve as one of the are a first step in breast cancer diagnosis. There are different types of mammograms, including 3D that offer a clearer picture of the breast. Mammograms are very safe, they emit a little bit of radiation, but not enough to pose a risk to most women and certainly not to avoid a potentially lifesaving test.

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