Mammograms

Question: I had a diagnostic mammogram and was scheduled for an ultrasound as well. The technologist said that after talking with the radiologist I did not need an ultrasound and to follow up with my family physician in a week or so. What does that mean? Is it a good sign? I should say I am 35 and have a small pea sized lump in my right breast. The mental anxiety is overwhelming.

Answer: Our breast imaging expert suggests that an ultrasound might be worthwhile, since you have a small palpable lump. Not all lumps are visible on mammograms. You are welcome to visit our breast center to have the ultrasound done. Be sure to bring copies of previous breast imaging studies for comparison. Thank you for your question.

Question: I’m so relieved this site exists. So I just turned 40 a few days ago and got my first mammogram (my best friend was recently diagnosed with breast cancer so I didn’t waste time). The report finds my left breast benign, my right breast, however, says “The breast tissue contains PATCHY REGIONS which are heterogeneously dense. In the area of dense fibroglandular tissue, noncalcified lesions might be obscured. There is nodular asymmetry of the right upper breast seen on the MLO view.” I now have to go back in and get another mammogram and an ultrasound. I’m supposed to go on vacation next week, so I can’t do these additional tests until September 8th. I’m already freaking out. Should I be worried enough to cancel my vacation so I can get the tests done a week sooner? Thank you.

Answer: Thank you for contacting the Breast Imaging Ask an Expert forum. We are glad to be able to provide this service to the public. We are dismayed that your first mammogram was not so simple. Our breast imaging expert says that the re-imaging is not an emergency, and can wait until after your vacation. The need to obtain additional mammogram views is very common, because some of the shadows that are seen on the routine mammogram views can be confusing. In most cases, the additional views show that the shadows are not a serious problem. A second mammogram also gives the radiologist an opportunity to see if changes have occurred. In the event that there is something that needs treatment, we hope you can find comfort in knowing that you will have a better chance than ever before to become cancer free after treatment, due to earlier detection and new treatments available. To schedule a breast imaging procedure at the Memorial Hermann Breast Center, please call 713-512-6040. LBJ Hospital also has quality breast image interpretation by experienced UT physicians, for an appointment call 713-526-4243.

Question: I want my husband present during the mammogram and the tech says no….I refused the test and left…..my husband goes to my gyn appointments, so why not there???????

Answer: No answer yet.

Question: I’ve had dense breasts on mammo, stable, benign nodes and calcifications in the left breast documented since 2002, documented no change in May 2012. In Dec 2012, I felt a lump, & the mammo 3/2013 showed architectural changes which were diagnosed as a 6 cm DCIS (quite large considering it wasn’t seen at all by the same facility 9 months before). After lumpectomy and reduction on the other side. the non-DCIS side pathology had lobular hyperplasia. what kind of follow up imaging would you recommend? I certainly don’t feel mammography alone is adequate surveillance anymore.

Answer: At this time, we don’t have a better imaging modality to offer as a screening test. The sensitivity of screening ultrasound is no better than mammography. In addition, ultrasound is operator dependent, time consuming, and yields many more false positives (which means many more biopsies). MRI is costly, time consuming, and also gives a higher number of false positive studies. As it stands now, the best follow up test after breast cancer treatment is still a mammogram, either annually or semi-annually for the first several years then annually (protocols vary in different facilities). There is debate whether MRI should be used to follow high risk patients such as those with a history of breast cancer. Data are still being accumulated to help answer this question. At this time, there are no formal guidelines to recommend MRI to all breast cancer patients. But MRI should be considered in the specific case you described (dense breasts, mammographic occult likely non-calcified DCIS).

Question: A recent mammogram showed dense breasts with a 6mm nodule by ultrasound. It is unchanged since last year. They are thinking it might be a papilloma. Last year I was sent to a breast surgeon and for a diagnostic mammo which neither consultant felt was needed. The same radiologist is now requesting an MRI. Good idea or waste of time?

Answer: Thank you for contacting the UT Ask a Breast Imaging Expert forum. Our experts feel that if the nodule is truly stable since last year, they would just follow it for another year or two to establish stability. If there is any concern that the nodule may have changed or if there is still concern for malignancy, our experts would recommend a biopsy instead of getting an MRI. MRI is costly, time consuming, and sensitive but not specific, meaning that there is a high rate of false positives. If you are interested in getting a second opinion from a UT-affiliated physician, you can call Toll Free: 1-888-488-3627, or go to the website.

Question: I have a small lump in my breast. I called and made an appointment for a mammogram, but the appointment is 6 weeks from now. Is it safe to wait that long to know what it is?

