- Mammogram Procedure
- What are the reasons for a mammogram?
- Who should get a screening mammogram?
- What are the risks of a mammogram?
- Mammograms not helpful in women 75 and older, study finds
- Understanding Your Mammogram Report
- What are calcifications?
- What are clip markers, and why are they used during biopsies?
- What is BI-RADS?
- Should I get a breast MRI scan instead of a mammogram?
- What should I do if I notice abnormal changes or symptoms even after mymammogram comes back normal?
- If I am diagnosed with breast cancer, should my children get mammograms atan earlier age?
- What does asymmetry mean in my mammogram report?
- What does fibroglandular density mean?
- My mammogram described my breasts as being “heterogeneously dense, whichmay obscure small masses.” What does that mean?
- Mammogram 101: Q&A with a Mammographer
- Who performs my mammogram?
- Who interprets my mammogram images?
- What happens after my mammogram?
- What happens to the images?
- Most Hospitalists Not Eager to Screen Inpatients for Breast Cancer: JHM Study
- Doing Mammography Right: A Specialist Speaks Out
- Breast Imaging, Reporting & Data System (BI-RADS) Scores
- Why should you know your BI-RADS score?
A mammogram is an X-ray examination of the breast. It is used to detect and diagnose breast disease in women who either have breast problems, such as a lump, pain, or nipple discharge, as well as for women who have no breast complaints. The procedure allows detection of breast cancers , benign tumors, and cysts before they can be detected by palpation (touch).
Mammography cannot prove that an abnormal area is cancer, but if it raises a significant suspicion of cancer, tissue will be removed for a biopsy . Tissue may be removed by needle or open surgical biopsy and examined under a microscope to determine if it is cancer.
Mammography has been used for about 30 years, and in the past 15 years technical advancements have greatly improved both the technique and results. Today, dedicated equipment, used only for breast X-rays, produces studies that are high in quality, but low in radiation dose. Radiation risks are considered to be negligible.
The development of digital mammography technology allows for improved breast imaging, in particular, for women less than 50 years of age, women with dense breast tissue, and women who are premenopausal or perimenopausal.
Digital mammography provides electronic images of the breasts that can be enhanced by computer technology, stored on computers, and even transmitted electronically in situations where remote access to the mammogram is required.
The procedure for a digital mammography is basically performed the same way as a standard mammogram.
With computer-aided detection (CAD) systems, a digitized mammographic image from a conventional film mammogram or a digitally acquired mammogram is analyzed for masses, calcifications, or areas of abnormal density that may indicate the presence of cancer. The images are highlighted by the CAD system for further analysis by the radiologist.
According to the National Cancer Institute:
- Screening mammogram. A screening mammogram is an X-ray of the breast used to detect breast changes in women who have no signs or symptoms of breast cancer. It usually involves 2 X-rays of each breast. Using a mammogram, it is possible to detect a tumor that cannot be felt.
- Diagnostic mammogram. A diagnostic mammogram is an X-ray of the breast used to diagnose unusual breast changes, such as a lump, pain, nipple thickening or discharge, or a change in breast size or shape. A diagnostic mammogram is also used to evaluate abnormalities detected on a screening mammogram. It is a basic medical tool and is appropriate in the workup of breast changes, regardless of a woman's age.
X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. Standard X-rays are performed for many reasons, including diagnosing tumors or bone injuries.
X-rays are made by using external radiation to produce images of the body, its organs, and other internal structures for diagnostic purposes. X-rays pass through body structures onto specially-treated plates (similar to camera film) and a “negative” type picture is made (the more solid a structure is, the whiter it appears on the film).
Each breast has 15 to 20 sections, called lobes, which are arranged the petals of a daisy. Each lobe has many smaller lobules, whichend in dozens of tiny bulbs that can produce milk.
The lobes, lobules, and bulbs are all linked by thin tubes calledducts. These ducts lead to the nipple in the center of a dark area ofskin called the areola. Fat fills the spaces between lobules and ducts.
There are no muscles in the breast, but muscles lie under each breastand cover the ribs.
