Mammography

The breast is a three-dimensional object composed of different structures located at different heights within the breast. These structures can overlap and cause confusion when viewed as a flat two-dimensional image. This confusion of overlapping of tissue is a leading reason why small/early breast cancers may be missed and normal tissue may appear abnormal, leading to unnecessary callbacks. By using our new breast tomosynthesis technology to create a three-dimensional image of the breast structure, radiologists can more clearly see through overlapping tissue to detect cancers, often at an earlier stage.

The Hologic system is the first FDA-approved breast tomosynthesis system in the U.S. Hologic 3-D MAMMOGRAPHY™ exams are now available in all 50 states and over 50 countries. To date, more than 8 million women have been screened with this advanced screening system.

Yes. Although mammography does use radiation to produce an image, the radiation dose to the breast is very low. The benefits of having a mammogram greatly outweigh the risk of any potential harm of having a mammogram done. According the American Cancer Society, the average mammogram exam has a radiation dose of 0.4 millisieverts (mSv). On average in the United States, people have a yearly radiation exposure to background/natural surrounding radiation of 3 mSv. So that would mean the average mammogram is about the same of 7 weeks of background/natural surrounding radiation. Also, the more the breast tissue is compressed, the lower the amount of radiation that is needed for an image.

If there is any chance of pregnancy, you should speak to your provider first. Although the radiation dose and risk to a fetus is very small, generally mammograms are not performed on pregnant women. Pregnancy can change your breast tissue and at times can make it difficult to evaluate for a screening mammogram. However, if you are having any problems, such as a lump, or have a very high risk of breast cancer, please let us know. Your provider, technologist and radiologist will work closely together to determine the best route of care for your individual case.

There is generally some discomfort with a mammogram; however, many people do not feel that the discomfort is intolerable. Your technologist is trained to help alleviate as much pain and discomfort as possible, while continuing to provide the best possible image. Compression of the breast must be used to help "see through" the breast tissue. The more the breast is compressed, the more the tissue spreads out, the easier it is for the radiologist to see through the different densities to make a diagnosis. Also, the more the breast tissue is compressed, the lower the amount of radiation that is needed for an image. Generally the discomfort only last seconds, in turn preserving years of life! Please tell your technologist performing the exam if you are having pain, especially if it is one specific area. There are many things that the technologist does during the exam and can do to help position your breast to lead to a more comfortable exam. A mammogram should never hurt so much that a patient feels the need to not have another one done or delay their future screenings! There are a few things that can be done to help reduce discomfort during your mammogram.

• You should try to schedule your mammogram a week after your menstrual cycle. During or immediately before/after your period, your breast tissue can become sensitive, thus increasing the level of discomfort during your exam.
• Consuming caffeine and using tobacco has been linked to breast tenderness. By avoiding both of these products can help reduce discomfort for both your mammogram and in your general breast health.
• Some patients have found that taking a nonsteroidal anti-inflammatory drug, such as ibuprofen, before their exam has helped them with discomfort. Please talk to your provider before taking any medications.
• GRHC uses a soft protective cover for most patients during their mammograms. This cover helps the patient's breast from sticking to the hard plastic during the exam. Many women like this addition and find that it also helps reduce the amount of cold they feel from the cool machine.
• RELAX… as silly as it may sound to relax during your mammogram, it will help! The more you tense up, the more your body fights against the compression, leading to more discomfort.

2-D and 3-D mammography are generally the same mammography "experience." It involves the same amount of compression and the same amount of pictures. However, 2-D mammography only shows a single image of the breast tissue, and there is no way to look through the thickness of the breast. Although GRHC offers digital 2-D and it is still a very good technology, we suggest looking into 3-D mammography. 3-D mammography takes a normal 2-D image and adds the ability to look through the thickness of the breast. This leads to being able to find cancers at an earlier stage, lessens the chance of additional images, and overall gives the radiologist more information.

