By Dr. Madhavi Raghu, Breast Imaging, Diagnostic Radiology, Nuvance Health
The breast imaging you may have throughout your life depends on your age, risk for breast cancer, findings from previous tests or if you have symptoms.
Here is what you need to know about breast imaging and why screening mammograms are so important.
What is a mammogram?
Mammography is a specialized type of medical imaging that uses low-dose x-ray to see inside the breasts. Screening mammograms can detect breast cancer before it causes symptoms.
Who should get a screening mammogram?
Women who are at average risk of developing breast cancer should start annual screening mammograms at age 40. Screening mammograms mean you do not have symptoms of breast cancer. See your doctor right away if you have any symptoms of breast cancer, such as a lump in your breast. They may recommend a diagnostic mammogram and possibly an ultrasound.
Nuvance Health offers self-referring screening mammograms, which means you can schedule a routine mammogram directly without a doctor order. Learn more about mammography at Nuvance Health and request an appointment.
A doctor order is required for supplemental tests such as breast ultrasound in women with dense breast tissue, or breast MRI for women at increased risk of developing breast cancer.
You may be at increased risk of developing breast cancer if you have a strong family history or a genetic predisposition such as BRCA1 or BRCA2 gene mutations.
Why should I get a screening mammogram?
Breast cancer is the second most common cancer among women in the United States; some kinds of skin cancer are the most common. Screening mammograms are currently the most reliable and effective way to detect breast cancer early before it causes symptoms.
Results from decades of research show that women who have regular screening mammograms are more likely to have breast cancer found early and have better long-term outcomes.
What is 3D mammography?
Tomosynthesis is an advanced 3D mammography technology that can detect small cancers and masses hidden in breast tissue better than standard 2D mammography. Studies have shown that tomosynthesis can detect 40 percent more cancers compared to a 2D mammogram.
Tomosynthesis also decreases the rate of false positives, which means the interpretation is more accurate. A small proportion of women need additional imaging based on their screening mammography results, which can cause anxiety. Most of the time, the additional imaging shows normal breast tissue, which is called a “false positive.”
Tomosynthesis is the standard of care at all Nuvance Health imaging locations and is available to patients regardless of their age or breast density.
What is a diagnostic mammogram?
A diagnostic mammogram uses the same mammographic equipment as a screening mammogram. However, specific views can be obtained during a diagnostic mammogram.
Your doctor may recommend a diagnostic mammogram if the screening mammogram detects something questionable that requires additional imaging. Your doctor may also recommend a diagnostic mammogram if you are experiencing symptoms of breast cancer, which include:
- Any change in the size or shape of the breast
- Irritation or dimpling of breast skin
- New lump in the breast or armpit
- Nipple discharge other than breast milk, including blood
- Redness or flaky skin in the nipple area or the breast
- Thickening or swelling of part of the breast
Having these symptoms does not mean you definitely have breast cancer, but it is important to be checked as soon as you notice any changes. Tell your doctor how you are feeling. They may recommend a diagnostic mammogram or other tests.
What is a breast ultrasound?
A breast ultrasound uses soundwaves to produce images that offer a closer look at breast tissue.
Women with dense breast tissue are eligible for breast ultrasound. Diagnostic or targeted ultrasound may also be performed if your doctor feels a suspicious lump during an exam, or if a mammogram reveals an abnormal finding.
What is a breast MRI?
Your doctor may recommend a breast MRI if you are at increased risk of breast cancer. A breast MRI uses magnetic energy to produce more detailed images than tomosynthesis. Contrast dye is injected so the radiologist can see clearly inside the breast. MRI of the breast is very sensitive, which can result in increased false positives.
What is a breast biopsy?
Ultrasound and mammogram typically answer diagnostic questions most of the time. However, for a small number of patients, the radiologist may recommend an image-guided breast biopsy to evaluate better a finding in the breast.
The radiologist will explain the procedure and carefully perform the biopsy, which may be done under ultrasound, mammography or MRI. The tissue sample is sent to the lab where a pathologist will test it.
The radiologist will contact the patient with the findings and next steps. In many cases, patients may return to annual screenings if the results do not show cancer. If the pathology results show breast cancer or a high-risk lesion, the patient will need to see a breast surgeon.
At Nuvance Health, nurse navigators contact patients and connect them with the appropriate follow-up care. We aim to streamline the process as much as possible for our patients.
Where should I go for breast imaging?
We recommend you go to a breast imaging center that is accredited, has tomosynthesis and access to highly skilled mammogram technologists and radiologists.
All Nuvance Health imaging locations are accredited by the American College of Radiology and provide the highest level of care for patients, including 3D mammography. Nuvance Health’s mammography technologists perform mammograms and board-certified, experienced radiologists interpret all images. Our radiologists are usually onsite to answer questions, too.
Does breast imaging involve radiation exposure?
Yes. However, modern mammography technology uses only a small amount of radiation. On average, the total dose for a screening mammogram is about 0.4 millisieverts (mSv), which is extremely low. For comparison, people in the United States are exposed to about 3 mSv of radiation each year just from their natural surroundings.
The benefits of annual screening mammograms outweigh the risk of possible radiation exposure. It is important to remember screening mammograms are critical in the early detection of breast cancer.
What are common concerns about breast imaging?
In addition to radiation exposure, common concerns about breast imaging are cost, time away from family or work for the test, and anxiety particularly related to callbacks from a screening mammogram.
Talk with your doctor if you have any of these concerns. Radiologists are also available at all Nuvance Health breast centers to address your questions about breast imaging and findings from your images.
Most health insurances cover screening mammograms. There are also programs for individuals without health insurance.
The total time a breast imaging test takes depends on the type of imaging and facility. On average, an actual mammogram takes about 15 to 20 minutes.
Most Nuvance Health imaging locations offer evening and weekend hours to accommodate your schedule.
The bottom line: Screening mammograms can save lives because they can detect early-stage breast cancer. Start annual screening mammograms at age 40 if you are at average risk for breast cancer and not experiencing symptoms. Talk with your doctor, such as your primary care physician or gynecologist, if you have questions about your risk for breast cancer or about breast imaging.
At Nuvance Health, you can schedule your screening mammogram without a doctor’s order. If you are age 40 or older, at average risk for breast cancer and have no symptoms of breast cancer, visit nuvancehealth.org/mammogram to request a screening mammogram appointment.