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One of the most effective ways to detect breast cancer as early as possible is done with routine mammograms. We know the disease is much more treatable when detected early.
Mammography helps radiologists see the normal and abnormal structures in
the breasts, including masses, microcalcifications and architectural
distortion. Masses can be benign (like cysts, which are fluid-filled), or
cancerous. Microcalcifications can also be benign or be a sign of early or
Our BreastCare Center team supports the American College of Radiology
(ACR) and the
Society of Breast Imaging
(SBI) recommendations that women age 40 and older who are at “average risk”
for breast cancer have an annual screening mammogram. These women do not
have any symptoms or family history of breast cancer.
If you are "at high risk” for developing breast cancer, it may be suggested
that you have more frequent mammograms, beginning earlier than age 40.
Please contact your medical provider if you have any questions about if and
when you should have a mammogram.
The BreastCare Center considers a woman to be “at high risk” and strongly
recommends screenings before age 40 if she:
Carries the BRCA1 or BRCA2 mutation
These are the most common genes that cause breast cancer.
exist to help determine if you are a candidate who should be tested for
the genetic mutation. If you think you could be a BRCA1 or BRCA2 gene
mutation carrier, based on the markers and/or your medical provider’s
suggestion, we recommend you consider meeting with one of our
supportive and specially trained genetic counselors. You will discuss
with them if testing might be appropriate for you, and what your
options might be if you are found to be a carrier.
When a patient is found to be a carrier of the BRCA1 or BRCA 2
mutation, and that patient’s mother or sister has had pre-menopausal
breast cancer, our BreastCare Center starts breast cancer screening 10
years before the age of diagnosis of the mother or sister (but not
before age 25).
Has a strong family history or undergone mantle radiation
A strong family history of breast cancer results in high lifetime risk
of breast cancer. If a woman has undergone mantle radiation for
Hodgkin’s disease between ages 10 and 30, we recommend breast screening
eight years after mantle radiation therapy (but not before age 25).
Has already had breast cancer, breast ‘atypia,’ or ovarian cancer
before turning 40
If a woman has already been diagnosed with breast cancer, breast
'atypia' (abnormal cells that are not quite cancer) or ovarian cancer
prior to age 40, we recommend early breast screenings. In these cases,
your medical provider will discuss when to undergo future screenings
First, a patient removes the necessary clothing (such as a top and/or bra,
and any jewelry worn on that area of the body) and is given an exam gown to
wear into the mammography room. Once inside, the patient stands in front of
a special X-ray (mammography) machine that has a platform on which to place
one breast. Working with the patient, a trained mammography technologist
gently lifts and positions the breast on to the platform. The breast is
carefully flattened and compressed between two special plates for each
X-ray exposure to achieve the clearest possible picture of the tissues.
A radiation beam passes through and forms an image of the breast on an
X-ray film. It is a low dose X-ray and does not harm the breast tissues.
At least two pictures of each breast are taken. For one picture, the
patient faces toward the platform and the image is taken looking down at
the breast. For a second image, the patient stands beside the machine. This
allows for a side view. Extra images may be needed if the patient has had
breast implants or if this test is being used to help make a diagnosis.
The degree of pressure needed to get the best picture possible may cause
discomfort momentarily. It does not harm the breast tissues. If any pain is
felt during your mammogram, you should tell the technologist. You might
also want to discuss using a pain medicine, such as ibuprofen, with your
medical provider beforehand.
While mammography does expose you to some radiation, today's mammography
equipment is designed so that this exposure is minimal. The dose received
from a routine screening mammogram is the same as the dose received from
natural background radiation over three months. It does not harm the breast
tissues and is safe.
We do not recommend screening mammography in pregnant women. If you have
symptoms of a breast abnormality, typically an ultrasound (which uses no
radiation) will be done first. A mammogram can be done if there is a
concern on the ultrasound, even if you are pregnant. The radiation dose is
very small and we shield the abdomen to limit exposure to the fetus.
If our specialists feel a mammogram is needed due to a breast abnormality,
a radiologist will speak with you about the benefits and risks before doing
Comparing mammograms made at different times on the same person is
extremely helpful in detecting subtle changes. If you have had a previous
mammogram at one of
BIDMC's breast imaging locations, we will have your images and any related medical reports. You do not need
to bring anything with you to the appointment.
If you've had a previous mammogram elsewhere, please either bring those
images and reports to your appointment or arrange for them to be sent to
us. Contact the Radiology Film Library at the facility where you had your
breast imaging done, and ask them for any of your breast images and reports
from the past three years.
