Mammography - Frequently Asked Questions

What is a mammogram?
What is a digital mammogram?
What is CAD?
What is the difference between a film screen and digital mammogram?
What is the difference between a Screening and Diagnostic Mammogram?
Who needs a mammogram?
Is a mammogram painful?
What does the term 'dense breast' mean?
What does the term 'fatty breast' mean?
What if I am pregnant and find a mass in my breast?
Should I have a mammogram while I am nursing?
What are fibrocystic changes in the breast?
What is a solid lump or nodule?
What is a breast biopsy?
What is a breast calcification?
What if I have breast implants?
Why would the doctor order a follow-up exam in six months?
Where does WRA perform mammograms?
How do I prepare for my mammogram?

What is a mammogram?
A mammogram is a low-dose x-ray technique to detect breast cancer. Modern mammography provides images of the inner structures of the breast.

As a diagnostic tool, the most important function of the mammogram is to help the board-certified radiologist find breast tumors which are too small to feel on physical examination. As a result, many breast tumors can now be found early, before they have spread to other parts of the body. This early detection can save lives.

What is a digital mammogram?
Digital mammography uses x-rays to produce an image on a computer screen. Digital processing produces an image in a shorter period of time than screen-film mammograms. This allows the technologist to review the image quality immediately and make adjustments accordingly. In addition, the digital images can be manipulated by the radiologist by adjusting the brightness and contrast levels, and magnification levels. Please note that compression of the breast is still required for a digital mammogram.

To learn more about WRA's participation in the ACRIN DMIST Study, please click here.

What is CAD?
CAD, or Computer Aided Detection, is a software program that results in greater diagnostic accuracy in mammogram interpretation.

What is the difference between a film screen and digital mammogram?
In digital mammography, an image is taken and seen in the same mammography room by the technologist on a computer within a few seconds. In film screen mammography, the image is not seen until the film is developed. This means that any positioning errors with a digital mammogram are more quickly seen, leading to fewer retakes and therefore less radiation. With digital mammography, the image of the mammogram can be altered by the radiologist in order to more clearly see certain areas. Both types of films are stored in the patient's jacket in our medical records department.

Please note that compression of the breast is still required for a digital mammogram.

What is the difference between a Screening and Diagnostic Mammogram?
Both types of mammograms are done exactly alike initially, with two views of each breast obtained at different angles. A screening mammogram is designed for a patient with no problems or palpable abnormalities. The patient’s exam is performed by the technologist and the patient then leaves after the technologist has confirmed that the images are technically satisfactory. If there is a technical problem or if there is a possible abnormality noted by the radiologist, the patient will then be asked to return for further evaluation, possibly including additional x-ray and/or sonography. This allows for faster patient throughput and overall decreased cost to the patient.

The diagnostic exam is designed to answer a particular clinical question. The radiologist reviews the initial films and decides at that time if additional evaluation, including x-rays and/or sonography are needed. Any further evaluation is done at the time of the initial visit and the patient is given her results by the radiologist. Diagnostic exams are also required for patients with complicated histories, i.e. post operative exams, breast implants.

Who needs a mammogram?
The American Cancer Society, the American College of Radiology, and the American Medical Association
recommend the following guidelines for screening mammography in women:

Baseline mammogram at or before age 40.
Screening mammogram every year after age 40.

These guidelines may change depending on your clinical history. Monthly breast self-examination for women age 20 and older is also essential for the early detection of breast cancer.

Is a mammogram painful?
Usually not, but you will feel pressure. The breast is compressed firmly between two plastic plates for about 5-8 seconds to allow good penetration of the x-rays. Most women notice little to no pain but do feel pressure. If you have experienced pain in the past try this to make it easier:

Have your exam done early in your menstrual cycle i.e. days 5-10.
Take 2 aspirin or 600 mg of ibuprofen one hour prior to the exam.

Are mammograms safe?
YES. But be sure that (1) you are to receive a low-dose mammogram, and (2) that the facility performing the mammogram is certified by the American College of Radiology and the FDA under the Mammography Quality Standards Act (1992). Washington Radiology maintains FDA certification and was the first practice in Washington to receive ACR accreditation in 1988. To obtain certification the equipment must meet strict guidelines of quality assurance testing. In addition, both the technologist performing the exam and the radiologist interpreting the exam must obtain continuing medical education credits specifically in mammography every three years and perform a minimum number of exams per year.