Each breast also contains blood vessels and vessels that carry lymph.The lymph vessels lead to small bean-shaped organs called lymph nodes,clusters of which are found under the arm, above the collarbone, and inthe chest, as well as in many other parts of the body.
What are the reasons for a mammogram?
Mammography may be used either for screening or to make a diagnosis.Women older than 30 years should undergo diagnostic mammography if theyhave symptoms, such as a palpable lump, breast skin thickening orindentation, nipple discharge or retraction, erosive sore of thenipple, or breast pain.
A mammogram may be used to evaluate breast pain when physicalexamination and history are not conclusive. Women with breasts that aredense, “lumpy,” and/or very large may be screened with mammography, asphysical examination may be difficult to perform.
Women who are at high risk for breast cancer or with a history oreast cancer may be routinely screened with mammography.
There may be other reasons for your health care provider to recommend amammography.
Who should get a screening mammogram?
Different health experts have different recommendations formammography. The following screening guidelines are for early detectionof cancer in women who have no symptoms:
- The American College of Radiology (ACR) and the Society of Breast Imaging (SBI) recommend that women get yearly mammograms starting at age 40. The Johns Hopkins Radiology and Radiological Science breast imaging section supports the ACR and SBI recommendation and encourage women to discuss their individual screening options with their doctor.
- The National Cancer Institute guidelines state that women in their 40s and older should have a screening mammogram on a regular basis, every 1 to 2 years.
- The American Cancer Society recommends that women with an average risk of breast cancer should have regular screening mammograms starting at age 45. Mammograms should be done every year for all women ages 45 to 54. Then you can switch to mammograms every 2 years. Or you have the choice to continue annual mammograms.
- Currently, the U.S. Preventive Services Task Force (USPSTF) recommends screening every 2 years for women ages 50 to 74.
- Women who are at an increased risk (family history, genetic tendency, past breast cancer) should talk with their health care providers about the benefits and limitations of starting mammography screening earlier, having additional tests (breast ultrasound, MRI), or having more frequent exams.
Women should talk with their health care providers about their personalrisk factors before making a decision about when to start gettingmammograms or how often they should get them. Consult your health careprovider regarding the screening guidelines that are appropriate foryou.
What are the risks of a mammogram?
You may want to ask your health care provider about the amount ofradiation used during the procedure and the risks related to yourparticular situation.
It is a good idea to keep a record of your pasthistory of radiation exposure, such as previous scans and other typesof X-rays, so that you can inform your health care provider.
Risksassociated with radiation exposure may be related to the cumulativenumber of X-ray examinations and/or treatments over a long period oftime.
If you are pregnant or suspect that you may be pregnant, you shouldnotify your health care provider. Radiation exposure during pregnancymay lead to birth defects. If it is necessary for you to have amammogram, special precautions will be made to minimize the radiationexposure to the fetus.
Some discomfort may be felt as the breast is compressed against theX-ray plate during the procedure. This compression will not harm thebreast, however.
There may be other risks depending on your specific medical condition.Be sure to discuss any concerns with your health care provider prior tothe procedure.
Certain factors or conditions may interfere with a mammogram. Theseinclude, but are not limited to, the following:
- Talcum powder, deodorant, creams, or lotions applied under the arms or on the breasts
- Breast implants, as they may prevent complete visualization of the breast. If you have breast implants, be sure to tell your mammography facility that you have them when you make your appointment. You will need an X-ray technologist who is trained in working with patients with implants. This is important because breast implants can hide some breast tissue, which could make it difficult for the radiologist to see breast cancer when looking at your mammogram images.
- Previous breast surgery
- Hormonal breast changes
Annual mammograms are the best tool for early detection of breast cancer. Hear women talk about the importance of breast screening, and what they would tell other women who might be hesitant to schedule a mammogram.
SCHEDULING : Breasts can be tender the week before and during menstruation, so try to schedule your mammogram for one to two weeks after your period starts. If you have breast implants, please notify the office when you schedule the exam.
PRECAUTIONS : If you are pregnant or think you may be pregnant, please check with your doctor before scheduling the exam. Other options will be discussed with you and your doctor.
