Getting Ready for Your Mammogram
It is time….the day has come…you are now 40 and your doctor advises it is time for your first screening mammogram. Here are some questions that may be running through your mind: “Will it hurt?” “How much compression will they use?” “Will they find cancer?” But have you ever considered the answer to this question? “Who will be reading my mammogram?” This question may prove to be the most important of all.
This may or may not come as a surprise, but it is actually a radiologist who is responsible for reading your mammogram, not your primary care physician or breast surgeon. The radiologist is often the invisible partner in your breast health team, but the success of a screening mammography campaign to identify cancer at an early stage (early stage=better chance for successful treatment) is largely dependent on the training and experience of the radiologist. All radiologists undergo dedicated training in mammogram interpretation, as well as interpretation of other breast imaging studies. Some radiologists choose to undergo additional training spending an extra year focused on breast imaging interpretation and breast procedures. These radiologists are referred to as fellowship-trained breast radiologists.
The bread and butter of the breast radiologists’ work day are interpreting screening mammograms. Interpreting a screening mammogram can be likened to searching for an abnormal cloud in the sky. Breast tissue is composed of two different types of tissue: fatty tissue and glandular tissue.
The fatty tissue is dark in the image (I like to compare this to the blue part of the sky), and the glandular tissue is white in the image (think clouds in the sky). Unfortunately, cancer is also white on the image, sometimes making it difficult to determine if the white part of the image is normal glandular tissue (the normal clouds in the sky) or breast cancer (the abnormal cloud), particularly if the patient has a significant amount of glandular tissue (think overcast sky).
Your Breast Radiologist’s Experience Matters
The more mammograms that a radiologist has interpreted, and the more frequently the radiologist is interpreting mammograms on a regular basis (daily versus once a month), the better chance the radiologist has to visually identify the abnormal white part on the image (the abnormal cloud in the sky) which may represent a new/subtle cancer. The whole point of obtaining yearly screening mammograms is to catch small cancer while it is still treatable, so it makes sense to have a dedicated breast radiologist on your breast health team.
Beyond interpreting screening mammograms, dedicated breast radiologists are also responsible for interpreting breast ultrasound and breast MRI studies which may be utilized to further evaluate an abnormal screening mammogram, breast pain, or a palpable finding, as well as provide an additional screening option for women who are at a higher risk of developing breast cancer. When an abnormality is identified on imaging, a biopsy is often recommended.
During a breast biopsy, the radiologist removes small pieces of tissue from the mass or abnormal tissue and gives this to the pathologist who will then determine a diagnosis. The breast radiologist is specifically trained to target these abnormal areas using either x-ray (stereotactic), ultrasound, or MRI technology to guide the biopsy.
Being able to see the tissue being sampled during the biopsy ensures that the area of concern is adequately targeted and the pathologist will have a representative tissue sample to make a diagnosis. Finally, after a diagnosis has been made from a breast biopsy, breast surgeons often ask the breast radiologist to place a small wire in the mass or abnormal tissue so that the surgeon has a physical road map guiding them to the tissue that needs to be removed surgically.
Breast radiologists are committed to the overall health of their patients and often participate in meetings with breast surgeons, pathologists, oncologists, and radiation oncologists. These team meetings are an opportunity for all of the breast health specialists to discuss each individual patient, including the imaging findings, any potential concerns or complications, the surgical and treatment plan, and follow-up recommendations.
As you can see, the breast radiologist plays a central role in the breast health of their patients. Unfortunately, it is not always easy to determine which radiologist will be reading your mammogram. Highly skilled breast radiologists may be found at various locations across the country including large dedicated breast imaging centers, academic centers, and rural community imaging centers. I encourage you to take an active role in your breast health and ask the question “Who will be reading my mammogram?” Ask about the credentials of the radiologists who service the imaging center.
Sometimes the screening mammograms will be interpreted by the radiologist who is at the facility you are visiting, or they may be interpreted at a different site by another radiologist. Either way, it should be a fairly simple question for the staff to answer- if I am having a mammogram on this specific day- who is the radiologist who will be reading my exam? Does the radiologist read mammograms on a regular basis? Are they fellowship trained? Optimum breast health is dependent on the patient and the healthcare provider is actively engaged- so be proactive and actively seek out a dedicated breast radiologist to be a part of your breast health team.
Written by Danielle Carroll, M.D.
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