Answer: Thank you for contacting this Ask a Breast Imaging Expert Forum. Our experts feel that, in general, breast cancer has a slow rate of growth. Doubling time (the time it takes for a tumor to double in size) for breast cancer is 7 to 28 weeks. It may take six to eight years for a breast cancer developing from one cell to grow to the size of one centimeter. So by the time a cancer is detected on mammogram it has likely been present for a few years. Waiting six weeks likely does not change to the prognosis but it likely will have a much bigger effect on the patient’s mental well being. Personally, I think 6 weeks is too long to wait because of the anxiety. You can try to find another facility that does not have as long a wait. However if you do decide to go to a different facility it is very important that you obtain your prior films and take them with you to the new facility for comparison. This will decrease the time for results as well as lessen the likelihood of a call back for additional imaging. UT physicians can provide you with expert mammogram interpretations in Houston at the Memorial Hermann Breast Center, 6400 Fannin Suite 1605 (call 713-512-6040) or at LBJ General Hospital at 5656 kelly Street (call 713-526-4243).

Question: i am 44 year old i have not done memogram exam in a long time. Do i need to take an appointment for that and what will be the cost?i do not have an insurance.

Answer: Thank you for contacting this Ask a Breast Imaging Expert forum. Our experts say that you are smart to have another mammogram. If at all possible, you should try to get copies of your first mammogram to bring with you when you get your next one, because being able to compare them is very helpful. But we think you should also get a complete medical checkup. A mammogram is only one important part of making sure you are healthy. If there are any questions about the mammogram results, you will want to have a doctor to help you decide what to do next. If you would like to make an appointment with a UT Physician, please call 1-888-488-3627, or go to the website: http://www.utphysicians.com/, or call LBJ General Hospital at 713-526-4243 for an appointment. For people who have difficulty with insurance and co-pay issues, the best option, if you live in Harris County, Texas, is to contact the Harris County Hospital District at 713-566-6400 or the website www.hchdonline.com/ , click on “patients” then click on “access care”. The website will tell you who qualifies for financial assistance and how to apply. Other counties have medical care assistance programs as well – go to the website for that county. At the Memorial Hermann and UT facilities, you are encouraged to ask the individual departments where you need a service about payment plans. There is also an organization called “The Rose”, which has several location including a mobile mammography unit which provides low cost breast imaging. Check them out at http://www.the-rose.org/ or call Toll Free: 866-680-4708, locally 281-484-4708. For high quality breast imaging, board certified and specialized mammography radiologists to analyze the images, and physicians who are available to patients for explanations and reassurance, please consider making an appointment at one of the Memorial Hermann Breast Centers (713-512-6040) or at the LBJ General Hospital (713-526-4243).

Question: Hi,I am 42. I had my first mammo in Oct 2011. They wanted more images so I had a diagnostic and an ultrasound. Ultrasound showed nothing. Diagmostic showed a spot. i was told there was no need for a biopsy just the typical 6 month followup. went back in May 2012 for another diagnostic. Was told by the radiologist that all looked well and again no need for a biopsy but the spot was still there and that is was just a part of my baseline and to come in for my normal Mammo at the end of 2012. Well I had annual mammo on 12/27 and just got a letter that more images are needed again. This is a large Breast center at a major hospital. patients get to talk to the Radiologist. Here is my question – because I am being asked for another diagnostic does this mean there are changes to my May 2012 images or is it normal for women to get on the annual mammo then follow up diagnostic train and stay on it? Once i have this diagnostic that will make 5 mammos for me within 15 months. Thanks for your help.

Answer: Thank you for contacting this Ask a Breast Imaging Expert forum. Our experts say that it is not unusual to have a patient with a “probably benign” lesion receive closer follow up for a two year period to make sure the area of concern is stable. It is also possible that there was a change seen or a new potential problem to look at more closely. The letter that goes out to request a “call back” – that is, to come back for more imaging – usually only says whether they are asking for more mammograms or ultrasound, and doesn’t give more details about why or how the repeat imaging will be done. You have indicated that the radiologists at the facility to which you are going are willing to discuss results with the patients, as they are at our Memorial Hermann or LBJ General Hospital Breast Centers. Perhaps it would be a good idea to call the facility and ask to speak to the radiologists before you go for the call back visit so that you know more about your particular situation. An important part of the radiologist’s evaluation of a mammogram is a comparison to previous images, so if you have not had all your imaging done at the same place, it would be important to arrange to have copies of all your previous mammograms brought to the facility to which you are now going. You need not worry about the radiation exposure for having 5 mammograms in 15 months. For comparison, one CT scan gives the equivalent of about 10 mammograms, so you are still well under the acceptable limits. Verifying that the lesion that is being checked is really benign is worth that amount of exposure. For high quality breast imaging, board certified and specialized mammography radiologists to analyze the images, and physicians who are available to patients for explanations and reassurance, please consider making an appointment at one of the Memorial Hermann Breast Centers (713-512-6040) or at the LBJ General Hospital (713-526-4243).