BREASTFEEDING : Please notify the technologist if you are currently breast-feeding.
PERSONAL HYGIENE : Do not use any deodorant, powder, lotion or perfume on the day of your exam.
CLOTHING : You must remove your clothing from the waist up and change into a patient gown. A locker will be provided to secure your personal belongings. Please remove all piercings and leave all jewelry and valuables at home.
your medical condition, your health care provider may request other specific preparation.
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Mammograms not helpful in women 75 and older, study finds
CHICAGO (Reuters) – Women 75 and older do not benefit from regular screening mammograms, researchers reported on Monday, offering some of the first evidence on whether screening makes sense in these women.
Although studies clearly show mammograms starting at age 50 prevent breast cancer deaths, until now, doctors have had little evidence about when to end screening, Dr. Otis Brawley of Johns Hopkins University and former chief medical officer of the American Cancer Society, wrote in editorial in the Annals of Internal Medicine.
“The study is important because a third of all American women die of breast cancer are diagnosed after the age of 70,” Brawley said in a telephone interview.
The U.S. Preventive Services Task Force, which sets screening guidelines, currently states that the evidence is insufficient to assess the harms and benefits in women 75 and older. Recommendations by other groups vary.
As a result, some 52% of women in the United States aged 75 and older still get regular mammogram screening, according to the paper published on Monday in the Annals of Internal Medicine.
“A lot of women over 75 and 80 are receiving mammograms,” study author Dr. Xabier Garcia-De-Albeniz of the Harvard School of Public Health, RTI Health Solutions and Massachusetts General Hospital, said in a telephone interview.
Brawley said clinical trials cannot be done to provide that evidence because too many people are convinced of the benefits of mammography, and would consider withholding screening to be unethical.
Garcia-De-Albeniz and colleagues set out to provide that evidence using claims data from the federal Medicare insurance program for the elderly. They studied data on more than 1 million women aged 70 to 84 who underwent mammograms from 2000 to 2008. Women in the study had a life expectancy of at least 10 years and no prior breast cancer diagnosis.
They found that in women aged 70 to 74, the benefit of screening outweighed the risks, which can include overdiagnosis, overtreatment and the anxiety of a potential breast cancer diagnosis. In women 75 to 84, screening did not substantially reduce the risk of dying from breast cancer.
The reason is ly that by 75, women are more ly to die from heart disease or neurological diseases such as dementia than breast cancer, the authors said.
Brawley said the findings underscore the need for more research to understand breast cancer in older women and better treatments for women in this age group.
Reporting by Julie Steenhuysen; Editing by Marguerita Choy
Our Standards:The Thomson Reuters Trust Principles.
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Understanding Your Mammogram Report
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Lisa Jacobs, M.D., Johns Hopkins breast cancer surgeon, and Eniola Oluyemi, M.D., Johns Hopkins Community Breast Imaging radiologist, receive many questions about how to interpret common findings on a mammogram report.
The intent of the report is a communication between the doctor who interprets your mammogram and your primary care doctor. However, this report is often available to you, and you may want to better understand it.
Both experts suggest that you sit down with your doctor to discuss the findings of the report to avoid confusion.
Here are answers to 10 of the most commonly asked questions:
What are calcifications?
Calcifications are calcium deposits in the breast tissue. They are very common, and the great majority are noncancerous. When many microcalcifications (tiny specs of calcium) are seen in one area, they are called a group.
What are clip markers, and why are they used during biopsies?
After a mammogram screening, a small percentage of women will have afinding that may require additional diagnostic imaging. This is called arecall.
If a patient is recalled, additional imaging will be performed, andonly about 2 percent of women may need a biopsy.
During a biopsy, aradiologist with breast imaging expertise inserts a small metallic clip inthe breast to help locate the biopsy site in case further testing isneeded.
What is BI-RADS?
The Breast Imaging-Reporting and Data System (BI-RADS) is a reporting andassessment system required by the federal government. This is a dictionarythat radiologists use to describe findings in a breast imaging report. Thissystem also organizes assessments and explains the importance of thefindings.
