FAQs About Mammograms

One of the most effective ways to detect breast cancer as early as possible is done with routine mammograms. We know the disease is much more treatable when detected early.

Mammography helps radiologists see the normal and abnormal structures in the breasts, including masses, microcalcifications and architectural distortion. Masses can be benign (like cysts, which are fluid-filled), or cancerous. Microcalcifications can also be benign or be a sign of early or local cancer.

Our BreastCare Center team supports the American College of Radiology (ACR) and the Society of Breast Imaging (SBI) recommendations that women age 40 and older who are at “average risk” for breast cancer have an annual screening mammogram. These women do not have any symptoms or family history of breast cancer.

If you are "at high risk” for developing breast cancer, it may be suggested that you have more frequent mammograms, beginning earlier than age 40. Please contact your medical provider if you have any questions about if and when you should have a mammogram.

The BreastCare Center considers a woman to be “at high risk” and strongly recommends screenings before age 40 if she:

• Carries the BRCA1 or BRCA2 mutation
  These are the most common genes that cause breast cancer. Several markers/clues exist to help determine if you are a candidate who should be tested for the genetic mutation. If you think you could be a BRCA1 or BRCA2 gene mutation carrier, based on the markers and/or your medical provider’s suggestion, we recommend you consider meeting with one of our supportive and specially trained genetic counselors. You will discuss with them if testing might be appropriate for you, and what your options might be if you are found to be a carrier.
  
  When a patient is found to be a carrier of the BRCA1 or BRCA 2 mutation, and that patient’s mother or sister has had pre-menopausal breast cancer, our BreastCare Center starts breast cancer screening 10 years before the age of diagnosis of the mother or sister (but not before age 25).
• Has a strong family history or undergone mantle radiation
  A strong family history of breast cancer results in high lifetime risk of breast cancer. If a woman has undergone mantle radiation for Hodgkin’s disease between ages 10 and 30, we recommend breast screening eight years after mantle radiation therapy (but not before age 25).
• Has already had breast cancer, breast ‘atypia,’ or ovarian cancer before turning 40
  If a woman has already been diagnosed with breast cancer, breast 'atypia' (abnormal cells that are not quite cancer) or ovarian cancer prior to age 40, we recommend early breast screenings. In these cases, your medical provider will discuss when to undergo future screenings with you.

First, a patient removes the necessary clothing (such as a top and/or bra, and any jewelry worn on that area of the body) and is given an exam gown to wear into the mammography room. Once inside, the patient stands in front of a special X-ray (mammography) machine that has a platform on which to place one breast. Working with the patient, a trained mammography technologist gently lifts and positions the breast on to the platform. The breast is carefully flattened and compressed between two special plates for each X-ray exposure to achieve the clearest possible picture of the tissues.

A radiation beam passes through and forms an image of the breast on an X-ray film. It is a low dose X-ray and does not harm the breast tissues.

At least two pictures of each breast are taken. For one picture, the patient faces toward the platform and the image is taken looking down at the breast. For a second image, the patient stands beside the machine. This allows for a side view. Extra images may be needed if the patient has had breast implants or if this test is being used to help make a diagnosis.

The degree of pressure needed to get the best picture possible may cause discomfort momentarily. It does not harm the breast tissues. If any pain is felt during your mammogram, you should tell the technologist. You might also want to discuss using a pain medicine, such as ibuprofen, with your medical provider beforehand.

While mammography does expose you to some radiation, today's mammography equipment is designed so that this exposure is minimal. The dose received from a routine screening mammogram is the same as the dose received from natural background radiation over three months. It does not harm the breast tissues and is safe.

Make sure the breast imaging facility where you have your mammogram performed has been accredited by the American College of Radiology »

We do not recommend screening mammography in pregnant women. If you have symptoms of a breast abnormality, typically an ultrasound (which uses no radiation) will be done first. A mammogram can be done if there is a concern on the ultrasound, even if you are pregnant. The radiation dose is very small and we shield the abdomen to limit exposure to the fetus.

If our specialists feel a mammogram is needed due to a breast abnormality, a radiologist will speak with you about the benefits and risks before doing the mammogram.

Comparing mammograms made at different times on the same person is extremely helpful in detecting subtle changes. If you have had a previous mammogram at one of BIDMC's breast imaging locations, we will have your images and any related medical reports. You do not need to bring anything with you to the appointment.

If you've had a previous mammogram elsewhere, please either bring those images and reports to your appointment or arrange for them to be sent to us. Contact the Radiology Film Library at the facility where you had your breast imaging done, and ask them for any of your breast images and reports from the past three years.