Question: my biopsy was positive.do i need a second opinion?

Answer: Thank you for contacting us at the Breast Imaging Ask an Expert forum. Our breast imaging experts said that if you have a positive biopsy, it is best that you move forward with an oncologist evaluation as soon as possible! A second opinion of the breast images would not give you any worthwhile information, but if you would like and are willing to cover the cost, a review of the pathology slides from your biopsy by one of our pathologists might be worth doing for your peace of mind. Your doctor can help you arrange for this to be done. Depending on pathology diagnosis and results of other pathology and imaging tests, the oncologist would determine whether you need immediate excisional surgery only, or have chemo or radiation afterwards, or have treatment before having surgery. If you need help finding the right oncologist or doctor with another specialty, you can call 713-222-CARE (2273) or toll free at 1-800-544-3399. English- and Spanish-speaking representatives are available seven days a week to help you.

Question: I have had a 2 mammograms and an ultrasound and they see something my breast tissue is dense and now they want to do a breast MRI. I tried to do one without sedation and it was so uncomfortable and I got a hot flash, felt like I couldnt breathe well and I freaked out and had to quit after 15 minutes. I was looking for alternatives and I called a place that offers 3d breast imaging for $50.00. Would this be advisable or should I just go do the MRI under sedation. I also have severe sleep apena, so I am concerned about the sedation.

Answer: I’m so glad you contacted our Ask an Expert about Breast Imaging forum. It can be frustrating and a little frightening when a mammographer recommends more imaging. The density of the breast is certainly a problem for mammograms, but not for ultrasounds. Without more details, if the ultrasound showed a suspicious mass that was also seen on mammogram, our mammographer would advise you to consider having a steriotactic biopsy. This is done on a special table where ultrasound is used to guide the biopsy needle. It is done using a local anesthetic (the area is numbed), and should give you the information that you really need. If the biopsy came back showing no cancer cells, you might want to consider getting your next mammogram with the 3D addition. If you need a place for high quality breast imaging with expert physician analyses, please consider making an appointment at one of the Memorial Hermann Breast Centers (713-512-6040) or at the LBJ General Hospital (713-526-4243).

Question: When I went for my mammogram recently, they put stickers on my nipples, and on a mole on my breast. Why did they do that?

Answer: Thank you for contacting our Ask an Expert Breast Imaging forum. Nipples and skin lesions can sometimes create abnormal shadows on mammograms. The sticker will be seen on the mammogram as a marker. That way, if there is something questionable seen on the mammogram in those areas, the radiologist will know where it is in relation to the markers. Nipples can sometimes appear as though they are abnormalities, so the marker will help identify what is or isn’t abnormal. The markers also occasionally help the doctor confirm that the x-ray was done properly, and mark the nipple for patients who have had previous surgery. If you need a place for high quality breast imaging with expert physician analyses, please consider making an appointment at one of the Memorial Hermann Breast Centers (713-512-6040) or at the LBJ General Hospital (713-526-4243).

Question: Ductal ectasia with intraductal lesions on ultrasound, which category of BIRADS is it?

Answer: Thank you for contacting the Breast Imaging Ask an Expert forum with this excellent question. The BIRADS (Breast Imaging and Reporting Data System) is a way for doctors to describe their opinion of your breast health in a way that is the same everywhere (standardized), and was set up by the American College of Radiologists, which oversees the quality and conduct of imaging in the Unites States. Our experts would classify the situation you described as a BIRADS 4a, meaning that although it is likely benign it should be biopsied. The doctor would also need information about the presence of symptoms such as discharges from the nipple to get an impression of how likely it is that this could indicate the presence of a malignancy, although our expert would recommend biopsy regardless of additional symptoms. If you need a place for high quality breast imaging with expert physician analyses, please consider making an appointment at one of the Memorial Hermann Breast Centers (713-512-6040) or at the LBJ General Hospital (713-526-4243).

Question: can a mammogram be done during pregnancy?