The assessments range from 0 to 6, with 0 indicating anincomplete evaluation, meaning more imaging is needed before a finaldecision about the findings can be made, and 6 indicating that there is aknown breast cancer diagnosis.
The assessments are used to share theappropriate next steps or recommendations with your healthcare team.
Yes. Compared to 2-D mammography, tomosynthesis provides a clearer image ofeach layer of the breast, which provides greater visibility for theradiologist. This allows more cancers to be seen and fewer false alarms;this is a state-of-the-art, improved mammogram.
Should I get a breast MRI scan instead of a mammogram?
Should I get a breast MRI scan instead of a mammogram?
- High-risk screening for patients with more than a 20 percent chance of developing breast cancer in their lifetime
- Bloody or clear nipple discharge
- Preoperative testing
- Chemotherapy follow-up
What should I do if I notice abnormal changes or symptoms even after mymammogram comes back normal?
Breast self-exams are important because they allow you to get to know yourbreasts and their “normal” appearance. If you notice abnormal symptoms orchanges to your breast geography, request additional testing.
Do not ignoreabnormal breast changes or symptoms, such as discharge or a lump, but keepin my mind that several lifestyle changes, such as weight gain, weightloss, hormone changes and hormone replacement therapy, can cause yourbreasts to change.
Note: The radiologist may call you back after a baseline mammogram (apatient’s first mammogram) for additional testing because he or she hasnothing to compare the mammogram to. This will also help identify changesto your breasts over time.
If I am diagnosed with breast cancer, should my children get mammograms atan earlier age?
Yes, but depending on the child’s age, an ultrasound or breast MRI scan maybe a better option. Consult with your primary care physician.
What does asymmetry mean in my mammogram report?
Breast asymmetry refers to the appearance of a part of the breast incomparison to the remainder of that breast and to the other breast. Aradiologist will examine a mammogram to look at the difference in position,volume and form of the breasts.
In most cases, the breasts are generallysymmetric in their density and architecture, but sometimes a report mayreveal asymmetric density, which is common and usually noncancerous.
However, a radiologist may decide to do further testing if there arechanges in breast tissue that are asymmetric, as this could also indicatean important finding.
What does fibroglandular density mean?
Fibroglandular tissue refers to areas in the breast containing milk glandsand milk ducts. Fibroglandular density refers to scattered areas of densityin the breast, which is normal tissue seen in combination with fat.
My mammogram described my breasts as being “heterogeneously dense, whichmay obscure small masses.” What does that mean?
This means that you have moderately dense tissue, which is common and not acause for concern. Sometimes, dense tissue can make it difficult toaccurately read a mammogram. You and your doctor can discuss options forsupplemental screening (i.e. screening method in addition to a mammogram),if necessary.
Mammogram 101: Q&A with a Mammographer
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Did you know you don’t need a referral, prescription or order form from your doctor to get a mammogram? Women over 40 who are not experiencing symptoms can make an appointment for their annual mammogram on their own.
Annual mammograms are the best tool for early detection of breast cancer. Most cancers detected by mammography have no symptoms.
To give you a behind-the-scenes perspective of your annual mammogram, Ginger Hill, mammographer at Johns Hopkins Medical Imaging, answers some commonly asked questions about how to prepare for your mammogram, who conducts them, who reads them and what happens after your exam.
Once you make your appointment for your annual mammogram, you don’t have to do much. Breasts can be tender the week before and during menstruation, so try to schedule your mammogram for one to two weeks after your period starts.
We ask women to not wear deodorant, powder, lotion or perfume on the day of their exam as they could show up on the mammogram.
For your comfort, we recommend wearing a two-piece outfit, so you are able to keep your pants or skirt on during the mammogram.
If you are breastfeeding or think you may be pregnant, please check with your doctor before scheduling your exam.
Who performs my mammogram?
Mammograms are done by licensed, board-certified technologists called mammographers. Mammographers are specially trained to perform and review breast images of the highest quality with the least amount of radiation exposure. Johns Hopkins mammographers are subspecialized and only conduct breast exams.
Ginger Hill wants patients to know that “as a mammographer, I am here to work with you to make this experience as comfortable as possible, to obtain a quality mammogram and ensure your breast health is taken care of.”