Ask if your images and reports can be sent digitally to us at the BreastCare Center. If that isn’t possible, please send them by FedEx or UPS to:

Beth Israel Deaconess Medical Center
Attn: Radiology Film Archive Dept.
Shapiro Clinical Center, 4th Floor
330 Brookline Avenue
Boston, MA 02215

Please call our Breast Imaging unit several days before your appointment to confirm that we have received the information. You can reach us at 617-754-9500.

A screening mammogram is performed regularly on women who:

• are usually over the age of 40
• do not have symptoms of a breast abnormality
• may or may not have a family history of breast cancer

The purpose of a screening mammogram is to look for any early signs of breast cancer, and our BreastCare Center recommends that all women have regular screening mammograms. The majority of these mammograms show no abnormality. Screening mammograms take about 15 minutes.

A diagnostic mammogram is performed when a woman has:

• symptoms of a breast abnormality
• felt a lump or her medical provider has felt something abnormal
• had a recent history of breast cancer
• a prior abnormal screening mammogram requiring immediate follow-up
• a potential abnormality seen on a recent screening mammogram

A diagnostic mammogram is performed the same way and with the same equipment as a screening mammogram, but usually more images will be taken in order to find answers. Diagnostic mammograms take about 20 to 30 minutes.

Common reasons why patients are recommended for a diagnostic mammogram include:

• A patient has a personal or family history of breast cancer
• A patient has signs or symptoms related to the breasts, such as a lump, breast pain, nipple discharge, unexplained skin changes of either breast, or new or unexplained asymmetry of the breasts
• A patient’s screening mammogram showed an abnormality

In some cases, we may recommend that a patient is further examined using a breast ultrasound to show additional breast images.

The entire exam will take approximately a half hour. A diagnostic mammogram may take slightly longer because additional images often need to be taken.

You will be asked to wait in our facility until the mammography images are reviewed by our technologist, who will make certain the clearest possible breast images were taken and don’t need to be repeated. Once that is confirmed, you may leave. Next, our BreastCare Center radiologists will read the images, interpret the results and write a report. That report is sent to your doctor, and patients are notified of results usually within five days by mail; or, your medical provider may contact you to discuss the results. If you had a referring physician, the report will be sent to that provider, too.

A member of our Breast Imaging team will contact you to discuss the findings and schedule additional imaging. It is important to keep in mind that if this happens, it does not necessarily mean you have breast cancer. The radiologist sees something on your screening that she or he is simply questioning, and you need to return for another mammogram and possibly an ultrasound.

Before you leave this follow-up appointment, you will receive your results and, if you would like, speak with our Breast Imaging radiologist. If the radiologist found a benign mass and wants to monitor the area more closely, you will be asked to return for a mammography (or ultrasound) in six months. If an abnormality remains on the additional images, you may need a biopsy. The biopsy can often be done that same day (if you choose). Approximately 20 to 40 percent of breast biopsies are cancerous. However, many women who receive abnormal mammogram results will return to having their annual screening mammography and need nothing else.

Mammograms can sometimes detect things that look like cancer but are not, and just a “false positive” result. About one in 10 to one in 12 women will have a questioned abnormality on their screening mammogram. So, if you have mammograms yearly for 10 to 12 years, you are likely to get this call at least once. The more mammograms you have over your lifetime, the more likely you are to be called back for a follow-up — and it could be because of a “false positive” result. If something is noticed on the mammogram, you may need to have additional testing, such as a diagnostic mammogram, a breast ultrasound and/or a biopsy.

This will help determine if there is an actual problem. We understand that getting called back can be upsetting, but we believe the benefits of mammography as a highly effective breast cancer screening tool are worth it.

Like all screening tests, the mammogram will not detect every single abnormality. The false negative rate for mammography is about 10 to 15 percent. That means that there are some cancers that are not seen with mammography. Therefore, it is critical that you have your mammogram screening at a qualified breast imaging facility with highly trained radiologists and technologists.

Breasts contain different types of tissue; some is fatty, some is fibrous, some is glandular. The fatty and fibrous tissue is what give breasts their size and shape, and also holds the glandular tissue in place. Breasts are considered dense if you have more fibrous and glandular tissue than fatty tissue.

Breast tissue density is determined by the radiologist who reads your mammogram. Radiologists classify breast tissue density into four categories:

• Fatty tissue
• Scattered fibroglandular tissue
• Heterogeneously dense tissue
• Extremely dense tissue

Patients whose mammogram results fall into the latter two categories are considered "dense."

