How to define a mammogram to your patient?

A mammogram is a low-dose x-ray exam of the breasts to look for changes that are not normal. The results are recorded on x-ray film or directly into a computer for a doctor called a radiologist to examine.

A mammogram allows the doctor to have a closer look for changes in breast tissue that cannot be felt during a breast exam. It is used for patients who have no breast complaints and for patients who have breast symptoms, such as a change in the shape or size of a breast, a lump, nipple discharge, or pain. Breast changes occur in almost all patients. In fact, most of these changes are not cancer and are called "benign," but only a doctor can know for sure. Breast changes can also happen monthly, due to your menstrual period.

What is the best method of detecting your patient's breast cancer as early as possible?

A full field digital mammogram plus a clinical breast exam, an exam done by your patient's doctor, is the most effective way to detect breast cancer early. Finding breast cancer early greatly improves a patient's chances for successful treatment.

Like any test, mammograms have both benefits and limitations. For example, some cancers can't be found by a mammogram, but they may be found in a clinical breast exam.

your patients should check their own breasts for lumps or other changes via a breast self-exam (BSE). Studies so far have not shown that BSE alone helps reduce the number of deaths from breast cancer. BSE should not take the place of routine clinical breast exams and mammograms.

If your patients choose to do BSE, remember that breast changes can occur because of pregnancy, aging, menopause, menstrual cycles, or from taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for breasts to be swollen and tender right before or during a menstrual period. If your patients notice any unusual changes in their breasts they should contact their doctor.

Explain how a mammogram is done to your patients?

Your patient stands in front of a special x-ray machine. The person who takes the x-rays, called a radiologic technician, places your patient's breasts, one at a time, between an x-ray plate and a plastic plate. These plates are attached to the x-ray machine and compress the breasts to flatten them. This spreads the breast tissue out to obtain a clearer picture. Your patient will feel pressure on the breast for a few seconds. It may cause your patient some discomfort; she might feel squeezed or pinched. This feeling only lasts for a few seconds, and the flatter your patient's breast, the better the picture. Most often, two pictures are taken of each breast - one from the side and one from above. A screening mammogram takes about 15-30 minutes from start to finish.

How to explain different types of mammograms to your patients?

  • Screening mammograms are done for patients who have no symptoms of breast cancer. It usually involves two x-rays of each breast. Screening mammograms can detect lumps or tumors that cannot be felt. They can also find microcalcifications (my-kro-kal-si-fi-KAY-shuns) or tiny deposits of calcium in the breast, which sometimes mean that breast cancer is present.
  • Diagnostic mammograms are used to check for breast cancer after a lump or other symptom or sign of breast cancer has been found. Signs of breast cancer may include pain, thickened skin on the breast, nipple discharge, or a change in breast size or shape. This type of mammogram also can be used to find out more about breast changes found on a screening mammogram, or to view breast tissue that is hard to see on a screening mammogram. A diagnostic mammogram takes longer than a screening mammogram because it involves more x-rays in order to obtain views of the breast from several angles. The technician can magnify a problem area to make a more detailed picture, which helps the doctor make a correct diagnosis.

A digital mammogram also uses x-rays to produce an image of the breast, but instead of storing the image directly on film, the image is stored directly on a computer. This allows the recorded image to be magnified for the doctor to take a closer look. Patients with dense breasts who are pre- or perimenopausal, or who are younger than age 50, may benefit from having a digital rather than a film mammogram. Digital mammography may offer these benefits:

  • Long-distance consultations with other doctors may be easier because the images can be shared by computer.
  • Slight differences between normal and abnormal tissues may be more easily noted.
  • The number of follow-up tests needed may be fewer.
  • Fewer repeat images may be needed, reducing exposure to radiation.

How often should your patient get a mammogram?

The National Cancer Institute recommends:

  • Patients 40 years and older should get a mammogram every 1 to 2 years.
  • Patients who have had breast cancer or other breast problems or who have a family history of breast cancer might need to start getting mammograms before age 40, or they might need to get them more often. Your patients should talk to their doctor about when to start and how often they should have a mammogram.

What can mammograms show your patient?

The radiologist will look at your patient's x-rays for breast changes that do not look normal and for differences in each breast. He or she will compare your patient's past mammograms (when necessary) with their most recent one to check for changes. The doctor will also look for lumps and calcifications.

  • Lump or mass. The size, shape, and edges of a lump sometimes can give doctors information about whether or not it may be cancer. 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.
  • Calcification. A calcification is a deposit of the mineral calcium in the breast tissue. Calcifications appear as small white spots on a mammogram. There are two types:
    • Macrocalcifications are large calcium deposits often caused by aging. These usually are not a sign of cancer.
    • Microcalcifications are tiny specks of calcium that may be found in an area of rapidly dividing cells.

If calcifications are grouped together in a certain way, it may be a sign of cancer. Depending on how many calcium specks your patient has, how big they are, and what they look like, your patient's doctor may suggest they have other tests. Calcium in the diet does not create calcium deposits, or calcifications in the breast.

What if your patient's screening mammogram shows a problem?

If your patient has a screening test result that suggests cancer, your patient's doctor must find out whether it is due to cancer or to some other cause. Your patient's doctor may ask about your patient's personal and family medical history. Your patient may have a physical exam. Your patient's doctor also may order some of these tests:

  • Diagnostic mammogram, to focus on a specific area of the breast.
  • Ultrasound, an imaging test that uses sound waves to create a picture of your patient's breast. The pictures may show whether a lump is solid or filled with fluid. A cyst is a fluid-filled sac. Cysts are not cancer. But a solid mass may be cancer. After the test, your patient's doctor can store the pictures on video or print them out. This exam may be used along with a mammogram.
  • Magnetic resonance imaging (MRI), which uses a powerful magnet linked to a computer. MRI makes detailed pictures of breast tissue. Your patient's doctor can view these pictures on a monitor or print them on film. MRI may be used along with a mammogram.
  • Biopsy, a test in which fluid or tissue is removed from your patient's breast to help find out if there is cancer. Your doctor may refer you to a surgeon or to a doctor who is an expert in breast disease for a biopsy.

What if your patient has breast implants?

Women with breast implants should also have mammograms. A woman who had an implant after breast cancer surgery in which the entire breast was removed (mastectomy) should ask her doctor whether she needs a mammogram of the reconstructed breast.

If your patient has breast implants, be sure to tell your patient's mammography provider that she has them if you make her appointment for her. The technician and radiologist must be experienced in x-raying patients with breast implants. Implants can hide some breast tissue, making it harder for the radiologist to see a problem when looking at your mammogram. To see as much breast tissue as possible, the x-ray technician will gently lift the breast tissue slightly away from the implant and take extra pictures of the breasts.

How should your patient get ready for a mammogram?

First, check with the place your patient is having the mammogram done for any special instructions your patient may need to follow up on before an appointment. Here are some general guidelines to follow:

  • If your patient is still having menstrual periods, try to avoid having the patient schedule a mammogram appointment during the week before the patient's period. Your patient's breasts will be less tender and swollen. The mammogram will hurt less and the picture will be better.
  • If your patient has breast implants, be sure to tell the mammography facility that the patient has them when an appointment is scheduled.
  • Wear a shirt with shorts, pants, or a skirt. This way, your patient can undress from the waist up and leave shorts, pants, or skirt on when getting mammogram.
  • Don't have patients wear any deodorant, perfume, lotion, or powder under their arms or on their breasts on the day of their mammogram appointment. These things can make shadows show up on their mammogram.