Who interprets my mammogram images?
You may never meet your radiologist, but the radiologist is a critical part of your health care team, working with your doctor to keep you healthy or find out why you are sick. Radiologists interpret mammogram and other screening and diagnostic images.
Radiologists are doctors who have continued their education to complete a four-year residency in radiology. A radiologist may act as a consultant to your doctor, or act as primary doctor in treating a disease.
Johns Hopkins breast imaging radiologists are subspecialty radiologists. This means they are fellowship trained, which provides additional training in all aspects of a specific body area or condition, and only read images in that area of expertise.
Johns Hopkins breast imaging radiologists only read breast images and are able to focus on the unique aspects of each breast image.
Studies have shown that subspecialist radiologists detect more cancers and more early-stage cancers and have lower callback rates than general radiologists.
Karen Horton, director of Johns Hopkins Medicine’s Department of Radiology and Radiological Science, explains the radiologist’s role: “I view myself as a detective trying to diagnose the patient’s problem by combining medical images with other information in the medical record to solve the mystery.
Radiology is a unique medical specialty because we use imaging technology to see what is happening on the inside of the body to diagnose and treat disease. We combine high-resolution images with multiple sets of medical record data (patient history, symptoms, demographics, etc.
) to determine why a patient is ill to help the referring physician chart the best plan of action to heal the patient.”
What happens after my mammogram?
There is typically no special type of care following a mammogram. However, your health care provider may give you additional instructions depending on your specific health condition.
The radiologist will send the report to your doctor and be a resource in creating an action plan if needed. If you are asked to come back for additional images, don’t be alarmed.
In the United States, approximately 5 to 15 percent of women are called back for additional imaging. Additional images might be another mammogram or a different imaging method, such as ultrasound or MRI.
The findings of this additional imaging are usually benign, meaning the changes are not caused by cancer.
What happens to the images?
The majority of women will have benign changes in their breasts caused by hormones or the aging process. Through yearly mammograms, these changes can be tracked and monitored. Previous images will be used as a resource to monitor any changes in the breast and flag suspicious changes.
Your health care provider should perform a clinical breast exam at your annual physical, and you can practice breast self-awareness by knowing what is normal for your breast and being able to identify small changes immediately. You should perform breast self-exams at least once a month at the same time frame in your menstrual cycle.
Women who are at an increased risk of breast cancer should talk with their health care providers about starting mammography screening earlier than 40, having additional tests (such as breast ultrasound or MRI), or having more frequent exams.
Increased risk can include:
- Family history
- Genetic tendency
- Breast density
- Past breast cancer
Eight 10 women who are diagnosed with breast cancer have no family history; being proactive about your breast exam is a critical step in your overall health.
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Most Hospitalists Not Eager to Screen Inpatients for Breast Cancer: JHM Study
A recent Journal of Hospital Medicine study found that most hospitalists do not believe they should be involved in breast cancer screening for their hospitalized patients who are overdue for a screening.
Study authors at Johns Hopkins Bayview (JHB) Medical Center in Baltimore surveyed nearly 100 hospitalists about their thoughts on ordering a mammography for hospitalized women and possible concerns for hospitalists ordering inpatient screenings.
Only 38% of those surveyed believed that hospitalists should be involved with breast cancer screening.
The main concerns, according to survey takers, were following up on the results of the screening and that the mammography might not be covered by patients’ insurance.
The Hospitalist caught up with lead author Waseem Khaliq MD, MPH, who is a hospitalist and assistant professor of medicine at Johns Hopkins School of Medicine and a member of the JHB Cancer Committee.
Question: What are the key takeaways from this study?
Answer: About three years ago, we looked up what the adherence rate is among women who are admitted to the hospital for breast cancer screenings, and what we found was that a lot of these women were nonadherent to the breast cancer screening.
So we polled those women who were nonadherent to the breast cancer screening and asked, “What if we were able to offer you a mammogram while you were in the hospital for other issues?” About 76% said that they would to have a mammogram while they were in the hospital.
