Frequently Asked Questions about Mammograms

Advances have been made in breast cancer treatment, but early detection remains the critical factor that allows most women to live normal lives. These answers to frequently asked questions both inform and encourage confident, empowering self-care.

When should I have my first screening mammogram and how often thereafter?
The 2003 American Cancer Society guidelines are:

Age 40 and older

• Annual screening mammography.
• Annual clinical breast exam.
• Consider monthly breast self exam.

Age 20 to 39

• Clinical breast exam every three years.
• Consider monthly breast self exam.

Women at increased risk of breast cancer might benefit from additional screening strategies. Consult your healthcare provider for more information.

A study demonstrated that mammography reduces the death rate due to breast cancer by 63%. When monthly breast self examination, yearly mammograms and health professional examinations are combined as recommended, it is possible to detect cancer at its earliest stage.

What is the difference between a screening mammogram and a diagnostic mammogram?
Screening mammograms provide a general overview using low-dose x-rays in search of cancer in women with no known breast problems. While not intended to diagnose cancer, screening mammography indicates when additional evaluation is necessary. If a questionable abnormality is detected, a more detailed diagnostic mammogram is the next step. Special x-ray views permit close, careful examination of any suspicious area. Fortunately, of the approximately 10 percent of women recalled after a screening mammogram for additional evaluation, only a small number will prove to have cancer.

If I’m under 30 and have breast pain, tenderness, or a lump, what type of exam is appropriate?
Please call your primary care provider’s office to talk to them about what you’re feeling. In general, breast ultrasound should be the first imaging study for young, pregnant, or lactating women with abnormal breast lumps. Mammography is reserved for young patients when the ultrasound examination is inconclusive or suggests breast cancer. Even though the examination sequence may be a little different than for women over age 30, the diagnostic process is the same for patients under age 30.

Women with pain or tenderness throughout the breast usually require reassurance, without the need for breast imaging studies. Localized breast pain is rarely associated with breast cancer. However, if pain is persistent over time, diagnostic evaluation with ultrasound and mammography may be advisable.

Why is ultrasound performed in addition to mammography?
Ultrasound is an excellent complementary examination, but it cannot substitute the screening mammogram. It is routinely performed for women with worrisome lumps whose mammograms are unrevealing and those whose mammograms show an area that requires further evaluation. Ultrasound is also used to guide interventional procedures, such as needle biopsy. A reliable diagnostic aid for most breast cysts, ultrasound can be used to guide cyst aspiration (withdrawal of fluid). Perhaps most important of all, ultrasound results can reassure women that no abnormality underlies a questionable new lump.

What procedures are used for a breast biopsy?
The type of biopsy to be performed depends on the type of breast abnormality. Since a majority of biopsies are benign (noncancerous), selection of the best approach is based on these principles:

• Most accurate diagnosis with smallest amount of tissue removed;
• Least amount of pain and scarring for the patient; and
• Most cost-effective biopsy method.

Image-guided needle biopsy with either ultrasound or stereotactic (computer-aided x-ray machine) guidance allows removal of a small amount of tissue for pathology analysis. Although this procedure can confirm cancer in a highly suspicious lesion, the biopsy more often verifies a lesion is noncancerous and thus prevents surgical biopsy or multiple follow-up examinations. No stitches are required, and results are generally available in 48 hours.

Surgical biopsy with wire guidance is usually performed when a larger piece of tissue is required. Placement of a small wire may be guided by mammography or ultrasound. Once it is correctly positioned, the surgeon uses the guide wire to direct removal of the breast abnormality. A special x-ray is then taken to show that the abnormality was removed. Results from a surgical biopsy are generally available in 48 hours.