What is a mammogram?

A screening mammogram is an x-ray of the breasts used to evaluate the tissue of a patient who has no breast problem and no personal history of breast cancer. It consists of two views, one using a vertical projection and the other using a horizontal projection.

A diagnostic mammogram is an x-ray of one or both breasts used to evaluate the tissue of a patient who has a new breast problem, has had a recent breast biopsy, has a personal history of breast cancer, or has been asked by a medical professional - either her doctor/nurse practitioner or the radiologist - to return for follow-up of previous findings. More than the standard two views of the breast are often done. In most cases, the patient will also consult with one of our radiologists.

How often should I have a mammogram?

For most women, a first or 'baseline' mammogram should be done at 35 years of age and regular, yearly mammograms should be done after 40 years of age. If the patient has a sister or mother who was diagnosed with breast cancer before age 50, she should begin yearly mammography when she is ten (10) years younger than that relative was when diagnosed. Patients should also begin regular screening at a younger age if they are known to carry an abnormal gene for breast cancer, have a personal history of breast cancer, a strong family history of breast and/or ovarian cancer, or if they have been treated for Hodgkin's lymphoma.

Is the mammogram painful?

To obtain a mammogram with the best possible detail, the breasts are compressed firmly during the exposure. This decreases the amount of radiation needed, prevents motion and displaces overlapping tissues. The better the detail on the mammogram, the greater the chance that any abnormality will be seen. When applied correctly, the compression will not damage breast tissue or breast implants. If the patient requests it, a specially designed pad can be used to increase her comfort. She must be sure to inform the technologist if she has concerns about the compression or finds it uncomfortable.

Why and when is ultrasound needed?

Breasts are normally a combination of fibroglandular tissue and fat. The greater the percentage of fibroglandular tissue, the more dense (white) the tissue will appear on the mammogram. Conversely, the greater the percentage of fat, the less dense (gray) the tissue will appear on the mammogram. Most abnormalities appear as densities. They are white on the mammogram and can be obscured by breast tissue that is dense and white. Ultrasound gives us another way to evaluate areas both of normally dense breast tissue and areas of abnormal density. It can also be used to guide needle biopsy or to identify and 'localize' an abnormality before surgery.

Ultrasound is not intended as a replacement for screening mammography. It is seldom used alone.

When will I know the results of my mammogram?

The Indianapolis Breast Center prides itself on giving the result to any patient requesting it while she is here. She should be aware that being given that result will prolong her time at our office, but it will decrease the chance of a 'call back' if there is an area that needs further evaluation and, of course, it means she will not have to wait for a mailed report.

If the patient is seen for a diagnostic mammogram, she will be given the result before she leaves. If the patient is seen for a screening mammogram, she may choose to leave when the examination is completed and the result will instead be mailed to her. Written reports will also be sent to any physicians of the patient's choice.

How early can a cancer be detected?

Both breast physical examination and mammography can detect breast cancer. Breast cancer is usually found much earlier by mammography - when it is smaller, less likely to have spread and more likely to respond to treatment. Multiple studies have confirmed that survival rates are better when the cancer is discovered by mammography alone.

Very small calcifications may be the first sign of breast cancer and are frequently seen while the cancer is still confined to the milk ducts. These calcifications cannot be felt but are seen with mammography.

The types of breast cancer vary greatly in how fast they grow. A cancer can be present for many years before it becomes large enough to identify or (much less often) it may be growing so rapidly that it is felt a few months after a normal mammogram.

Remember, a mammogram is done to detect breast cancer early. It cannot prevent breast cancer.

What if my mammogram, ultrasound or physical examination is abnormal?

In most cases, a mass, calcifications or other abnormality or change found with a mammogram, ultrasound or physical examination will prove to be benign and not cancer.  However, biopsy may be needed to confirm that.

If an abnormality is suspected, both breast imaging and physical examination will be used to get as much information about it as possible. In some cases, that information will be enough to reassure us that there is no abnormality. In other cases, follow-up evaluation will be requested and/or antibiotic therapy, biopsy, or referral to another specialist may be recommended. The findings and recommendations will be discussed with the patient and with her we will decide how to proceed. As with the routine mammogram, all physicians of the patient’s choice will be notified of the findings.

