Get the Picture: Mammograms

Okay, so you’ve called the doctor. You have an appointment. What happens then?
Chances are, in addition to a clinical breast exam, you’ll be scheduled for a mammo-
gram.
Why are mammograms so important? They can detect cancer that can neither be seen
nor felt, thus identifying the earliest forms of breast cancer. The radiologist who reads
the film can see suspicious spots smaller than the head of a pin. Depending on where
these spots are, it could take several years before they’re large enough to feel or see.
Thus, mammography involves two purposes:
1. A diagnostic mammogram usually follows if you find a lump or visible abnor-
mality.
2. A screening mammogram is usually an annual routine for women over 40 (al-
though some experts still argue over age).
Based on family history and personal health, you
and your doctor should decide when to do a first
or baseline mammogram. The baseline serves as a
frame of reference so future mammograms can
identify change. You and your doctor must also
decide how frequently to have routine mammo-
grams. While annual mammograms are typical
after age 40, those of us at high risk may have
them every six months (more on risk factors in
Chapter 15, “Caution Flag: Risk Factors”). And
some doctors recommend only every other year if
you’re between 40 and 50. If you’re low income
and age 40 or over, ask your doctor about free or
low-cost breast screening. With the hundreds of
local and state programs available, there is no rea-
son for a person not to have a mammogram be-
cause she can’t afford it.
Some women complain about how much a mam-
mogram hurts. But, really, folks, it’s not that bad.
Yes, those little plates on which the breast rests always seem a little cold (no, they
don’t have refrigeration coils in them). Yes, the plates squeeze the breast as flat as
possible in order to get a clear picture (no, they aren’t the hinges of hell). But many
clinics now use heating pads to warm the plates and allow the patient herself to deter-
mine how much pressure the plates exert. It may be
temporarily uncomfortable, but it can also save your
life. It did mine.
Like all areas of medicine, mammography is an ever-
improving science. New equipment, like digital mam-
mography machines, projects the breast image on a
screen and allows for manipulation to give the best
view. It virtually eliminates the need for any repeat
mammograms. Just make sure whatever equipment they
use for your mammogram is accredited by the American
College of Radiology. Ask your doc or, if you really want
to check it yourself, you’ll find a label attached to the
machine that gives its accreditation number.
In certain cases, your doctor may use an ultrasound
with or without a mammogram. The doc will usually
use an ultrasound, a painless exam using sound waves,
if he or she needs to distinguish between a solid and
fluid-filled lump (sound waves go through fluid but
bounce off solid lumps). He or she will also use ultra-
sound if you’re pregnant (radiation may harm the fetus)
or if you can feel a lump that doesn’t show on a mam-
mogram (usually because of dense breast tissue, typical
in younger women).