Answer: Thank you for contacting our Ask a Breast Imaging Expert forum. The answer to this question is: it depends on the reason. Generally, all x-ray exams including mammograms – no matter how small the dose of radiation that is used – are avoided during pregnancy if at all possible. That is because the danger of radiation exposure is a cummulative risk over a lifetime, and because no one really knows how even a small exposure will affect a fetus. Studies looking back at exposure to fetuses have uncovered no problems. However, if it is not urgent, radiologists generally will tell you to wait if you can. In situations where the exposure was before the mother knew she was pregnant, we would advise you to speak to the radiologist at the center where the mammogram was done as soon as possible. Usually, today’s mammography machines use an extremely low dose that is focused on a specific area not near the fetus, and is not cause for alarm. If you know that you are pregnant but must have a mammogram due to symptoms, the technologist can use a lead apron over the belly as just a little more protection. If you need to have a mammogram during pregnancy and are looking for high quality breast imaging with expert physician analyses, please consider making an appointment at one of the Memorial Hermann Breast Centers (713-512-6040) or at the LBJ General Hospital (713-526-4243). Let the scheduler know about your pregnancy.

Question: I recently went to a new imaging center. They asked me to get a copy of my previous mammograms. When I did, I saw on the report my doctor gave me that there was a BI-RADS number that changed after I brought my old mammograms in. What is that?

Answer: Thank you for contacting Ask a Breast Imaging Expert. This question shows us how important it is to find a breast imaging center with which you are comfortable, and as much as possible, to continue to use the same imaging center year after year. An important part of the radiologist’s evaluation of a mammogram is a comparison to previous images. The “Breast Imaging Reporting and Data System “(BIRADS) score is a very simplified conclusion to an expert evaluation of a mammogram. BIRADS was developed by the American College of Radiologists as a way to standardize the radiologist’s opinion of how likely it is that a mammogram shows cancer, and the kind of follow up that is required. There is a description of the categories 0 to 6 on the website http://breastcancer.about.com/od/diagnosis/a/birads_2.htm The breast radiologists at UTHealth are always happy to discuss mammorgaphy results with patients who have mammograms at our centers. If you need a place for high quality breast imaging with expert physician analyses, please consider making an appointment at one of the Memorial Hermann Breast Centers (713-512-6040) or at the LBJ General Hospital (713-526-4243).

Question: can I get yearly ultrasounds instead of yearly mammograms?

Answer: Thank you for contacting Ask a Breast Imaging Expert. Although it would be nice to have a screening test that does not use radiation, mammograms can see calcifications and changes in the makeup and structure of the breast that are not seen well on ultrasound. Ultrasound can provide information about whether a mass is solid or fluid filled, which can not be determined by a mammogram, so it can be a useful addition to mammography. Finally, ultrasound has a higher false positive rate than mammography. If you need a place for high quality breast imaging with expert physician analyses, please consider making an appointment at one of the Memorial Hermann Breast Centers (713-512-6040) or at the LBJ General Hospital (713-526-4243).

Question: How do I know if a place that offers mammograms is a good place for me to go?

Answer: Thank you for contacting Ask a Breast Imaging Expert. Women can get high-quality mammograms in breast clinics, hospital radiology departments, mobile vans, private radiology offices, and doctors’ offices. There are several types of accreditations and certifications for mammography centers. The Food and Drug Administration (FDA) certifies mammography facilities that meet strict quality standards for their x-ray machines and staff and are inspected every year. The Memorial Hermann Breast Care Centers and the LBJ Hospital breast imaging area also have accreditation by the American College of Radiology (ACR), as well as board certified radiologists who are dedicated to breast imaging. For more information, visit this website. To schedule your mammogram, call the Memorial Hermann Breast Centers (713-512-6040) or at the LBJ General Hospital (713-526-4243).

Question: I read that we should NOT get yearly mammograms, then I read that we should. It gets confusing. What am I really supposed to do?

Answer: Thank you for contacting Ask a Breast Imaging Expert. You are correct to realize that there is a debate among the experts about whether to get a yearly mammogram or only every 2 years, and the age at which regular mammograms should start. The organization which, in 2009, published a recommendation against breast self-examinations and yearly mammograms is called the United States Preventive Services Task Force (USPSTF), which is a group of experts formed by the US government agency called the Agency for Healthcare Research and Quality (AHRQ). Their decision was due to not having enough proof that the current standards (yearly mammogram after age 40) actually saved lives. They were concerned about the number of false mammograms that resulted in unnecessary biopsies and anxiety that turned out to be “for nothing”. They also felt that women over 75 years old did not benefit from mammograms. HOWEVER, The American Cancer Society as well as most breast centers, including the Memorial Hermann Breast Centers, continue to recommend yearly mammograms and encourage breast self-exams. You should make yourself aware of the benefits and limitations of screening. You can start by visiting the ACS website for more information, or to schedule your mammogram, call the Memorial Hermann Breast Centers (713-512-6040) or at the LBJ General Hospital (713-526-4243).