Looking at that background, we polled this question to our hospitalists, too. What we found out was that a lot of the hospitalists were not willing to order a mammogram or were not too excited about getting a breast cancer screening done in the hospital setting.
A majority told us that they’re more worried about how those results are going to be followed up, and it is possible that even if they order this mammogram that it may interfere with patient care or patient discharge.
Then who would cover the cost of the mammogram if they do it in the inpatient setting?
So although a third of the hospitalists would still order a mammogram for those women who were high risk … a majority of them were not willing to because there were some perceived barriers to that.
Q: What is your reaction to the concerns with screening inpatients?
A: I can understand the concerns that most of the hospitalists have in regard to screening every patient that comes to the hospital. What I think we can do is, at the very least, we can be smart enough to figure out if a patient were at high risk for developing cancer and at least have those patients who were at high risk get screened.
Q: Where do you think hospitalists should go from here with regard to their patients who are overdue for breast cancer screenings?
A: We need to test for the feasibility and the financial issue of actually getting a screening mammogram in the hospital setting. I think down the road it should not matter what setting a patient [intersects] with the health system; it could be inpatient or outpatient.
Patients should be provided the care and prevention needs that are recommended for their routine care. The next step should be doing a feasibility study, looking at whether or not these mammograms can be done in the hospital setting and do not interfere with the patient’s acute care.
Candace Mitchell is a freelance writer in New Jersey.
Doing Mammography Right: A Specialist Speaks Out
TOWSON, Maryland—“Mammography is still the gold standardfor the screening and diagnosis of breast cancer, but thatdoesn’t mean it is always done right,” said GildaCardenosa, MD, head of breast imaging at the Cleveland Clinic.“There is a lot of bad mammography out there, even with all the
regulations that are in place.”
Speaking at the Seeking Excellence in Breast Cancer Care conferencesponsored by the Johns Hopkins Medical Institutions, Dr. Cardenosadescribed in forthright terms what she feels must be done to raise
the quality of breast imaging nationwide.
One of the first steps, she said, is to keep clear the distinctionbetween screening and diagnostic mammography. “Screening is doneon asymptomatic women,” Dr. Cardenosa said. If the physician isin any way concerned about patient symptoms or findings on thephysical examination, then the patient should receive a diagnostic,
not a screening mammogram.
“Screening is only about detection and perception,” shesaid. If a physician receives a screening mammogram reportrecommending biopsy, “that’s not appropriate,” shesaid. “What is appropriate in such a situation is a simpleobservation that might note, for instance, a suspicious spot,
apparent microcalcifications, or other manifestations.”
She decried mammography “boutiques” where, for about $50, awoman can get a basic breast scan but, chances are, inadequate reviewor interpretation. The best way to look at screening mam-mograms isnot while the patient is waiting on site, she said, although somecenters advertise they do this. “They say, ‘We’ll giveyou an answer right away!’ and any responsible radiologist
hearing that must wonder, Do they care if the answer is right?”
Dr. Cardenosa said that it is better for the radiology specialist toset aside several hours of quiet time, gather perhaps 50 mam-mograms,and go through them undisturbed. “During that time, all theviewing professional needs to ask is whether the woman appears to benormal, or if there is something in the mammogram that arouses
suspicion,” she said.
The interpretation of diagnostic imaging, however, calls for adifferent mind-frame. “In diagnostic imaging,” Dr.Cardenosa said, “I am focused only on one patient,” andwhether that patient’s findings require biopsy or another
Who Does the Call Back?
When a screening mammogram does detect something seemingly abnormal,the patient must be called back for further tests. Dr. Cardenosabelieves it is better to let the radiology specialist do thatdirectly. “That way, the radiologist can elicit information fromthe patient, schedule further views and tests appropriate to the
situation, and do it quickly,” she said.
Physicians often disagree with her. Frequently, she said, she gets acall from a doctor who protests, “You’re taking over mypatient.” Is this the right mind frame? she asked. “If Isee something suspicious,” Dr. Cardenosa said, “I want to
call the patient back.”
A Cleveland Clinic study showed that when radiologic reports arereferred back to physicians, the result is delay and lower compliancewith requests for follow-up. “When the radiology program did notcall patients back directly, about 70% had their studies done withina month,” she said. “When patients were called directly,
that rate rose to 92.2%.”