A woman's individual level of density can vary due to weight and hormonal changes. Density may also decrease with age — younger women tend to have denser breast tissue than older women. Having dense breast tissue is not abnormal; however, recent studies have shown that having it may increase the risk of breast cancer relative to women with only fatty tissue. Dense breast tissue appears white on a mammogram, as do masses — both benign and cancerous — meaning mammograms can be less accurate in detecting breast cancer if a woman has dense breasts.

A law in Massachusetts effective January 1, 2015, requires all mammography providers to notify patients of their breast tissue classification and explain what that classification means.

No additional screening is required if a patient is found to have dense breast tissue, though it may be recommended depending on your individual risk of breast cancer. Many doctors believe that most women found to have dense breast tissue without other risk factors will not need any additional exams; talk to your doctor about your risk and whether additional screenings, such as 3-D mammography, breast MRI, or whole breast ultrasound, may be right for you.

Breast Imaging at BIDMC and its outpatient offices are all completely digital. Digital mammography utilizes the latest technology available for breast imaging. There is a slight decrease in radiation dosage, a faster exposure time and improved image contrast, making it easier for radiologists to see abnormalities, compared to film mammography.

Our BreastCare Center has been a digital mammography site for many years. We also offer 3-D mammography (digital breast tomosynthesis), the most advanced screening technology available, in our Boston and Chestnut Hill locations.

Digital mammograms can be transmitted electronically from one facility to another, allowing for better coordination among a patient’s physicians. And, because the images can be transferred electronically, our patients have the advantage of being able to have their mammograms at any of our BIDMC locations.

Similar to a digital camera, images are collected digitally so they can be manipulated by software programs which enhance image characteristics. If we see something of concern on a digital mammogram, we can digitally magnify that area on our computer monitor.

With older film mammography, a single piece of film is put into each cassette and the technologist has only one chance to obtain the correct exposure for an optimal image. Once the film is exposed, it can’t be manipulated.

Please check with your health care insurance company about the exact details of your coverage. The Affordable Care Act mandates that coverage of mammograms for breast cancer screening be given without a co-pay or deductible beginning with plan years starting after August 1, 2012. This doesn’t apply to health plans that were in place before it was passed. State laws, which are all different, and other federal laws cover those plans.

Each state differs in what its law says about mammogram screening coverage — and some are more generous than others. 3-D mammography and other breast screening procedures may not be covered by every insurance policy and result in an additional fee; check with your insurance company about what exactly is covered under your plan.

In most cases, a diagnostic mammogram, breast ultrasound or breast MRI has to be ordered by a physician in order for it to be covered by insurance.

Yes. If a woman has breast implants, the mammography technologist will push the implants out of the way and take additional images of each breast. Implants make it difficult to see the underlying breast tissue, which is why we need to take extra views. If a woman with implants feels a lump in her breast, we will do an ultrasound in addition to the mammogram because, often, ultrasound allows us to see a lump that may be obscured by the implant.

Although it is rare, men can get breast cancer. According to the American Cancer Society (ACS), in 2012, approximately 2,190 new cases of invasive breast cancer were diagnosed in men and 410 men died from the disease. The ACS also says that because male breast cancer is uncommon, there is unlikely to be any benefit in screening men in the general population with mammograms. Mammography for screening has not been studied in men, and is usually done only if a lump is found.

But, men have breast tissue, too, and need to be aware of any changes in their breasts. These changes include nipple discharge or turning inward, redness or scaling of the nipple or skin around it, skin dimpling or puckering, or a lump or swelling, which is often, but not always, painless. Sometimes, before a tumor in the breast tissue is large enough to be felt, a lump or swelling under the arm or around the collar bone is evident, which could be caused by breast cancer that has spread to lymph nodes.

It is important to know that most breast lumps in men are caused by a harmless enlargement of breast tissue; however, contact your medical provider immediately if you see any lumps or changes in the breast or breast area.

BIDMC accommodates all who need breast imaging. We have done mammograms on patients in wheelchairs, with multiple sclerosis, who have had a stroke, and some who are very elderly. If needed, two technologists will work together to ensure our patients are as comfortable as possible while performing the screening or test.

Please call 617-754-9500 Monday through Friday between 8 a.m and 6 p.m. When you call to schedule a screening mammogram, we will ask you for basic information such as your Beth Israel Deaconess Medical Center records number or your Social Security number.

You can also schedule a mammogram screening at our other breast imaging locations.