Ask if your images and reports can be sent digitally to us at the
BreastCare Center. If that isn’t possible, please send them by FedEx or UPS
Beth Israel Deaconess Medical Center
Attn: Radiology Film Archive Dept.
Shapiro Clinical Center, 4th Floor
330 Brookline Avenue
Boston, MA 02215
our Breast Imaging unit several days before your appointment to confirm
that we have received the information. You can reach us at 617-754-9500.
On the day of your mammogram, you should not use talcum
powder, perfume, lotion or deodorant on your breasts or underarms, as they
will appear as specks in the images the radiologist reviews. If you forget
this, you should tell the technologist, who will provide a cleansing towel
to clean it off before your mammogram. We also recommend that you wear a
comfortable two-piece outfit, so you only need to disrobe from the waist up
to change into an exam gown. You should eat and drink as your normally do
and continue to take any medications that you normally take.
A screening mammogram is performed regularly on women who:
are usually over the age of 40
do not have symptoms of a breast abnormality
may or may not have a family history of breast cancer
The purpose of a screening mammogram is to look for any early signs of
breast cancer, and our BreastCare Center recommends that all women have
regular screening mammograms. The majority of these mammograms show no
abnormality. Screening mammograms take about 15 minutes.
A diagnostic mammogram is performed when a woman has:
symptoms of a breast abnormality
felt a lump or her medical provider has felt something abnormal
had a recent history of breast cancer
a prior abnormal screening mammogram requiring immediate follow-up
a potential abnormality seen on a recent screening mammogram
A diagnostic mammogram is performed the same way and with the same
equipment as a screening mammogram, but usually more images will be taken
in order to find answers. Diagnostic mammograms take about 20 to 30
You will be asked to wait in our facility until the mammography images are
reviewed by our technologist, who will make certain the clearest possible
breast images were taken and don’t need to be repeated. Once that is
confirmed, you may leave. Next, our BreastCare Center radiologists will
read the images, interpret the results and write a report. That report is
sent to your doctor, and patients are notified of results usually within
five days by mail; or, your medical provider may contact you to discuss the
results. If you had a referring physician, the report will be sent to that
A member of our Breast Imaging team will contact you to discuss the
findings and schedule additional imaging. It is important to keep in mind
that if this happens, it does not necessarily mean you
have breast cancer. The radiologist sees something on your screening that
she or he is simply questioning, and you need to return for another
mammogram and possibly an ultrasound.
Before you leave this follow-up appointment, you will receive your results
and, if you would like, speak with our Breast Imaging radiologist. If the
radiologist found a benign mass and wants to monitor the area more closely,
you will be asked to return for a mammography (or ultrasound) in six
months. If an abnormality remains on the additional images, you may need a
biopsy. The biopsy can often be done that same day (if you choose).
Approximately 20 to 40 percent of breast biopsies are cancerous. However,
many women who receive abnormal mammogram results will return to having
their annual screening mammography and need nothing else.
Mammograms can sometimes detect things that look like cancer but are not,
and just a “false positive” result. About one in 10 to one in 12 women will
have a questioned abnormality on their screening mammogram. So, if you have
mammograms yearly for 10 to 12 years, you are likely to get this call at
least once. The more mammograms you have over your lifetime, the more
likely you are to be called back for a follow-up — and it could be because
of a “false positive” result. If something is noticed on the mammogram, you
may need to have additional testing, such as a diagnostic mammogram, a
breast ultrasound and/or a biopsy.
This will help determine if there is an actual problem. We understand that
getting called back can be upsetting, but we believe the benefits of
mammography as a highly effective breast cancer screening tool are worth
Like all screening tests, the mammogram will not detect every single
abnormality. The false negative rate for mammography is about 10 to 15
percent. That means that there are some cancers that are not seen with
mammography. Therefore, it is critical that you have your mammogram
screening at a qualified breast imaging facility with highly trained
radiologists and technologists.
