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Mammogram Recommendations and Commonly Asked Questions

Featured Speaker

Michael Olson, MD

Michael Olson, MD

About this Podcast

About This Podcast

At Aspirus we are dedicated to the early detection and treatment of breast cancer through screening and diagnostic mammograms, ultrasound, MRI and image-guided interventions.

When should a woman have her first mammogram?

There are differing opinions about how often a woman should have a mammogram? What are the medical recommendations? Do the recommendations change with age?

If a woman has a history of breast cancer in her family, does that change the recommendations? Is there a certain time of the month that a woman should schedule her mammogram to mitigate discomfort? And, if something suspicious is found what options are available relative to tests to determine next steps?

We will be talking with Dr. Michael Olson from Aspirus Langlade Hospital about some common questions women have about mammogram screening.



Melanie Cole (Host):  When should a woman have her first mammogram? There are differing opinions about how often a woman should have a mammogram. At Aspirus, we’re dedicated to the early detection and treatment of breast cancer through screening and diagnostic mammograms, ultrasound, MRI, and image-guided interventions. My guest today is Dr. Michael Olson. He’s a general radiologist and the director of the imaging department at Langlade Hospital with a special interest in musculoskeletal and women’s imaging. Welcome to the show, Dr. Olson. What about some of the things, the differing opinions about how often a woman should have a mammogram? When should a woman have her first mammogram and how often thereafter?

Dr. Michael Olson (Guest):  Well, first of all, I would like to say thanks for having me. It’s great to be here. That question used to be a pretty straightforward question, so let’s start with the traditional thinking then later on we’ll address the report causing all the confusion for our patients. The American College of Radiology, Society of Breast Imaging, and American Cancer Society still recommend that annual screening begin at age 40 if the patient is not at an increased risk for breast cancer. The recommendations are for yearly screening mammogram and for screening to continue as long as the patient is in good health and is willing to undergo additional testing including biopsy. Those with an increased risk of breast cancer are advised to start screening mammography earlier. The high risk group includes patients with genetic mutations such as BRCA or a genetic syndrome that predisposes them to the development of breast cancer, untested patients with a first degree relative with the genetic mutation, patients having received radiation to the chest wall between 10 and 30 years of age, and lastly, those patients with the lifetime risk of developing breast cancer greater than 20 percent, which is calculated utilizing a breast cancer risk model such as the Gail risk calculator. Those patients with increased risk usually start sooner, sometimes around 30 or 10 years before their first degree relative was diagnosed with cancer. In these patients, additional imaging modalities such as the MRI is often utilized in addition to the annual mammogram for screening purposes. These are just general guidelines and the age at which those high risk patients start screening mammography, and the additional imaging modalities utilized is ultimately a shared decision making process between the patient and her healthcare provider. 

Melanie:  People hear about mammograms. They think they’re very painful. I have had tons of them and I think it’s just a very short little thing. Explain the mammogram process and give women out there a little bit of encouragement. It doesn’t hurt that badly. It’s just a quick thing and it could save a life.

Dr. Olson:  Yeah, you’re absolutely right, and the techs I’ve gotten so good at performing these procedures and really decreasing the amount of tenderness that women have during the mammogram. I’ll just take you through a day during your screening mammogram. The patient will be advised to not wear deodorant, talcum powder, or lotion that may show up on the mammogram or obscure or mimic a cancer. Patient comes to our department, fills out a questionnaire about any true problems related to their breast, hormone use, pertinent family history, and prior mammograms that could potentially be available for comparison. The patient will then put on a gown and clean her breasts before the technologist takes the patient to the mammography room for imaging. So the breast is gradually compressed with a paddle and two images of each breast are obtained with a low-dose x-ray machine, are tapped down in an angled view for a minimum total of four pictures. The breasts are compressed to hold them still and reduce the amount of blur, to increase the sharpness of the imaging, to spread out the tissues so we can see the whole breast adequately. I can say if the patient is prone to cyclical breast tenderness, they can schedule their mammogram during the first part of their cycle. They can avoid caffeine in the morning of the exam, or they can take something for the pain such as ibuprofen an hour before their mammogram. With that being said, like I said earlier, the technologies have gotten so good that that’s rarely a complaint anymore and it can stabilize, your right.

Melanie:  Well, it certainly can and it’s really not a big deal. Now you’re a radiologist, so you look at these pictures. I always go and look afterwards. How long does it take you after a woman has her mammogram to get to the pictures, to look at them? Because we women we sit there, Dr. Olson, and we wait for that call, that inevitable call that we all hate that says you have to come back in and have now a diagnostic. What is it you are looking for?

