That’s right, it isn’t about the best screening mammogram EXPERIENCE, it is about the best screening mammogram INTERPRETATION. Why do you endure the screening mammogram on a yearly basis? The goal when choosing a facility to obtain your annual mammogram should not be to have the best spa-like experience (although this can be a nice touch), finding the facility that lets you get away with the lightest compression possible, or even the most convenient mammogram facility geographically. The reason you put up with the annual breast compression is to catch breast cancer at its earliest stage when it is most treatable. So what can you do to help ensure you get the best interpretation possible from your screening mammogram?
Choose a facility where an experienced breast radiologist will be reading your screening mammogram.
As discussed in a previous article, not all radiologists have obtained the same training and level of expertise when it comes to their ability to interpret a screening mammogram. I encourage you to contact the facility where you are having your mammogram and ask for the credentials of the radiologist who will be interpreting your mammogram. Does the radiologist read mammograms on a regular basis? Has the radiologist undergone additional training in breast imaging interpretation through a dedicated breast imaging fellowship? Choosing the facility for your screening mammogram should be based on the credentials of the interpreting radiologist, not on the extraneous decorations and niceties of the facility or the most convenient location to your home or office.
Choose your ideal imaging facility and stick with it.
With standardized patient positioning during mammography, breast tissue maintains a similar appearance from year to year on each mammogram. New glandular breast tissue (the white part of the image) does not increase in quantity as you age, but you may slowly lose glandular tissue over time. This results in the mammogram looking fairly similar year after year- think of this as your breast “fingerprint.” Because a new small cancer can look just like glandular tissue, it is very important for the breast radiologist to compare your mammogram with prior mammograms. If a questionable area of density (increased area of white on the image) can be shown to not change over a period of time, then the breast radiologist will feel confident that this density represents normal breast tissue. However, if a new area of density appears on the mammogram, or the structure of the glandular tissue changes, this could represent an early subtle finding of breast cancer. Without the benefit of prior mammograms for comparison, these early changes indicating a developing breast cancer may be overlooked as “normal” breast tissue, delaying the eventual breast cancer diagnosis until cancer has grown even larger on the next year’s mammogram, where the change becomes evident.
If you have to change breast imaging facilities, let the new facility know where your last mammogram was performed.
Ideally, having your mammogram performed at the same facility year after year ensures that the breast radiologist has access to all prior breast imaging studies, which is invaluable when interpreting your current mammogram (see #2). However, life happens- you may move across town or across the country, change insurance companies, etc…and it may be necessary to change facilities. Don’t worry- this isn’t the end of the world! You can still benefit from having prior mammograms available for your breast radiologist, it will just take a little extra effort on your part. When you schedule your mammogram at a new facility, it is immensely helpful if you let the scheduler know the name of the facility including the City and State where your last mammogram was performed.
You will be asked to sign a waiver allowing the new facility to obtain your prior medical records. The new facility will then request the prior mammogram images to be sent so that they will be available for the breast radiologist at the time of your screening mammogram appointment. Ideally, this should be done PRIOR to your appointment so there is no delay in interpreting your mammogram. Many breast radiologists will not give a final interpretation for a mammogram until the prior images have arrived for comparison. If the location of your prior mammogram is not provided before your appointment, the interpretation of your current mammogram may be delayed while the images are requested and delivered.
If you are having any new breast symptoms, let the scheduler know at the time you schedule your appointment.
Any new breast symptoms may be an early sign of breast cancer. Breast symptoms that are important to note include a new lump in the breast (also referred to as a palpable finding), a palpable finding which has increased in size, skin changes/puckering, nipple retraction, breast pain, and nipple discharge. If you are experiencing any of these symptoms, additional imaging may be necessary to fully evaluate your symptoms. If you tell the scheduler that you are experiencing any of these symptoms, the facility will have time to contact your primary care provider and request an order for more detailed imaging to evaluate your new symptoms prior to your appointment.
Come prepared on the day of your examination.
Do not wear deodorant or powder on the day of your exam. Some components of deodorant and body powders can obscure subtle findings in the breast and axilla (armpit area). Wipes are generally available for removal if you forget, but it is best to come prepared if possible.
During the examination.
The success of a screening mammogram to detect subtle cancers lies in the visualization of the small details on the image. There are two factors that can result in obscuring these small details, both of which are within your control. The first consideration is the amount of breast compression you tolerate. I haven’t met a woman yet who claims to enjoy having their breast compressed. It is not comfortable, I get it, I too have a yearly mammogram.
However, the more compression you tolerate, the more fine details the breast radiologist will be able to see on the image. Increased compression also helps prevent the second factor- motion. Increased compression=less motion. Additionally, when the technologist asks for you to hold your breath- it is imperative that you hold your breath and hold as still as possible while the image is being obtained. Even the smallest amount of motion can render the mammogram image unclear. This may result in a repeat image (increased radiation exposure), at the time of your exam, or worst case scenario, the radiologist may ask for you to return at another time to repeat an image.
If you are reading this, you are probably willing to endure the compression and short-term discomfort of the exam in an attempt to identify breast cancer at the earliest moment. However, all 6 of these factors contribute greatly to the accurate interpretation of your mammogram. So why not go the extra mile to ensure you obtain the best interpretation possible?
Written by Danielle Carroll, M.d.