Breasts contain different types of tissue; some is fatty, some is fibrous,
some is glandular. The fatty and fibrous tissue is what give breasts their
size and shape, and also holds the glandular tissue in place. Breasts are
considered dense if you have more fibrous and glandular tissue than fatty
Breast tissue density is determined by the radiologist who reads your
mammogram. Radiologists classify breast tissue density into four
Scattered fibroglandular tissue
Heterogeneously dense tissue
Extremely dense tissue
Patients whose mammogram results fall into the latter two categories are
A woman's individual level of density can vary due to weight and hormonal
changes. Density may also decrease with age — younger women tend to have
denser breast tissue than older women. Having dense breast tissue is not
abnormal; however, recent studies have shown that having it may increase
the risk of breast cancer relative to women with only fatty tissue. Dense
breast tissue appears white on a mammogram, as do masses — both benign and
cancerous — meaning mammograms can be less accurate in detecting breast
cancer if a woman has dense breasts.
A law in Massachusetts
effective January 1, 2015, requires all mammography providers to notify
patients of their breast tissue classification and explain what that
No additional screening is required if a patient is found to have dense
breast tissue, though it may be recommended depending on your individual
risk of breast cancer. Many doctors believe that most women found to have
dense breast tissue without other risk factors will not need any additional
exams; talk to your doctor about your risk and whether additional
screenings, such as
breast MRI, or whole
breast ultrasound, may be right for you.
Breast Imaging at BIDMC and its outpatient offices are all completely
digital. Digital mammography utilizes the latest technology available for
breast imaging. There is a slight decrease in radiation dosage, a faster
exposure time and improved image contrast, making it easier for
radiologists to see abnormalities, compared to film mammography.
Our BreastCare Center has been a digital mammography site for many years.
We also offer
(digital breast tomosynthesis), the most advanced screening technology
available, in our
Digital mammograms can be transmitted electronically from one facility to
another, allowing for better coordination among a patient’s physicians.
And, because the images can be transferred electronically, our patients
have the advantage of being able to have their mammograms at any of our
Similar to a digital camera, images are collected digitally so they can be
manipulated by software programs which enhance image characteristics. If we
see something of concern on a digital mammogram, we can digitally magnify
that area on our computer monitor.
With older film mammography, a single piece of film is put into each
cassette and the technologist has only one chance to obtain the correct
exposure for an optimal image. Once the film is exposed, it can’t be
Please check with your health care insurance company about the exact
details of your coverage. The Affordable Care Act mandates that coverage of
mammograms for breast cancer screening be given without a co-pay or
deductible beginning with plan years starting after August 1, 2012. This
doesn’t apply to health plans that were in place before it was passed.
State laws, which are all different, and other federal laws cover those
Each state differs in what its law says about mammogram screening coverage
— and some are more generous than others. 3-D mammography and other breast
screening procedures may not be covered by every insurance policy and
result in an additional fee; check with your insurance company about what
exactly is covered under your plan.
In most cases, a diagnostic mammogram, breast ultrasound or breast MRI has
to be ordered by a physician in order for it to be covered by insurance.
Yes. If a woman has breast implants, the mammography technologist will push
the implants out of the way and take additional images of each breast.
Implants make it difficult to see the underlying breast tissue, which is
why we need to take extra views. If a woman with implants feels a lump in
her breast, we will do an ultrasound in addition to the mammogram because,
often, ultrasound allows us to see a lump that may be obscured by the
Although it is rare, men can get breast cancer. According to the American
Cancer Society (ACS), in 2012, approximately 2,190 new cases of invasive
breast cancer were diagnosed in men and 410 men died from the disease. The
ACS also says that because male breast cancer is uncommon, there is
unlikely to be any benefit in screening men in the general population with
mammograms. Mammography for screening has not been studied in men, and is
usually done only if a lump is found.
But, men have breast tissue, too, and need to be aware of any changes in
their breasts. These changes include nipple discharge or turning inward,
redness or scaling of the nipple or skin around it, skin dimpling or
puckering, or a lump or swelling, which is often, but not always, painless.
Sometimes, before a tumor in the breast tissue is large enough to be felt,
a lump or swelling under the arm or around the collar bone is evident,
which could be caused by breast cancer that has spread to lymph nodes.
It is important to know that most breast lumps in men are caused by a
harmless enlargement of breast tissue; however, contact your medical
provider immediately if you see any lumps or changes in the breast or
BIDMC accommodates all who need breast imaging. We have done mammograms on
patients in wheelchairs, with multiple sclerosis, who have had a stroke,
and some who are very elderly. If needed, two technologists will work
together to ensure our patients are as comfortable as possible while
performing the screening or test.
Please call 617-754-9500 Monday through Friday between 8
a.m and 6 p.m. When you call to schedule a screening mammogram, we will ask
you for basic information such as your Beth Israel Deaconess Medical Center
records number or your Social Security number.