So you’ve just turned 40! You’ve made it through your thirties and now your doctor tells you that she is ordering a mammogram! What a time.
It’s your very first experience with this type of test and anxiety often runs high. What should I expect? Is it painful? When will I know the results? What if the results are bad? What if they are just unclear? What does this result even mean?
These are all legitimate questions that we as breast surgeons talk about everyday. And today, we are going to guide you through your first mammogram.
What is a mammogram?
Mammograms are specialized x-rays designed to look into breasts to detect abnormalities. These abnormalities can range from benign entities to cancers and the entire spectrum between. Simple mammograms produce two-dimensional images. But, a breast is a 3-dimensional structure (top to bottom, left to right, front to back). So, during your mammogram, you will have two different angles of images taken. These two angles, each with two dimensions, will then allow radiologists to look at your breast tissue in each of the three planes.
Will it hurt?
Mammograms are non-invasive x-rays images. There are no needle pokes, no contrast or dye injections, and most often your first mammogram can take only a few minutes. To obtain the x-ray image, a breast is placed on a surface or piece of plastic (like a table) and the x-ray machine comes either from the top or the side of the breast. In order to create the best possible image quality, the amount of overlapping tissue must be minimized. Therefore, pressure is placed on the breast either from the top or from the side to “thin” the breast as much as possible. This “pressure” or “compression” can create minor discomfort, though the compression occurs only for a few minutes time.
I’ve heard about 3-D mammograms…What is this? Do I need one?
3-dimensional mammograms are also called Digital Breast Tomosynthesis (DBT), which is a technology which was originally introduced in the late 1990’s. Since then, its utility has been widely proved to improve the detection of cancers and other breast abnormalities. DBT creates 3-D images as opposed to the traditional 2-D images as described above. This allows radiologists to further decrease the visualized overlapping tissue. The society which produces expert statements by radiologists now recommends DBT in patients with dense tissue, a higher personal risk of cancer, and can be considered in all women older than 40. Speak to your physician about receiving DBT.
What do these results even mean?
So, you’ve gotten through your first mammogram and you log into your patient portal to discover your results are ready! But, what is this language? What do these results even mean? Well, for a long time, there was no standard reporting system for breast imaging and patients (and many doctors) were left confused as to how to interpret results. In response in the early 1990s, radiologists began using what is known as the BiRADS system. BiRADS (Breast imaging-reporting and data system) is now the standard way to report all breast imaging and allows for streamlined interpreting and managing of results. There are 7 categories that your mammogram can fall into:
BiRADS 0: This means that more information is needed to give you a full recommendation. Either an ultrasound or more images are needed to give a clear answer on whether your mammogram is negative or requires you to receive a biopsy.
BiRADS 1: Negative! Your breasts are free of any abnormal or benign lesions, or any findings which require further investigation.
BiRADS 2: Benign! Just as good as BiRADS 1, but this time they found a lesions which looks benign. Not a completely negative test (because they found an area), but what the image shows is NOT concerning. Rest easy.
BiRADS 3: Probably benign! The radiologists found an area that is different from the rest of your breast, but it looks benign. These patients are most-often recommended more imaging in 6-months to closely follow that area. Less than 2% of these findings are cancerous at the time of imaging, so rest easy.
BiRADS 4: A biopsy is heading your way. The radiologists found an area that is concerning for cancer. But sit tight for a second here. BiRADS 4 includes lesions which have anywhere from a greater than 2% to 95% risk of cancer (quite a big range). This does require a biopsy, however, and may require more imaging to get the best look at this area.
BiRADS 5: A biopsy is definitely heading your way. The radiologists found an area that is quite concerning for cancer. This category includes lesions which have greater than a 95% chance of being cancer. If you have questions regarding biopsies or what this area could be, talk to your doctor.
BiRADS 6: If you fall into this category, you have already had a biopsy and the radiologists are confirming that they see the area which has been biopsied and proven cancer. This category does not apply to those receiving their first mammogram.
I’ve been called-back for more images… Do I have cancer?!
We as breast providers understand the anxiety that comes with any imaging test and its results. We want to be sure that when we give you an answer, it is the right one. So, often we want more images to be very sure. This can include either an ultrasound, or mammograms taken from additional angles to create the best look at a finding. This does NOT mean you have cancer.
Ok, I’ve had my mammogram…Should I see a surgeon?
We, as breast surgeons, are happy to discuss any concerns you have regarding mammograms or other breast imaging techniques. Certainly, if there are areas of concern or you have questions regarding your findings, do not hesitate to reach out to your provider or ask for a referral to a specialist.
Congratulations, you’ve gotten through your first mammogram! Don’t forget, the National Comprehensive Cancer Network recommends annual mammography, so be sure to make your appointment for next year. Until then, we’ll be here monthly to provide information about breast cancer and breast surgery, and to guide you through whatever challenges you may face.
Emily L. Siegel is a board certified general surgeon and fellowship-trained breast surgeon in Los Angeles, CA. After attending Williams College for her undergraduate studies, she went on to receive her MD from the USC Keck School of Medicine and subsequently trained in General Surgery at Cedars-Sinai Medical Center. After pursuing research interests in breast cancer, she finished her specialty training in Breast Oncology Surgery at H. Lee Moffitt Cancer Center in Tampa, Florida, a quaternary referral research hospital, and one of the nation’s top cancer centers. Her research interests include the surgical management of breast cancer and she is widely published in journals and medical textbooks.
Having grown up in Los Angeles, she is dedicated to providing care in the city and community in which she was raised. With interests in benign, malignant, and high risk breast disease, her practice encompasses all aspects of breast health.
[…] breast which looks abnormal (either BiRADS 4 or BiRADS 5 results – For more info on this, see our last post). Before we dive into what some of the results of a biopsy can be, let’s talk about the process […]