Mammogram

A mammogram is an examination that uses X-rays to create images of breast tissue. It’s a breast cancer screening tool, checking for cancerous or pre-cancerous cells before symptoms develop, when the cancer is easier to treat. Clinical trials have proved that screening mammograms save lives from breast cancer.

We also use mammograms to diagnose breast cancer in people who have symptoms, such as a lump, or who had abnormal results on a screening mammogram. Screening and diagnostic mammograms both use ionizing radiation to produce pictures of breast tissue.

A mammogram machine is designed specifically for breast tissue. Two plates compress your breast to flatten the tissue and the machine sends X-rays through your breast to a detector.Compression makes the quality of the pictures much better. The uniform thickness reduces the radiation needed and tissue stability helps show very tiny calcifications in the tissue.

X-rays easily pass through soft tissues such as skin and fat, which appear in shades of gray on the image. Denser structures, such as tumors or deposits of calcium that could indicate breast cancer, absorb the radiation and show up as white on the image.

A screening mammogram uses a very low dose of radiation and typically involves two pictures of each breast. A diagnostic mammogram is used to take more detailed pictures of specific areas of your breasts from different angles or with magnification.

Mammograms can be two-dimensional (2D) or three-dimensional (3D). A 2D mammogram takes two pictures of each breast from above and from the side. A 3D mammogram, also called digital breast tomosynthesis, takes pictures from multiple angles as the machine moves around each breast. These pictures are combined to create the 3D images for the radiologist to look at different layers of each breast.

Benefits of 3D mammography

Studies show that a specialized breast radiologist is more effective at finding breast cancer early when using 3D mammography instead of 2D mammography, especially for people with dense breast tissue. Using 3D mammography can also lower the risk of recall from screening mammograms due to false positives (images that look abnormal even though breast cancer isn’t present).

Additional benefits of 3D mammography include:

• Better precision: We can zoom in, magnify, change contrast, and view the breast as individual slices, resulting in more precise images.
• Enhanced comfort:Flexible plates are more comfortable during breast compression.
• Instant availability:: Digital images are stored electronically and can be digitally transferred to another site or recorded on CDs.

Free mammograms at Penn Medicine

The Penn Medicine Breast Health Initiative offers free mammograms (screening and diagnostic) and diagnostic services like breast ultrasounds and biopsies. These no-cost services are for un-insured and under-insured women who are older than 40. Other services available through this program include:

• Assistance connecting with a health insurance enrollment specialist
• In-person language interpreters at appointments as needed
• Patient navigation services and breast health education
• Public transportation tokens to assist in getting to and from appointments
• Referrals for free cervical cancer screening and diagnostic services

The American College of Radiology and the United States Preventive Services Task Force and the American Society of Breast Surgeons recommend that all women have a screening mammogram beginning at age 40. A mammogram every year is the strategy that will save the most lives and catch the most early cancers. Your provider may recommend earlier or more frequent mammograms if you’re at an increased risk for breast cancer due to family history, genetics, or other reasons.

In some cases, you may need other types of breast imaging. Talk to your health-care provider about the best screening plan for you. You may need a diagnostic mammogram if you have signs or symptoms of disease, such as:

• A lump in your breast or armpit you can feel or see
• Focal breast pain or tenderness
• Changes in breast shape or size
• Discolored, flaky, or puckered nipple
• Abnormal results on a screening mammogram
• Nipple discharge
• Thickening or dimpling of breast skin

A mammographer (a radiation technologist who specializes in mammography) performs your mammogram. A breast radiologist (doctor who specializes in breast imaging) reviews and interprets your images. Be sure to tell your mammographer if you have breast implants, are breastfeeding, or think you might be pregnant.

There’s not a lot of special preparation for a mammogram. It’s best to have your exam when your breasts aren’t swollen or tender, so avoid scheduling your mammogram the week before your period.

Don’t put deodorant, antiperspirant, powder, or lotion on your breasts or underarms the day of your exam, as these can affect the image. Most imaging centers have alcohol wipes available so you can remove these substances. We’ll also ask you to remove jewelry, piercings, and clothing from your waist up.

During a mammogram, here’s what you can expect:

1. You put on a gown that opens from the front.
2. The technologist helps you position your breast on a plate. Another plate compresses your breast, which may feel a bit uncomfortable. Compression for each image lasts less than 30 seconds.
3. The technologist steps to the workstation control area to take the images. They may ask you to hold your breath for a few seconds at a time.
4. We usually take 2 images of each breast. Occasionally, the mammographer may need additional images to complete your exam and ensure the highest quality.
5. The total time spent in the room for a mammogram is between 10 and 15 minutes.

There’s no recovery time after a mammogram. You can return to normal activities right away.

Your health-care provider will receive your mammogram results. By law, you must receive an explanation of your mammogram results within 30 days. You may get a letter in the mail, or your results may be available sooner if you have access to an electronic medical records system. MyChart by myPennMedicine makes it easy for you to view your mammogram results as soon as they’re available.

If you have an irregular mammogram or we call you back for a repeat mammogram, it doesn’t mean you have cancer. False positives do happen. In fact, about 50 percent of women who get annual screening mammograms will have a false positive exam at some point in their lives.

Mammograms are very safe. The exam uses a very low dose of ionizing radiation. It is less radiation than each person receives from the environment each year. Experts agree that the benefits of mammography (saving lives from breast cancer) far outweigh the risks of radiation exposure.

At Penn Medicine, we use the most advanced breast imaging technology available to detect breast diseases as early as possible. When you turn to us for breast care, you’ll find:

• National recognition: We are accredited by the American College of Radiology (ACR) in both mammography and stereotactic breast biopsy. Penn Medicine is also home to several ACR-designated Comprehensive Breast Imaging Centers of Excellence.
• Experienced team: We perform more than 24,000 breast imaging studies each year. These studies are interpreted by board-certified and breast fellowship-trained radiologists. Our technical staff are sub-specialty certified in mammography.
• Leading-edge breast procedures: We conduct the highest quality interventional procedures, including stereotactic, ultrasound-guided, and MRI-guided breast biopsies and localizations. Radiologists and pathologists with specialized expertise in breast diseases work together to give you the answers you need.
• Multispecialty approach: Radiologists, medical oncologists, radiation oncologists, nurse navigators, and surgeons provide collaborative care for people diagnosed with breast cancer. Abramson Cancer Center is designated by the National Cancer Institute as a comprehensive cancer center.