A Mammogram Primer

By: William J. Gradishar, MD
By: Julie Gralow, MD
With regular mammograms, women may reduce their risk of dying from breast cancer by more than 60 percent, according to the American Cancer Society. These X-ray pictures can reveal the presence of small cancerous lesions in the breast up to two years before they can be detected with a self-examination.
There is little question that regular mammograms are an effective means of cancer prevention, especially for women after menopause. And although the importance of regular breast cancer screening has, to a large degree, become common knowledge, many women do not know what to expect from a mammogram examination.

Below, breast cancer experts Dr. William Gradishar and Dr. Julie Ruth Gralow, answer some important questions about the process of breast cancer screening with mammogram.

Where does one go to get a mammogram?
JULIE GRALOW, MD: There are lots of places to get mammograms associated with clinics and in hospitals. It?s usually not too hard to find a radiology unit that does mammography.


Go through the process for us, if you could, Dr. Gralow, from the time a woman gets to this location until the procedure is taken place.

JULIE GRALOW, MD: First we do a regular breast exam, so we know if there are special areas that we should be focusing on during the mammogram.

We get two pictures of each breast from different views so that we can look at the tissue in a different way. To take the pictures, the breast needs to be flattened, splayed out, if you will, so that we can get a good look at everything that?s in the whole breast.

WILLIAM J. GRADISHAR, MD: Sometimes it can be uncomfortable because the mammographer is trying to capture as much of the breast tissue in the image as possible. Keep in mind, the breast tissue goes up to the breastbone. It goes all the way under the arm, potentially down low.

Dr. Gradishar, what are mammographers looking for when they receive the mammogram results?
WILLIAM J. GRADISHAR, MD: First, they always want to look at prior mammograms if they?re available so that they can compare the old ones to the new ones. They?ll be looking for any areas that are new that weren?t apparent on the previous mammogram. They?ll be looking for any sort of salt and pepper appearance, a speckling that may indicate an underlying problem.

Sometimes there are areas on the breast in the mammogram that suggest what?s called an "architectural distortion." which can mean that something is pulling on the tissue, or tempting it in some manner. That may be a clue to the radiologist, again, that there?s an underlying problem.

Dr. Gralow, does an abnormality always suggest breast cancer?
JULIE GRALOW, MD: No. As a matter of fact, most abnormalities found on a mammogram are not cancer. Most of the time, when a woman is told she might have a little spot on her mammogram, it?s not actually cancer.

How long does the test take?
JULIE GRALOW, MD: The procedure probably takes about half an hour in the office. But the X-rays are actually on for a very, very short period of time.

How long does it take to get the results?
WILLIAM J. GRADISHAR, MD: In most institutions where they do a large volume of mammogram screening and diagnostic mammograms, women will receive the results relatively quickly. But if a woman has not heard her results, she should always check to confirm that they are normal.

How do you suggest women make decisions about future screening based on negative or positive results of a mammogram?
JULIE GRALOW, MD: I think if you have something that feels abnormal or unusual about your breast, especially if you?re in your forties or over, you needs to have it explained. Even if you can?t see it on a mammogram, if you have some problem with your breast, you need to either be reassured that it?s normal, or it needs to be biopsied and investigated further.

If you don?t have any abnormalities of your breast, and the mammogram is read as normal, then I wouldn?t push it any farther than that. I would still do my monthly exams and make sure that I was aware of any changes in my breast, and make sure I come back in a year for another mammogram and another health professional?s exam.

A Mindful Approach
Approximately 70 percent of American women who are diagnosed with breast cancer survive it. And the earlier a cancer is found, the better a woman?s chances are of getting effective treatment. So do regular self-examinations and get regular mammograms, because effective prevention starts with you.

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