Not all mammograms are created equal. Here are 12 steps to getting a top-notch mammogram.
Women know mammograms may save their lives. In fact, a 2011 poll by the American College of Radiology found that nearly 90 percent of women who had a mammogram felt it was important for their health. But not all mammograms are created equal. So how can you ensure that you get the best mammogram possible?
Getting a mammogram that will safeguard your health is a team effort. You trust the technologist to get clear, crisp images of your breasts. You trust the radiologist to read the mammograms correctly, flagging any suspicious areas or giving you the all-clear.
And the government is doing its part: Thanks to the Mammography Quality Standards Act (MQSA), mammogram facilities must meet certain baseline standards for quality of equipment, personnel and practices. (The facility must post a certificate indicating it has met these standards.)
Regardless of theses safeguards, you’re part of the equation, too. “A woman who can tolerate good positioning and good compression is certainly helping her own cause in getting a high-quality mammogram,” says Carol H. Lee, M.D., chair of the American College of Radiology Breast Imaging Communications Committee.
Here, 12 things you can do so that inside look at your breasts is as good as it can be.
1. Bring previous Mammograms with you…if the mammogram facility doesn’t already have them. Your radiologist will want to compare your current mammogram with past ones to see if anything has changed. “Women don’t appreciate how important it is to have comparisons,” says Dr. Lee. “Let’s say a lump has shown up on your mammogram for ten years. If I see it this year, I won’t be concerned because I know it has been there many years and hasn’t changed. If I don’t have your previous mammogram and I am seeing you for the first time, I might do more pictures or recommend a biopsy.”
2. Mention any changes. Say your gynecologist has examined your breasts and didn’t feel anything. She writes you an RX for a routine mammogram. But by the time you schedule an appointment, you’ve felt a lump. What to do? Sure the radiologist may see that lump. But it’s better to let your doctor know so she can re-examine you and order a diagnostic mammogram. During a routine screening mammogram, two pictures of each breast are taken—one from the top and one from the side. During a diagnostic mammogram the technologist will typically take a top and side view and “an additional image or two focusing on the area of concern,” says Susan Brown, M.S.R.N., managing director of health & science education at Susan G. Komen ® in Dallas.
3. Be honest. When you go for your mammogram you’ll be asked a series of questions, including how old you are; how old you were when your period started and stopped; how many children you have; and whether you’re taking hormones. Your answers may help the radiologist “identify problems and interpret any findings,” says Brown. And if you have a personal or family history of breast or other cancers, let your doctor and the radiologist know. This information could affect the type of breast cancer screening you receive. The American Cancer Society recommends that women 40 and older have a mammogram every year. But women at high risk for breast cancer should get both a mammogram and MRI annually. What’s more. they should start breast cancer screening before age 40. Those at moderately high risk should discuss the benefits of early screening and MRIs with their doctor.
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4. Know your breast density. The denser breast tissue is—meaning it has more connective tissue than fat—the harder it is to see tiny tumors that may be present. That’s because both dense tissue and cancer show up white on a mammogram. On the other hand, fatty tissue creates a dark background, making it easier to spot cancer. While breasts typically become less dense as women grow older, this isn’t always the case. And taking hormone replacement therapy may contribute to breast density. Ask the radiologist if your breasts are dense. If they are, you may benefit from additional screening with an ultrasound or MRI. (For more info, visit www.areyoudense.org.)
5. Curb the toiletries. Don’t use antiperspirants on the day of the mammogram. Some facilities don’t want women to use lotion or fragrance in the breast and underarm area either. (Check before your appointment.) “Some powders, deodorants and ointments contain materials that can show up on the mammogram,” says Dr. Lee. “The materials look like little white calcium deposits, or calcifications.” These may or may not be a red flag for early cancer.Z inc oxide is a big no-no. Some women may dab it on irritated skin under their bra, says Dr. Lee. “Zinc oxide is very tenacious,” she adds. “Once it gets on the skin, it stays there even if you scrub.”
6. Cut the caffeine. If you know that caffeine makes your breasts tender, don’t have coffee, tea or other caffeinated drinks for about a week or two prior to your appointment.
7. Tame your hair. If you move your head as the technologist prepares to take the picture and a stray strand falls across your breast, that can obscure the image and you’ll need a redo. So tie your hair back with a barrette or elastic band.
8. Minimize the ouch factor. Having your breasts smooshed between the bucky (the metal plate on which breasts are positioned) and the compression paddle can hurt, but it’s crucial. “The better the compression, the clearer the picture will be and the lower the dose of radiation you’ll need,” says Dr. Lee.
Some strategies for reducing discomfort: Take over-the-counter ibuprofen or acetaminophen a few hours before your mammogram. Or spread some OTC four percent lidocaine gel on your breasts and chest wall. A 2008 study published in the journal Radiology reported that women who used gel had less breast discomfort than women who took acetaminophen or ibuprofen. Just remove the gel at least a half an hour before the test. Another option: Request the MammoPad ®. More than 1500 facilities offer the one-time use, FDA-approved, soft foam cushion that’s placed on the bucky, lessening discomfort. (FYI: The pads aren’t covered by insurance; out-of-pocket costs range from $5 to $10.)
9. Time your mammogram. Schedule it for the first week of your menstrual cycle. Your breasts will be less tender, for one. If you routinely have mammograms, there may be another benefit: A 2011 study published in the journal Radiology reported that breasts may also be less dense. The researchers reported that in women who’d had regular mammograms during the previous two years, mammography was more sensitive at detecting lesions during the first week of the menstrual cycle. (Among women having a mammogram for the first time, mammography was less sensitive during week one.)
10. Don’t move. When the technologist leaves the room to take the x-ray of your breasts, make like a statue. Really. When she tells you to hold your breath, hold it. “When you breathe, you move,” says Dr. Lee. “It’s not dramatic but a little bit of motion can blur the image.” When the radiologist scrutinizes your x-ray, she’s looking for “tiny, little findings,” says Dr. Lee. “Just a little blur can degrade the image, making it less clear.” Each breath hold is a few seconds, tops. In between the shots, you can breathe to your heart’s content.
11. Chill out. Research has found that mindfulness meditation can reduce pain and anxiety. You don’t have to sign up for a crash course in meditation or be a gung-ho yogi to relax. Instead, take slow deep breaths—inhaling through your nose and exhaling through your mouth, before the procedure and as each breast is positioned on the bucky and compressed. But hold your breath when the technologist tells you to.
12. Follow up with a call. MQSA guidelines require that each mammography facility provide the woman’s doctor (or the woman if she doesn’t have a physician) with a written interpretation of the results that’s signed by the radiologist. If you don’t get your results within a week to 10 days, contact your doctor. (If you don’t have a doctor, call the facility.) “This is one of those instances where you can’t assume no news is good news,” says Brown. “You need to be proactive about getting results.”