Dr. Olson:  Yeah. So there’s a little confusion around that process, too, because a lot of times the patients walk out and say, “Why can’t the tech tell me what’s wrong immediately?” The technologist is really there to examine the image quality, and that’s what they look at after the images are taken. The radiologist can view the images that are sent to a separate work station. At our institution, we read them within 24 hours then we generate a report to that patient’s referring physician, relaying our interpretation and the appropriate follow-up. So if the patient doesn’t have anything that’s defining, they’ll also get a letter stating that they can return for annual screening mammography in a year. Otherwise, if an abnormality is found on the screening mammogram, our technologist will call that patient within a couple of days and let them know that they do have to come back for additional imaging.

Melanie:  Is there a certain time of month you would recommend having your mammogram? Does that change the pain level if we’re bloated if we feel like our breasts are very tender at a certain time of the month?

Dr. Olson:  Oftentimes, they recommend doing the mammogram in the first 10 days of your cycle and that will be the time when your breasts experience the least amount of tenderness.

Melanie:  Okay. So, you know, we can do that sort of near the beginning of the cycle. If a woman has a history of breast cancer in her family, do you recommend doing a diagnostic? And what about if she has dense breasts, is there anything different you would do as a radiologist if a woman does have this BRCA history or the gene or very dense breasts?

Dr. Olson:  Yeah, those with the BRCA history or an increased risk of breast cancer, like I stated earlier, are going to be in kind of a different screening pool. They’re going to use additional imaging modalities, whether it’s full breast ultrasound at some institutions or breast MRI, especially those patients with dense breasts because dense breasts can really hide and obscure small masses on mammograms. This is really kind of becoming a popular topic. A lot of radiologists are even reporting the density of a patient’s breasts in the report and are required to do so in some states such as Connecticut. If a patient has dense breasts or has an increased risk of breast cancer, then additional imaging modality can definitely be helpful.

Melanie:  We love getting the letter that we’re all clear, but if something suspicious is found, then what usually is that diagnostic mammogram? What is the next step? Do we go right to ultrasound or MRI? What do you tell us we have to do next?

Dr. Olson:  Yeah. So, the callback process is another kind of confusing topic for patients. They’ll get that call and they’ll think, “Oh, I have cancer” or “Oh, the technologist took bad pictures.  But, you know, that’s not the case, and I’m here to reassure patients that 90 percent of patients that have a screening mammogram will be interpreted by the radiologist as normal or having benign or non-worrisome features but there are the 10 percent that have to come back for additional imaging. That just simply means that additional pictures are needed, utilizing techniques such as increased compression at a slightly different angle or a 3D breast tomosynthesis to determine if the finding is a real finding or it’s just a superimposition of tissues. They also may be called back to blow up or magnify some calcifications to better characterize them, the calcifications that were found on the screening mammogram. Then if that abnormality persists on the additional views, they may have an ultrasound that same day for further characterizations of mammographic findings. Although 10 percent of patients that are called back, 80 to 90 percent of those will need no further workup after the additional views are obtained and just a small percentage then go on to image-guided biopsy.

Melanie:  I know this depends on the patient and such but, Dr. Olson, when you look at a mammogram, a screening mammogram, can you tell when you see something suspicious? Do you have a feeling if it’s cancer or not? Because everybody wonders this, “Can the doctor really tell right off the bat?”

Dr. Olson:  Well, sometimes you can tell and sometimes you get a real good feeling of “Oh, boy, something is concerning” or benign. But with that being said, I’ve seen things that are benign that look cancerous and some things that look cancerous on mammograms turn out to be benign. So, there is that crossover there. It just kind of depends on the mammogram.

Melanie:  In just the last minute or so, please give the listeners your best advice on all this confusion over annual screening mammograms, really your best advice and why they should come to Aspirus for their mammograms.

Dr. Olson:  Well, the United States Preventative Services Task Force in 2009 released the report revising their recommendation and that’s created a lot of confusion. Although I agree with some things that are being said by the Task Force, the bottom line is that screening mammography has decreased the overall mortality from breast cancer by 15 to 30 percent. Therefore, I think it’s important for women to continue to have their screening mammogram because ultimately, early detection and treatment of the potentially progressive risk for breast cancers is very important.

Melanie:  Thank you so much. All women should get their annual screening mammograms. Just listening to this show, you’ve learned great information. You’re listening to Aspirus Health Talk. For more information, you can go to aspirus.org. That’s aspirus.org. This is Melanie Cole. Thanks so much for listening.