What does the term 'dense breast' mean?
This term describes how much glandular tissue is present in the breast. The more you have, the thicker and denser it will appear on the mammogram and feel with physical examination. This is predominantly a genetic trait and not related to diet or other factors.

What does the term 'fatty breast' mean?
"Fatty breast" means that there is more fatty tissue than glandular tissue in the breast. Again, this is predominantly genetically predetermined and often has nothing to do with overall body fat content. However, as you age or gain substantial weight, you may develop more fat in your breasts.

What if I am pregnant and find a mass in my breast?
Do not ignore the mass or attribute it to changes from your pregnancy. See your doctor. A sonogram, which uses sound waves and not radiation, can be performed to assess the nature of the mass without harming the fetus. From a sonogram, the radiologist can determine whether the mass is filled with fluid (benign) or solid (possibly a tumor). If it is essential to obtain an x-ray (mammogram) it is usually safe for a fetus, particularly beyond the 14th week of pregnancy, with the patient's abdomen shielded by a lead apron.

Should I have a mammogram while I am nursing?
If you have a breast lump or a breast problem, obtain a mammogram or possibly a sonogram to evaluate the immediate problem. If you have no symptoms, but are scheduled for a routine exam, it is best to wait approximately three to six months after terminating nursing. This time period allows changes in the breasts caused by pregnancy to resolve. However, if you plan on nursing for an extended period (more than one year) obtain a mammogram as needed based on your age and risk factors. If you do obtain a mammogram while nursing, it is recommended to either pump or nurse just prior to the mammogram or pump and discard milk after your exam (the irradiated milk). The next milk production will be unaffected.

What are fibrocystic changes in the breast?
This phrase describes symptoms of a normal variant of a benign condition affecting 50 to 60 percent of all women. The spectrum of fibrocystic changes, determined by physical examination, ranges from a lumpy pattern to cysts (fluid filled sacs) within the breast. The breasts may become fuller and more tender the week or so before menstruation. Some women have severe tenderness, swelling or even pain off and on all month. Nicotine and caffeine may aggravate this condition. A low-fat diet, not smoking, and taking vitamins E and B6 provide relief for fibrocystic symptoms for many women.

What is a solid lump or nodule?
These terms refer to a mass within the breast that contains solid tissue. A lump or nodule could represent a rounded clump of normal tissue, a fibroadenoma (a benign tumor), or possibly a malignancy. These conditions often require further evaluation, such as biopsy.

What is a breast biopsy?
A biopsy involves removing breast tissue for examination under a microscope. Biopsy is the most accurate method of diagnosing the nature of a breast lump or calcification. Eighty percent of breast biopsies indicate benign tissue. A biopsy may require surgery (excisional biopsy) or needle biopsy (Mammotome®, core needle or fine needle). (May use mammographic or sonographic guidance.)

What is a breast calcification?
These are small deposits of calcium of varying sizes, shape and location in the breast. Breast calcifications are usually benign. However, deposits found in a small, tight group often signal increased cellular activity in the area and may require a biopsy for further evaluation. Changes in the pattern of calcifications or new calcifications may indicate the presence of a small breast cancer.

What if I have breast implants?
Women with breast implants should obtain mammograms according to the same recommendations for women with non-augmented breasts. However, mammograms must be individualized for patients with implants. Specialized mammographic views, often called "implant displaced" views, are performed of each breast with the implant gently pushed back in order to optimally visualize as much breast tissue as possible. The risk of rupturing the implant is minimal.

Why would the doctor order a follow-up exam in six months?
A follow-up exam is often recommended to more closely observe "benign-appearing" conditions in the breast -- calcifications, nodules, changes in tissue -- to confirm stability over a period of time.

Where does WRA perform mammograms?
Mammograms are performed at our Sterling, Fairfax, Bethesda, Chevy Chase and 2141 K Street, NW offices.

How do I prepare for my mammogram?
Do not use deodorant, powder or lotion in the breast and underarm area. For your comfort, two piece outfits are recommended. Please bring previous films not performed at WRA to your appointment.

If you have experienced pain in the past try this:

Have your exam done early in your menstrual cycle i.e. days 5-10.
Take 2 aspirin or 600 mg of ibuprofen one hour prior to the exam.