Mammograms are used as a screening tool to detect early breast cancer in women experiencing no symptoms and to detect and diagnose breast disease in women experiencing symptoms such as a lump, pain, or nipple discharge. 

Screening mammography

Mammography plays a central part in early detection of breast cancers because it can show changes in the breast up to two years before a patient or physician can feel a lump. Current guidelines from the American Cancer Society, the American Medical Association, and the American College of Radiology recommend screening mammography every year for women, beginning at the age of 40. Research has shown that annual mammograms lead to early detection of breast cancers, when they are most curable and breast-conservation therapies are available.

The National Cancer Institute adds that women who have had breast cancer and those who are at increased risk due to a genetic history of breast cancer should seek expert medical advice about whether they should begin screening before the age of 40 and about the frequency of screening.

Diagnostic mammography

Diagnostic mammography is used to evaluate a patient with abnormal clinical findings- such as a breast lump or nipple discharge- that have been found by a woman or her physician. Diagnostic mammography may also be done after an abnormal screening mammography in order to further evaluate the area of concern on the screening exam. 

If you have menstrual or monthly periods, it is best to have your diagnostic mammogram one week after the start of your period. The breasts will not be as tender at this time and you will not feel as much discomfort or pain for the few seconds when the breasts are pressed between the plates used to take the x-ray images. 

If you have breast implants, please let us know so we can schedule a longer appointment. With the presence of implants, more time is required to ensure clear images are captured. 

Please do not wear any deodorant, perfume, lotion, or talcum powder on the day of your appointment as these substances may create shadows in your mammogram. Please wear a two-piece outfit so you only need to undress from the waist up. Bring any previous mammograms with you to your appointment so they can be compared with your diagnostic mammogram.

When you arrive for your appointment, you will be given a gown and asked to change from the waist up. A specialty trained technologist will explain the mammography procedure to you and ask a few questions around prior mammograms, your breast health, and any family history of breast disease. Your breasts will then be put, one at a time, between two special plates and the mammography technologist will gradually compress your breast between the plates of the mammography machine for a few seconds while x-rays are taken. 

Two views of each breast are performed at minimum. You will be asked to change positions between images. The routine views are a top-to-bottom view and an angled side view. The process will be repeated for your other breast. You must hold still and may be asked to keep from breathing for a few seconds while the x-ray image is taken to reduce the possibility of a blurred image. The technologist will walk behind a clear lead glass screen to activate the x-ray machine. 

While the compression may be uncomfortable, the process only takes a few seconds. Compression of breast tissue is necessary to:

• Even out the breast thickness so that all of the tissue can be visualized.
• Spread out the tissue so that small abnormalities are less likely to be obscured by overlying breast tissue.
• Allow for the use of a lower dose x-ray since a thinner amount of breast tissue is being imaged. 
• Hold the breast still in order to minimize blurring of the image caused by motion. 
• Reduce x-ray scatter which allows for a sharper image.

If you have breast implants, be sure to tell your patient coordinator when booking as these appointments require additional time. 

During your appointment, you will be assigned to a technologist who is trained in x-raying patients with implants. This is important as breast implants may hide breast tissue, which can make it difficult for the radiologist to identify breast cancer or other abnormalities. For this reason, the technologist will gently lift the breast tissue away from the implant for proper views. 

You will feel pressure on your breast as it is squeezed by the compression paddle. Women with sensitive breasts may experience some discomfort. If this is the case, schedule the procedure when your breasts are least tender (usually one week from the beginning of your period). Be sure to inform the technologist if pain occurs as compression is increased. If discomfort is significant, less compression is used. 

Beam recognizes that mammograms may be uncomfortable for some patients, so our technologists will work to ensure that you are as comfortable as possible through the duration of your exam.

Like all x-rays, having a mammogram exposes you to a small amount of radiation. Such risk is far outweighed by the benefit of early detection of breast cancer, significantly reducing mortality associated with the disease. 

You may experience breast tenderness and bruising following your exam. This usually resolves in a few days.

If you have breast implants, there is an extremely small risk of damage to the implant from the exam.

It is important to note that a mammogram cannot detect all forms of breast cancer, even when cancer has caused a lump that can be felt. In such circumstances, a normal mammogram does not mean that the lump can be ignored. In this situation, other diagnostic tests such as a breast ultrasound and needle biopsy may be necessary. 

Breast ultrasounds are sometimes utilized in young women as opposed to a mammogram as breast tissue is often dense in young women, making a mammogram more difficult. 

As a test for cancer, mammography is the gold standard. If there is a lump, ultrasound is a useful test in addition to the mammogram, in order to focus in on the area and as a tool to provide additional information – e.g. identifying if a lump is solid or filled with fluid (cystic).