Mammography Q&As

Mammography Q&As

Is 3D mammography available at the Carol Milgard Breast Center?

Yes! The Carol Milgard Breast Center is honored to be the first in Pierce County to provide this technology to patients. 3D mammography, in combination with 2D mammography, has become our new standard of care and is available to all patients for screening and diagnostic mammograms.

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.

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. 3D mammography complements standard 2D mammography.

What will my mammogram be like?

3D mammography complements standard 2D mammography. No additional breast compression is required and it only takes a few more seconds. 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 will be 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 1-2 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. Your report will be finalized within 24 hours and delivered to your referring health care provider and a results letter will also be mailed to you.

Under the 21st Century Cures Act, we are required by law to provide you access to your results within 24 hours of them being finalized. Unfortunately, this means you could receive your results prior to receiving communication from our team. Please call your referring health care provider if you have questions or concerns about your exam results.
How effective is mammography?

Evidence has shown that mammography is one of the most effective tools for detecting breast cancer. When an abnormality does appear on a diagnostic mammogram and biopsy is recommended, only one out of four proves to be malignant (cancerous). Some breast cancers cannot be detected on a mammogram, but mammography is still the best screening tool available for detecting cancers. Because some breast cancers do not show up on mammograms, it is important to incorporate regular breast self-examination and an annual clinical breast exam by your health care provider as part of your breast health routine.

How often should I get a mammogram?

The Carol Milgard Breast Center and TRA Medical Imaging advise women to get screening mammograms every year starting at age 40. 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 93 percent or higher survival rate in the first five years. If you have a family history of breast cancer or breast abnormalities, your health care provider may have you start annual mammogram screening earlier than 40.

Why aren't you following the new American Cancer Society guidelines?

The Carol Milgard Breast Center and TRA_MINW are located in an area of the United States that has a higher rate of breast cancer, according to the Centers for Disease Control. We are working with our hospital partners to come up with a guideline that is in the best interest of our community and our patients.

Until then, we have not changed our recommendation that women get yearly screening mammograms every year starting at age 40. 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 for survival. Women whose breast cancer is detected at an early stage have a 93 percent or higher survival rate in the first five years.
The Society of Breast Imagingthe American Congress of Obstetricians and Gynecologists, and the American College of Radiology also recommend annual screening mammograms for women starting at age 40.
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.

Should I have a mammogram if I’m breast feeding?

Routine screening mammograms should be postponed if you are breast feeding. For a screening mammogram, we recommend you wait six 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, both 2D and 3D, 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 lbs. 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.

With 3D mammography, do women still need an annual screening mammogram?

Yes. All women are at risk for breast cancer, regardless of symptoms or family history. Mammograms often can detect potential problems before they can be felt. Early detection greatly increases treatment options and the likelihood of successful recovery. Although 2D/3D combination exams have been proven to detect more cancers, the Carol Milgard Breast Center and TRA Medical Imaging continue to advise women to get screening mammograms every year starting at age 40.  Evidence has shown that women who skip a yearly mammogram may miss the opportunity for an early breast cancer diagnosis.

Why do women still need an annual mammogram when 3D has an improved cancer detection rate?

Breast cancer is the most diagnosed cancer in women, affecting one in every eight women in the U.S. The goal of screening exams is to identify breast abnormalities as early as possible, facilitate early cancer detection, and thereby provide patients with more treatment options and a better chance for survival. Yearly mammography will help detect subtle new findings. Women whose breast cancer is detected at an early stage have a 93 percent or higher survival rate in the first five years.

Breast cancer doesn’t run in my family. Why do I need a mammogram?

Regular mammography is important for ALL women. Three out of four women diagnosed with breast cancer have no family history or significant risk factors for the disease. ALL women are at risk for breast cancer with the risk increasing as they age. If you are female and 40 or older, we recommend a screening mammogram every year regardless of your family history.

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

Radiation exposure to the breast is very low. The radiation dose for a combined 2D/3D mammography exam is 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.

Do all imaging sites in our region offer 3D mammography?

Not yet. The Gary E. Milgard Family Foundation awarded the breast center an extraordinary grant so that we can provide 3D mammography to all patients to make early detection of breast cancer even earlier. The Carol Milgard Breast Center is proud to be the first to offer this new technology in Pierce County.

As part of an overall commitment to quality and access to care for all women in our communities, our owners/partners, CHI FranciscanMultiCare Health System and TRA Medical Imaging, have also committed to implement 3D mammography throughout the region in their own breast imaging sites within the next few years. This will make Pierce County one of the most progressive areas in the nation offering this groundbreaking technology.

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 one in 17.1 million.

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

Should I use a thyroid guard when getting a mammogram?

According to the American College of Radiology (ACR), “Scientific evidence shows that risk to the thyroid from mammography is negligible and that thyroid shielding during mammography is unnecessary.” The use of thyroid guards is not recommended by the ACR, breast center, or other public health experts.

The breast center does make thyroid guards available to patients who request them, but we make sure that patients understand the risks of using the shield, as well as the low risk of radiation exposure to the thyroid with or without the shield. Our top priority is to respect our patients’ preferences and to make sure that they feel completely safe when getting their mammograms.

For more information, see Mammography and the Risk of Thyroid Cancer by the American Journal of Roentgenology.

I have a thyroid disease. Should I wear a thyroid guard when getting a mammogram?

No. The recommendation is the same for women with and without thyroid disease. The use of thyroid guards is not recommended by the American College of Radiology, breast center, or other public health experts.

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.

What is Computer Aided Diagnostics (CAD)?
The Carol Milgard Breast Center provides computer aided diagnostics (CAD) with all screening mammograms. CAD uses sophisticated computer software to analyze the images following initial interpretation by a radiologist. CAD is believed to improve the diagnostic accuracy of a mammogram exam by up to 20 percent.
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