If you’re a woman age 40 or older, you can do something great for your health in minutes: schedule a mammogram.
“One in 8 women will get breast cancer, but treatment is getting better and better,” says UNC Health radiologist Elijah Burton, MD. “Early detection is crucial, so you can start treatment when the cancer is still at a small size and the risk of it being elsewhere in the body is low.”
Dr. Burton shares what to expect before, during and after your mammogram.
Scheduling Your Mammogram
For people at average risk for breast cancer, experts recommend beginning screening mammograms at the age of 40.
If you’re at increased risk for breast cancer, your doctor will recommend that you start getting mammograms earlier. If you have a parent or sibling who had breast cancer, you should start screening when you’re 10 years younger than they were at diagnosis, Dr. Burton says. “If your mother was diagnosed at 45, you should start at 35.”
You might also need an earlier mammogram if you have a history of radiation (if you had cancer treatments when you were young, for example) or if you know you have a genetic mutation that can cause breast cancer.
You can schedule your mammogram at any time of the month that’s convenient for you; some people report more discomfort during their period. You can get a mammogram while breastfeeding, though it’s typically more comfortable to try to pump or feed right before your exam. If you’re pregnant, talk to your doctor. Mammograms are generally safe during pregnancy but it might be OK to wait until you deliver.
When you schedule, you might be asked if you’d prefer a 2D or a 3D mammogram. Both are safe and both can detect early signs of breast cancer, but “there’s more and more data supporting 3D mammograms because they provide a better detection of abnormalities,” Dr. Burton says; both are typically covered by insurance. “Getting a 3D mammogram may decrease the chance you need to return for additional imaging and may increase the chance of finding cancers when they are small.”
Don’t wait until your screening mammogram to report breast issues such as pain, a lump or mass or discharge from the nipple. You’ll need a diagnostic mammogram, which requires more imaging. Talk to your doctor as soon as possible, or get in touch with the mammography department for instructions on how to proceed.
Preparing for Your Mammogram
On the day of your mammogram, don’t wear deodorant or lotion on your chest or arms. If you forget, there will be wipes.
“Deodorant and lotion can create an appearance of calcifications on the image, which makes it more difficult to interpret, which means we might have to call you back for another one,” Dr. Burton says.
Plan to wear a two-piece outfit; you’ll need to take off your bra and shirt but can wear pants or a skirt during the mammogram.
If you’ve had a previous mammogram at a different location, you’ll want to make sure your past imaging is sent to the new facility.
“We can evaluate subtle changes from year to year. If there’s a finding that’s been stable for years, it’s less likely to be cancer,” Dr. Burton says.
Bring your insurance card to the appointment. Expect to do some paperwork before you’re escorted to a locker room where you’ll remove your clothing above the waist and put on a robe. There are typically lockers for you to store your belongings, or you may be given a bag. Then you’ll sit in a second, more private waiting room, until your mammogram technologist is ready for you.
“We know patients are nervous, so we try everything we can to make these places comfortable, warm and inviting so that you can be at ease,” Dr. Burton says.
What Happens During Your Mammogram
A technologist, the medical professional who performs the imaging, will take you to a private room with a mammogram machine.
“They will coach you through everything you need to do,” Dr. Burton says. “They do dozens of mammograms every single day and are wonderful at making you feel comfortable, respecting modesty and getting the images we need for your screening.”
You’ll remove the robe from one of your shoulders, exposing one breast. The technologist will guide you on where and how to stand in relation to the machine. Using gloved hands, they’ll position your breast on the plate of the mammogram machine. Then, they compress the breast with another plate. The position you’re holding can feel awkward, and you will feel the squeeze of the compression; most patients consider the examination uncomfortable but not painful.
“A lot of people worry about the discomfort, but it’s usually not as bad as they think it will be,” Dr. Burton says.
While deep breaths can be soothing during an exam like this, the technologist will instruct you to briefly hold your breath at times while they take the image.
For a screening mammogram, they’ll take two images of each breast, meaning you’ll hold your breath and feel a squeeze four times total. Sometimes, people with larger breasts need an additional image to capture all of the tissue. But no matter your breast size, from very small to very large, the technologist will be able to get the images they need.
Generally, the whole thing takes 15 to 20 minutes.
What Happens After Your Mammogram
Your technologist will look at the image to make sure it’s adequate, but they won’t provide any sort of feedback about your results. Your images will be uploaded into a computer system, where a radiologist like Dr. Burton reviews them.
“For a routine screening mammogram, you’ll have one of two results,” he says. “Your exam could be benign or normal and you should have another in a year. If we see something, you’ll get a phone call that you need additional imaging.”
Don’t panic if you get the call that you need another appointment.
“At UNC, 1 in 10 patients, on average, is going to get a call back because the radiologist sees something that needs extra imaging, but many things end up being benign,” Dr. Burton says.
Your next step will depend on what the radiologist sees; you may need another mammogram that’s more focused on a certain part of the breast or another type of imaging, such as a breast ultrasound or a breast MRI.
If you have dense breasts, which means you have more fibroglandular tissue than fatty tissue, mammograms alone may not be adequate for sufficient breast cancer screening. The density of your breasts is largely genetic.
“About half of all women have dense breasts, but you won’t know until your first mammogram,” Dr. Burton says. “With dense breasts, there’s a higher chance of missing a small cancer, which is why we usually recommend a form of supplemental breast cancer screening such as MRI.”
There are other options for women with dense breasts coming soon, Dr. Burton says, but for now mammograms remain the gold standard for everyone.
“There’s no reason for anyone to not get a mammogram,” Dr. Burton says. “A lot of people wait because they’re afraid of getting a diagnosis, but it’s important to not put off your breast health or any breast concerns you may have. Breast cancer is very treatable, but early detection is crucial.”
If you have questions about your breast cancer risk, talk to your doctor. If you need a doctor, find one near you.The post What to Expect at Your Mammogram first appeared on UNC Health Talk.