What if I have a nipple discharge?

Nipple discharge is of greatest concern if it is spontaneous and involves a single duct. In that case it is still most often benign; however, it can result from a cancer in the duct. To evaluate it further, we will do mammography and ultrasound and also send samples of the discharge for testing. When indicated, based on those examinations, we will send the patient for surgical consultation. If surgery is used to remove the abnormal duct, the surgery is often preceded by a ductogram, a special x-ray taken after injection of dye into the duct. Magnetic resonance imaging may also be indicated in certain cases.
 

MRI

What is magnetic resonance imaging of the breast and why is it done?

Magnetic resonance imaging is a form of imaging that uses magnets and radio waves to produce an image. It is often used with intravenous contrast (dye injected into a vein). In the breast, mammography and ultrasound allow us to evaluate the structure of the breast. Magnetic resonance imaging also shows us structure but, because the contrast indicates where there is greatest vascularity, it also indicates where there is an active process within the breast. This allows us to identify abnormalities that might otherwise be missed.

Magnetic resonance is not a replacement for mammography and ultrasound. It is a valuable supplement.

Some of the reasons for magnetic resonance imaging are:

- To evaluate the extent of disease prior to surgery
- To evaluate the response of a cancer to chemotherapy
- To evaluate a patient with a strong family history of breast cancer
- To evaluate a patient when the significance of findings on
mammography and ultrasound is uncertain
- To evaluate breast implants

How is magnetic resonance imaging done?

At the Indianapolis Breast Center, we use magnetic resonance equipment specifically designed to image the breasts. The patient lies on her abdomen with her breasts extending through an opening in the examination table. The table is contoured to increase her comfort and her breasts are not compressed as they are for a mammogram. When indicated, an intravenous injection is started. The table is moved into the magnet with the patient's feet first and scanning is done. Although the technologist is not in the room with the patient during scanning, she is able to both see and hear the patient at all times.
There are ordinarily no side effects of magnetic resonance imaging and the patient can resume normal activities when it is completed.

The aurora is designed specifically for your comfort.  During the exam, you will lie on your stomach with your breast place d in openings in the Aurora examination table, so that they are suspended away for your chest.  Unlike conventional x-ray mammography, breast MRI does not require your breast to be compressed, so you should not experience any discomfort.  Plus you will enter the machine feet-first, which reduces feeling of claustrophobia sometimes associated with full-body MRI scanners.

If indicated, you will receive an injection (usually in the arm) of a contrast enhancement agent called gadolinium that helps to highlight various structures in breast tissue.  The gadolinium is administered through a small intravenous catheter which is placed by a technologist or nurse.

A scan will be taken and then repeated after the gadolinium is administered.  For best results, you should relax, lie very still and breathe normally.  The technologist  can see and hear you at all times.  The entire exam takes about 30 minutes.

How do I prepare for the exam?

No special preparation is required.  You can eat and drink as you normally would, engage in regular activities and take any prescriptions or medication.  Plan to arrive about 30 minutes before your appointment time.  You will be asked to change into a gown since belts, zippers, snaps and thread in clothing may contain metal that disturbs MRI signals.

We will ask you several questions before you enter the MRI exam room.  You will have to remove all metallic objects, such as jewelry, glasses, hairpins and dentures (personal belongings will be secured in a locker).  Please be sure to tell the technologist if you have metal implants, a cardiac pacemaker, permanent dental bridges, braces or other metal objects.

What about after the exam?

There are no side- or after- effects with MRI, so you can resume your normal activities as soon as your exam is over.  The radiologist will interpret your MRI scan and a report of the findings will be forwarded to your doctor.

Does insurance cover breast MRI?

Most major health insurance carriers cover breast MRI.  If your health plan requires you to have a written referral for this type of exam, please be sure to obtain the necessary paperwork prior to your appointment, so that we can bill your carrier directly.

Click here to learn more about your MRI exam.