What doctors look for in a mammogram

If you are a woman over 40, you should think about getting your annual mammogram in order to detect signs of breast cancer.

Debra L. Monticciolo, MD, FACR, the section chief of breast imaging on the medical staff at Baylor Scott & White Clinic – Temple, answers some common questions you may have about mammograms, and what your doctor is looking for.

What is a mammogram?

A mammogram is an x-ray exam of the breast that’s used to detect and evaluate breast changes.

“Mammograms can find cancer before a woman can feel it,” Dr. Monticciolo said.

Why do I need a mammogram?

Years of research over multiple clinical trials have confirmed a 40 percent reduction in breast cancer mortality can be achieved with regular mammography screening.

What is my radiologist looking for?

When you get a mammogram, your results will be read by a radiologist. A radiologist is a physician that specializes in medical imaging, sometimes referred to as “reading x-rays.” In addition to image interpretation, breast imaging radiologists do minimally invasive needle biopsies using x-ray, ultrasound and MR guidance.

“We look for signs of breast cancer, some of which are obvious and some of which are very subtle,” Dr. Monticciolo said. “Sometimes we see something and cannot tell whether or not it represents cancer.”

In those cases, doctors often can do other things to decide—additional imaging or needle biopsy.

What will they see on my mammogram?

When your radiologist looks at your mammogram, she will try to look for abnormalities or early signs of cancer. Some elements of concern include:

Tiny mineral deposits in breast tissue

These are called calcifications, and these tiny mineral deposits look like small white spots on a mammogram. They may or may not be caused by cancer.

A mass

A mass is another important change seen on a mammogram.

Masses are areas that look abnormal and they can be many things, including cysts (non-cancerous, fluid-filled sacs) and non-cancerous solid tumors. However, a mass may sometimes be a sign of cancer.

Breast density

Your radiologist will also analyze your breast density from your mammogram. This is analyzing your breast tissue and how much of it is made up of fatty tissue.

Dense breasts are not abnormal, but they are linked to a higher risk of breast cancer and can make it harder to find cancers on a mammogram.

Reading mammograms is challenging. The way the breast looks on a mammogram varies a great deal from woman to woman.

If I have to come back, does that mean I have cancer?

If a woman has a mammogram, there is a chance that she will be asked to return for additional imaging. No, this does not necessarily mean you have cancer.

“That happens about 10 percent of the time,” Dr. Monticciolo said. “Most of the additional imaging will show nothing suspicious and a small number will be asked to return in six months for another study.”

“The cancers we detect early are easier to treat and survival is much better.”

Of those women, an even smaller number may need a needle biopsy to make sure they don’t have cancer. This is less than 2 percent of women, and some of these won’t be breast cancer either. Some biopsies show benign disease.

“The cancers we detect early are easier to treat and survival is much better,” Dr. Monticciolo said.

What if I’m hesitant to get a mammogram?

Mammograms are not perfect and not all breast cancers can be diagnosed with mammography, but that is not a reason to avoid mammography.

“Mammography helps many women,” Dr. Monticciolo said. “Mammography has been saving lives for decades. This will only continue if women get them.”

If you’re confused about the benefits of mammography, talk to your doctor. It’s unfortunate that it is so misunderstood.

“This confusion is unfortunate,” Dr. Monticciolo said. “We should not go back to the days when tumors were only diagnosed when they were palpated. Many are too advanced at that point.”

To protect yourself against breast cancer, schedule a mammogram today.

What doctors look for in a mammogram