These results suggest that another way to improve mammography isteamwork. “Many institutions talk about how their providers workas a team, but for that to be true, they do actually have to worktogether and make sure their views of any patient’s situation
match up,” Dr. Cardenosa commented.
She said that the Cleveland Clinic has a radiology call back programin which a secretary trained in patient communication telephonespatients within 24 hours of mammogram interpretation. “When thepatient is reached by phone, an appointment is scheduled, and thereferring physician is e-mailed with specifics of the
appointment,” she said.
Radiology and Biopsy
Dr. Cardenosa also emphasized the importance of adequate mammographybefore breast biopsy. She said that too often surgeons do not havethe right radiologic views or guidance to know where to sampletissue. “Blindly taking patients to surgery does not make
sense,” she said.
She also decried the use of needle aspiration without radiology.“If we blindly aspirate, we’re not going to find earlybreast cancer,” she said. “Before we put a needle into
anything, let’s look at it.”
She urged the same approach for nipple discharge, because negativecytology by itself does not rule out the presence of breast cancer.“If the ducts are cut to relieve the discharge, the patient maycome back years later with invasive carcinoma,” she said.“And if a surgeon does cut and send tissue to the pathologist,
is the pathologist going to know where to find the lesion?”
Finally, Dr. Cardenosa urged health care organizations to stoptreating mammography as a “loss leader” and the mammographycenter as an unwanted stepchild. “Nobody wants us around becausewe lose money,” she said.
“Third-party payers will also tryto ratchet costs down, but any other specialty, it’s costlyto do right.” She also said that not all radiology centersshould perform mammography.
“It’s a specialty and requires
specialists to be done correctly.”
Breast Imaging, Reporting & Data System (BI-RADS) Scores
When a radiologist interprets a mammogram, he or she assigns a score to it used to communicate with doctors about how concerned he or she is about the findings.
Did anything look abnormal? How serious is the abnormality that was found? This and other information is efficiently summed up in one number, called the Breast Imaging Reporting and Data System (BI-RADS) score.
BI-RADS scores range from 0 to 6:
0: This score identifies a mammogram study that is still incomplete. The X-ray may have been cloudy, making it difficult to read the images. This can happen, for example, if you moved at the precise moment the picture was taken.
In any case, further information is needed to make a final assessment and assign the true BI-RADS score. If you’ve received a BI-RAD score of 0, you need to make sure that additional imaging is done, such as some extra mammography views or an ultrasound.
1: This score is good news! It means that your mammogram is negative (that is, no evident signs of cancer were found) and that you should continue to have routine screenings.
2: This score also means that your mammogram is normal, with no apparent cancer, but that other findings (such as cysts) are described in the report. You’ll be instructed to continue your routine screening.
3: Now we are entering a gray zone. A BI-RADS score of 3 means that your mammogram is probably normal but that there’s an approximately 2 percent chance of cancer. You’ll be asked to follow-up with a repeat mammogram in six months. And if you have a family or personal history of breast cancer, the radiologist may opt to do more tests now rather than wait.
4: This score means that the findings on your mammogram are suspicious. To make a diagnosis, the doctors will need to perform a biopsy to get a small tissue sample.
More than 90 percent of women with a BI-RADS score of 4 can have a core biopsy performed without the need for general anesthesia or an incision in the breast. At our Breast Center, if a biopsy is warranted they are commonly performed the same day the mammogram is read.
Nationally, the rate of open excisional biopsies is much higher than necessary. Our rate is very low; more than 90 percent of biopsies done here are core biopsies.
5: This score means that your mammogram results are highly suspicious, with a 95 percent chance of breast cancer. You will need to have a biopsy for diagnosis. Talk to your doctors about what course of action to take.
6: This means that you have already been diagnosed with breast cancer and the pathologist has confirmed the diagnosis.
Why should you know your BI-RADS score?
Knowing your BI-RADS score will help ensure that you get the proper follow-up after your mammogram. It is part of what you need to know to actively participate in your medical care.