A mammogram is an X-ray of the internal structures of the breast, and it is the best tool we have at detecting abnormalities in the breast. Finding a lump in your breast, noticing breast discharge or receiving a callback for “additional views” after your screening mammogram can be a stressful situation.
To begin to understand mammography, here is a simple description of the breast and its basic internal structures.
The breast goes through many changes each month in response to hormones and also changes as we age, become pregnant and are breast-feeding.
The internal structure of the breast consists of fat, connective tissue, lobules and ducts. Eighty percent of the size of the breast is from fat and connective tissue. To picture this, think of a cluster of grapes. The grapes themselves would be the lobules and the vines would be the ducts. In mammography, we need to be able to see through all of this tissue. Lobules sitting on top of each other can make it more difficult to see all of the tissue between, and it can look like overlapping tissue. Imagine one grape sitting on top of the others. This is where compression helps, when we flatten out the tissue, we are basically spreading out the lobules, so we can see everything.
A screening mammogram is ordered when there are no known problems. Two “views,” or pictures, of each breast are taken while it is briefly being compressed between two paddles. The angles the mammography technician takes the views from are top to bottom and an angled view from the inside to the outside edge of your breast. The radiologist then looks at your pictures and assigns a score called the BIRADS score. If the radiologist assigns a score of zero, this means that he or she needs additional pictures or information to be more confident that the questionable area is clearly a normal finding.
At this time, women are sent a letter in the mail from their mammography facility stating additional views are needed. Mammography facilities are required to send out this letter to the patient through the Mammography Quality Standards Act and also to the patient’s health care provider.
A diagnostic mammogram may be ordered at this time. If you have breast pain, discharge or more information is needed from your screening mammogram, your provider will order a diagnostic mammogram. Additional pictures are taken of the area in question by flattening the area in question and magnifying the area. At Montana Breast Health, the radiologists will talk to you about their preliminary findings from the diagnostic views and or their recommendations for follow-up or biopsy.
The good news is 80 percent of suspicious findings on mammograms are related to non-cancerous conditions. There are many benign processes in the breast. Mammography combined with yearly breast exams by your health care provider and monthly breast self-exams are the best tools we have to promote breast health.
Registered nurse Michelle Weaver Knowles is the breast health navigator and breast cancer survivor at the Montana Breast Health Center at Community Medical Center.