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Mammography Q & A

What are the benefits of using 3D mammography?

Many studies in Europe and the U.S. have substantiated superior breast cancer detection rates when combining 3D mammography with conventional 2D mammography. Studies have demonstrated a 10%-30% increase in overall breast cancer detection (over 2D imaging alone). This ability to detect breast cancer at an earlier stage will save more lives. Two of the top benefits are improving the early detection of breast cancer and providing peace of mind due to greater clarity and accuracy. This increased accuracy reduces the number of call-backs (by as much as 30%), sparing women the anxiety, inconvenience and expense of coming back for further imaging.

What is 3D mammography?

Digital breast tomosynthesis (tomo), also known as 3D mammography, is a revolutionary new screening and diagnostic breast imaging tool to improve the early detection of breast cancer. During the 3D part of the exam, an x-ray arm sweeps over the breast, taking multiple images in seconds. Images are displayed as a series of thin layers that can be viewed by our radiologists as individual images or in a dynamic interactive animation. Approved as an imaging modality by the FDA in early 2011, 3D mammography is used in combination with 2D digital mammography. CORA has proudly offered 3D mammography to our patients in Bend and Redmond since 2015.

How is 3D mammography different than 2D?

Traditional digital mammography takes two-dimensional pictures of the breast and is still one of the most advanced tools available for detecting breast abnormalities. But rather than viewing the breast tissue in 2D images, our radiologists can examine the tissue one thin layer at a time, in a sense traveling through the structure of the breast like flipping pages of a book. Fine details are more visible and are less likely to be hidden by overlapping tissue. The minimal radiation dose is similar for 2D and our newer 3D exams.

What will my mammogram be like?

Your mammogram will be performed in a private suite by a female technologist who is certified in breast imaging. Before the exam, you will undress from the waist up, change into a soft robe, and remove any powder, deodorant, lotion and/or perfumes from your underarms and breasts (because material in these products can interfere with accurate visualization of your breast tissue). A screening mammogram takes multiple views of each breast, from above and from the side. A diagnostic mammogram may contain standard views and/or additional views of a specific area. Images are obtained by firmly and briefly pressing the breast tissue between a compression paddle and a plate. Adequate compression is essential to detect subtle abnormalities.

Does a mammogram hurt?

Because compression is needed to detect subtle abnormalities in the breast, some women experience minor discomfort during a mammogram exam, especially if their breasts are tender. Others experience no discomfort at all. The best way to reduce discomfort is to schedule your exam a week after your menstrual cycle and take a non-aspirin pain reliever (such as Tylenol, Advil or Aleve) an hour before your exam.

Why is a baseline mammography important?

Your first mammogram, or baseline, is valuable because it gives the radiologist a starting point for comparison with all future exams. Occasionally, a subtle abnormality is only seen when a radiologist compares your current mammogram to ones you’ve had before.

How will I get the results of my mammogram?

Your mammogram and any other related exams will be interpreted by the breast center’s board-certified radiologists who specialize in breast imaging. Your screening mammogram report is typically finalized within 24 hours and delivered to your referring health care provider. A results letter will also be mailed to you. Should your mammogram results recommend further imaging, the breast center will call you 1 to 2 days following your screening mammogram to schedule a diagnostic mammogram or other testing. If you had a diagnostic mammogram or additional imaging, you will know before you leave your appointment whether or not further testing is required. We will also send those results to your provider.

How effective is mammography?

Evidence has shown that mammography is most effective tool for breast cancer screening. Since annual screening mammography became available in the early 1990s, breast cancer deaths have been reduced by 39%. Mammograms are the only proven screening test to show such staggering results. However, there are limitations of mammography. Depending on your breast density, the ability to detect a cancer or abnormality ranges from 75-89%.  Therefore, because some breast cancers do not show up on mammograms, it is important to continue regular monthly breast self-examination and an annual clinical breast exam by your healthcare provider as part of your breast health routine.

How often should I get a mammogram?

CORA advises women to get screening mammograms every year starting at age 40. One in every six new breast cancers occurs in women in their 40s. The American College of Radiology, the Society of Breast Imaging, and NCCN (National Cancer Consortium) all recommend annual mammograms beginning at age 40. Other recommendations do exist, but they admit that beginning later or choosing to screen every other year will cause more women to die from the disease. Evidence has shown that women who skip a yearly mammogram may miss the opportunity for an early breast cancer diagnosis. Women whose breast cancer is detected at an early stage have a 98% percent or higher survival rate in the first five years. Our goal is to detect cancer before you can feel it.

What if I don’t have any risk factors for breast cancer?

85% of all new breast cancers are diagnosed in women without any known risk factors or family history of breast cancer. Only 5-10% of cancers have a genetic or hereditary component. If you are an average risk woman, you have a 1 in 8 lifetime chance of developing breast cancer. The goal of screening exams for early breast cancer detection is to identify breast abnormalities as early as possible. If breast cancer is found early, there are more treatment options and a better chance of survival. Women whose breast cancer is detected at an early stage have a 98% percent survival rate in the first five years.

What if I am at higher risk for breast cancer?