• It detects smaller breast cancers and/or cancers that are at an early, more manageable stage. This helps reduce how invasive breast cancer treatment might be.
• It also helps reduce the amount of additional views or tests you might need. This does not eliminate the chance of getting called back for more pictures; however, it does greatly reduce our callback rates.
• It helps localize an area of interest, making it easier and faster to locate during a biopsy if one is needed.
• It creates significantly clearer or diagnostic images of extremely dense breast tissue.

We ask our mammography patients to use no lotion, powder or deodorant the day of their exam. If you forget, please tell your technologist doing your exam and they will give you a wipe to remove it. Some products have items in the ingredient lists that can show up on the images or interfere with the exam itself.

The technologist will ask you a series of questions and go over the 3-D/tomosynthesis consent form if you wish to have a 3-D mammogram. They will have you change from your waist up and give you a cape-like gown to change into.

During the exam, the technologist will position your breasts, one at a time, onto an imaging plate. They will then slowly compress the breast with a compression paddle to the amount needed. You will have two to three images of each breast done during a routine mammogram. There may be times the technologist needs to repeat an image for motion, artifact, etc., thus increasing the amount of images taken.

The technologist performing your exam is not able to release any results or information about your exam. The radiologist is here Tuesday and Thursday mornings and can only read your mammogram on a specialized computer monitor that is located on site at GRHC. All mammograms are read on those two mornings. The radiologist will compare your previous mammograms to your current one. Once they read your exam and the report is finalized, it is sent to the provider who ordered your exam. They then take time to review the exam and report before giving you the results of your exam. Please allow two to three days after the time of an available report before calling your provider for results. The Radiology Department will also send you a letter in the mail with the results of your mammogram.

If you had previous mammograms at another facility, please give us time to retrieve the previous exams. Your exam will not be read until we have the previous years to compare them to. To save time, please let us know where your previous exams were at the time of scheduling so we can request them to be sent.

We suggest you call your insurance before having any diagnostic imaging, including mammograms, as all insurances and each policy can be different.

Routine/screening/preventative mammograms

Generally insurances will cover standard screening mammograms. What this means is your exam is a routine/yearly/preventative mammogram. You are not having pain, lumps or discharge and you do not have a history of breast cancer. Most insurance cover one per year and some require your next mammogram to be one year and one day from your previous exam. Please be sure to check with your insurance to see what their guidelines for coverage are. More and more insurance companies are starting to cover the 3-D/tomosynthesis screening mammograms; however, not all insurances cover 3-D imaging at this time. Please check before your appointment to be sure of coverage. If you wish to have a 3-D mammogram and your insurance does not cover it, the out-of-pocket cost to you is a reasonably low rate. Please talk to your mammography tech for details. These mammograms are generally done when a radiologist is not present.

Diagnostic mammograms

These mammograms are generally done outside of your routine mammogram. This is if you are having pain, lumps, discharge or have had a history of breast cancer within the last five years. Not all insurances count these as preventative, thus making them apply to your deductible. So yes, they are generally covered, but you may have to hit your deductible first. You will also be asked to come at a time a radiologist is present.

Callback/additional views/6 month follow-ups

These mammograms are generally done because there was an area on your screening mammogram that the radiologist could not clear completely as normal. Do not worry, as most of these exams do end up being normal; however, to be sure we need to get some additional pictures that are not considered part of the screening process. Unfortunately, not all insurances count these as part of your preventive coverage, thus making them apply it to your deductible. So yes, they are generally covered, but you may have to hit your deductible first. You will also be asked to come at a time that the radiologist is present.

Under the age of 40

Depending on your or your family's history, you may fall in a category that's recommended to have a mammogram done before the age of 40. If you are having any problems, such as a lump, this exam would be considered a diagnostic exam (please see Diagnostic section). If you are not having any problems but you are required to start having your screening mammograms at an earlier age because you have the BRCA gene or a strong family history of breast cancer, please be sure to check your insurance coverage before your exam. Some insurance does not cover preventative mammograms until after the age of 40, or some only cover one before the age of 40. You will also be asked to come at a time a radiologist is present.