Question: How would a mammogram be done on someone with breast implants?

Answer: Thank you for contacting Ask a Breast Imaging Expert. The answer would partly depend on whether the mammogram is being done on a person with implants for cosmetic reasons or as part of a reconstruction following surgery for a breast cancer. For people with cosmetic implants, mammograms are recommended yearly. This is accomplished by gently moving the implant aside for each view, or picture, that is taken, and by taking more views. Many doctors also recommend an MRI every few years for people with silicone implants, to check for leaks or ruptures. For those with reconstruction and an implant after surgery, your doctor may prefer to ask for a mammogram only on the unaffected side, with a physical breast exam or other kind of imaging (like MRI) used to examine the affected side for recurrence. This is because there is often no original breast tissue left, and because surgery leaves the tissue with scars that don’t image well with a mammogram. Please do not hesitate to make your yearly mammogram appointment at one of the Memorial Hermann Breast Centers (713-512-6040) or at the LBJ General Hospital (713-526-4243). These facilities are experienced in performing mammogaphy for people with implants.

Question: I read about a breast imaging technique called thermography. Can you tell me if it is available at your breast center? I am afraid of getting so much radiation if I get yearly mammograms!

Answer: Thank you for contacting Ask a Breast Imaging Expert. First of all, let me assure you that the amount of radiation you receive from a mammogram is very small, about 0.4 mSV (millisievert), or the amount of radiation that you get from your natural surroundings in about 7 weeks. The very small risk with that amount of radiation is far outwieghed by the benefit of finding a breast cancer at an earlier stage. Thermography is a form of imaging that uses changes in heat detected over the breast tissue based on the theory that tumors and new blood vessels give off more heat. The idea is a good one, and efforts are being made by some scientists to make them more sensitive than they are now. However, at this point it is NOT a recommended substitute for a mammogram. Thermography is not available at any UT-affiliated breast center. Please do not hesitate to make your yearly mammogram appointment at one of the Memorial Hermann Breast Centers (713-512-6040) or at the LBJ General Hospital (713-526-4243).

Question: What is the difference between a regular mammogram and a digital mammogram?

Answer: Thank you for contacting Ask a Breast Imaging Expert. The procedure for both types of mammograms is the same. Instructions will be given to you before the date of the mammogram when you make an appointment at one of our Breast Centers. Since 1969, the low dose of x-ray that is used for a mammogram was recorded on a silver-based x-ray film. Digital mammography, developed in 2004, is computer based, and uses digital detectors to create an electronic image from the x-rays. It works in a way that is similar to a digital camera. Some locations of the Memorial Hermann Breast Center use digital mammography which can detect problem areas in dense breasts (common in women under 50) more accurately than film-based mammograms.

Question: I have an order for a Diagnostic Mammogram, what is the difference between a Diagnostic vs. Screening Mammogram?

Answer: Thank you for contacting Ask a Breast Imaging Expert. That is a great question and one that is asked often. A screening mammogram is the basic annual screening test that is done when there are no abnormalities suspected on physical examination or previous x-rays. A Diagnostic Mammogram is a more extensive examination that is used to determine whether an abnormal finding needs further evaluation. We would like to encourage you to contact either one of our Breast Centers to schedule your exam.

Question: I am a 62 year old female who has yearly mammograms. This year I received a call back after a screening 3D Mammogram. Findings: There are 2 possible nodular asymmetry in the lateral left breast at a middle depth seen best on the cc view. My Diagnostic Mammogram was scheduled a month later ( seems a long time to wait for an appointment), but with all this time on my hands waiting, I was hoping you could help me understand this. Thanks in advance.

Answer: I am sure that it is a stressful situation getting called back from a screening mammogram, especially that you have to wait for a month to find out the answer. The good news is that the majority of the findings on screening mammograms will resolve on diagnostic work up. Sometimes breast tissue could have overlapping on screening mammograms and present as asymmetries. The radiologist will perform a detailed imaging work up in the area of concern and determine if the finding on screening mammogram is real or not. Hope that this helps.

Question: They put a marker under my Breast to mark a mole and now its all red and has a sore.

Answer: I’m sorry you are going through this. It is possible that you had an allergic reaction to the adhesive. Removing the marker is the best step for recovery. An over the counter topical steroid cream can help with the inflammation. Make sure to keep the area clean and avoid scratching. It should be getting better during the course of the week. If it persists or worsens, please contact your provider. In the future, let the technologist know you experienced this to avoid reactions.