CORA and the American College of Radiology recommends all women be evaluated for their risk level by age 30. If you have a family history of breast, ovarian, or pancreatic cancer, or you have had a prior breast biopsy with atypia, chest wall radiation at a young age, or are Ashkenazi Jewish, you may be at increased risk. You can review this information with your provider or try an online risk assessment tool here:  https://bcrisktool.cancer.gov/
When you come for imaging at CORA’s Breast Center, we will evaluate your risk during your visit.

What if I’m pregnant?

It is important that you inform the technologist about being pregnant or the possibility of pregnancy before a mammography exam. We delay screening mammograms until after pregnancy and optimally begin 4 to 6 months after cessation of breastfeeding. If you are pregnant and have a new focal breast concern, we will begin our evaluation with ultrasound.

Should I have a mammogram if I’m breastfeeding?

Routine screening mammograms should be postponed if you are breastfeeding. For a screening mammogram, we recommend you wait 4 to 6 months after you stop nursing to allow your breasts to return to normal. If you experience any unusual breast symptoms while you are still nursing, please see your health care provider. You may need to be referred for a breast ultrasound and possibly a diagnostic mammogram. It is advisable that you nurse or pump immediately before coming in for your diagnostic exam so that the breasts are as empty as possible.

Is mammography safe for women with breast implants?

Yes. Mammography is safe for women with breast implants. Most breast implants are designed to withstand hundreds of pounds of pressure. A mammogram generates an average of 20 pounds of pressure. If you have breast implants, it is just as important that you participate in regular mammography screenings. When you schedule your appointment, please let the scheduler know that you have breast implants, as additional time may be required for your exam.

What is a mammogram with breast implants like?

Mammography with breast implants requires special positioning and additional mammographic views. A mammogram with breast implants will usually consist of multiple views of each breast, from above and from the side, and additional views displacing the implant. Displacement views consist of moving the implant back toward the chest wall and bringing the breast tissue forward. Images are then acquired by firmly and briefly pressing the breast tissue between a compression paddle and a plate. Adequate compression is essential to detect subtle abnormalities. Damage to implants from a mammogram procedure is extremely rare. You should know that visualization of breast tissue around implants can be more difficult. This makes regular breast self-exams and clinical breast exams by your health care provider an important part of your breast health routine.

Will I be exposed to unnecessary radiation by getting a mammogram every year starting at age 40?

Radiation exposure to the breast is extremely low and well below the acceptable limits defined by the FDA. The dose is also only a fraction of the level of radiation everyone receives annually from the natural background of being outdoors. One screening mammogram is equivalent to 5 to 7 weeks of radiation we are all exposed to on earth, called background radiation. If you have a yearly mammogram from age 40 to 75, the radiation is equivalent to two CT scans.

Does having a mammogram increase my chance of developing thyroid cancer?

Some women have expressed concern, due to an erroneous media report, that the small amount of radiation a patient receives from a mammogram may significantly increase the likelihood of developing thyroid cancer. According to the American College of Radiology (ACR), this concern is not supported in scientific literature. The ACR is a professional medical organization dedicated to being the premier source of information on radiology and nuclear medicine.

The ACR explains that the radiation dose to the thyroid from a mammogram is extremely low and is equal to the amount that a person receives from natural background sources simply from standing outside for 30 minutes. For women who receive annual mammograms from age 40 to 80, the total lifetime risk of developing cancer from the tiny amount of radiation scattered to the thyroid is less than 1 in 17.1 million.

The harmful risk of breast cancer going undetected and untreated due to skipped mammograms are infinitely higher than the nearly non-existent risk that a mammogram could cause thyroid cancer.

Does the breast center offer thermography as well as mammography?

No. The breast center does not offer themography because it is not a credible alternative to mammography. The U.S. Food and Drug Administration (FDA) issued a safety communication in 2011 regarding the use of thermography in breast cancer screening. The FDA stated, “…thermography is not a replacement for screening mammography and should not be used by itself to diagnose breast cancer. The FDA is not aware of any valid scientific data to show that thermographic devices, when used on their own, are an effective screening tool for any medical condition including the early detection of breast cancer or other breast diseases.”

Public health agencies and national medical and professional societies agree with the FDA that mammography is still the most effective method of detecting breast cancer in its earliest, most treatable stages. These organizations include the American Cancer Society, the American College of Radiology, the Centers for Disease Control and Prevention, the National Cancer Institute, and the Society of Breast Imaging.

The position of the American College of Radiology is that, “Thermography has not been demonstrated to have value as a screening, diagnostic, or adjunctive imaging tool. Thermography is not a substitute for mammography screening. Mammography remains the gold standard for breast cancer screening. We recommend that women begin annual mammography screening at age 40.”
For more information, see the FDA article, Thermogram No Substitute for Mammogram.

When should I stop getting my screening mammogram?

CORA, the American College of Radiology and American Cancer Society recommend to continue annual screening mammography until age 84 as long as your remain in good health.

What if I have dense breast tissue?

Dense tissue refers to the amount of glandular tissue we see on your mammogram, relative to the amount of fatty tissue. Half of all women have dense tissue around the age of 50. However, we inform patients about their breast density because dense tissue does slightly increase the risk of developing breast cancer and it does make your mammogram slightly more difficult to evaluate. This means it is even more important to continue regular yearly screening mammograms, monthly self-exams, and annual physical exams by your provider. Any changes should be evaluated with diagnostic mammography and ultrasound. Some women will choose to also screen with whole breast ultrasound in addition to regular mammograms.
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