Mammogram

I would reinforce Dr. Moore's answer that not all breast findings need an MRI. There is no way that any of us can tell based on the information provided whether or not an MRI or other imaging will be helpful or necessary in this case - an understanding of the patient's clinical situation as well as review of the mammograms and any available pathology reports is necessary. In general, calcifications do not show up on MRI. There is no question that there are cancers that will show up on MRI that are missed by other imaging, but again each case needs to be properly evaluated before a blanket recommendation for MRI is made. There is no best imaging test for the breast, but that also does not mean that every test should be done in every person. Calcifications are very commonly seen in the breast. More than 50% of all mammograms performed have calcifications. The vast majority of them are related to benign or "normal" things. Surgery is one of the things that can produce calcifications. According to a recent Medscape article "high quality mammography is the best diagnostic tool for the identification of breast calcifications." When we interpret mammograms we characterize calcifications in terms of their their shape, number, distribution and size. We then categorize them as normal, benign, probably benign, or suspicious. Suspicious calcifications are biopsied, even though there is no palpable lump, or breast pain, or any other findings.

In one study 300 biopsies were performed on suspicious calcifications and only 100 of them were cancers. So even those that look suspicious are not always related to cancer.

MRI of the breast is a very sensitive test that is not always specific. If you have a lump that is palpable, or is seen on mammography or ultrasound, MRI may help. It can also find unsuspected small lesions as part of preoperative planning. MRI is not good at looking at calcification. Could MRI show you something really small that is in the area of the calcifications that is not seen on other tests? Possibly, but if the calcifications are in the area of the surgery MRI might be abnormal anyway, and more difficult to interpret.

Every case is different and every medical decision is made in the context of that patient's personal and family history, physical findings,and all imaging results. Patients are best served when they have a doctor who listens to them and whom they trust. Decisions are then made together. Unfortunately medicine is not an exact science, and our knowledge is still incomplete, in spite of the advances we have made.

How should you prepare?
1>If possible, you should schedule your test for the week after your period, and not before or during period, since your breasts may be tender.

2>Do not wear talcum powder,lotion or deodorant under your arms or on your breast on the day of the exam. These can appear on the mammogram as calcium spots.

3>Describe any symptoms or problems related breast to the technologist performing the exam.

I tell patients to schedule the mammo just at the end of menses or shortly thereafter so it doesn't hurt so much. Try a morning appt and do not use deodorant, lotion, or powder as it sometimes can show up as calcifications [which are really on the skin but the radiologist can't tell]. This could result in a call back and unnecessarily upset you. Bring your deodorant with you and put it on after your mammo. And lastly don't assume that "no news is good news". If you haven't gotten a letter in a couple of weeks, call the doctor who ordered the mammo to get results. Human error happens.

1) 3D mammograms are also called tomosynthesis and they are superior to 2D (regular) mammograms. This type of imaging is a special kind of mammogram that produces a 3D image of the breast. The image is obtained by using several low dose x-rays taken at different angles. The breast is compressed similar to the way it is for a mammogram except the x-ray tube moves in a circular arc around the breast; the imaging is completed in less than 10 seconds.
The reasons tomosynthesis is superior to 2D mammograms are:
Less breast compression (less discomfort)
Shorter length of time for test to be completed (10 seconds vs. several minutes)
More pictures are obtained in multiple different angles of the breast (more accurate)
A 3D image makes it easier to find an abnormality than traditional mammogram.

2) There are some discrepancies in the difference in amount of radiation exposure between standard mammogram versus 3D mammogram.
According to the American College of Radiology there is about twice the amount of radiation in a 3D mammogram but “it improved the accuracy with which radiologists detected cancers, decreasing the number of women recalled for a diagnostic workup.”

A study published in Radiographics, peer-reviewed journal, lists the radiation dose of tomosynthesis at 145 mrad.

Just an fyi, the National Cancer Institute lists an average two-view mammogram as delivering 200-400mrad.

Everything I read and studied listed the doses for 3D mammogram as being under 300mrad (see resources below).

Thanks,
Heather

Resources:

http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional/page6" target=_blank>http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional/page6

http://www.acr.org/SecondaryMainMenuCategories/NewsPublications/FeaturedCategories/CurrentACRNews/FDA-approves-first-3-d-mammography-system.aspx" target=_blank>http://www.acr.org/SecondaryMainMenuCategories/NewsPublications/FeaturedCategories/CurrentACRNews/FDA-approves-first-3-d-mammography-system.aspx

http://radiographics.rsna.org/content/27/suppl_1/S231.full#sec-2" target=_blank>http://radiographics.rsna.org/content/27/suppl_1/S231.full#sec-2

http://www.acrin.org/PATIENTS/ABOUTIMAGINGEXAMSANDAGENTS/ABOUTMAMMOGRAPHYANDTOMOSYNTHESIS.aspx" target=_blank>http://www.acrin.org/PATIENTS/ABOUTIMAGINGEXAMSANDAGENTS/ABOUTMAMMOGRAPHYANDTOMOSYNTHESIS.aspx 1) 3D mammograms are also called tomosynthesis and they are superior to 2D (regular) mammograms. This type of imaging is a special kind of mammogram that produces a 3D image of the breast. The image is obtained by using several low dose x-rays taken at different angles. The breast is compressed similar to the way it is for a mammogram except the x-ray tube moves in a circular arc around the breast; the imaging is completed in less than 10 seconds.
The reasons tomosynthesis is superior to 2D mammograms are:
Less breast compression (less discomfort)
Shorter length of time for test to be completed (10 seconds vs. several minutes)
More pictures are obtained in multiple different angles of the breast (more accurate)
A 3D image makes it easier to find an abnormality than traditional mammogram.

2) There are some discrepancies in the difference in amount of radiation exposure between standard mammogram versus 3D mammogram.
According to the American College of Radiology there is about twice the amount of radiation in a 3D mammogram but “it improved the accuracy with which radiologists detected cancers, decreasing the number of women recalled for a diagnostic workup.”

A study published in Radiographics, peer-reviewed journal, lists the radiation dose of tomosynthesis at 145 mrad.

Just an fyi, the National Cancer Institute lists an average two-view mammogram as delivering 200-400mrad.

Everything I read and studied listed the doses for 3D mammogram as being under 300mrad (see resources below).

Thanks,
Heather

Resources:

http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional/page6" target=_blank>http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional/page6

http://www.acr.org/SecondaryMainMenuCategories/NewsPublications/FeaturedCategories/CurrentACRNews/FDA-approves-first-3-d-mammography-system.aspx" target=_blank>http://www.acr.org/SecondaryMainMenuCategories/NewsPublications/FeaturedCategories/CurrentACRNews/FDA-approves-first-3-d-mammography-system.aspx

http://radiographics.rsna.org/content/27/suppl_1/S231.full#sec-2" target=_blank>http://radiographics.rsna.org/content/27/suppl_1/S231.full#sec-2

http://www.acrin.org/PATIENTS/ABOUTIMAGINGEXAMSANDAGENTS/ABOUTMAMMOGRAPHYANDTOMOSYNTHESIS.aspx" target=_blank>http://www.acrin.org/PATIENTS/ABOUTIMAGINGEXAMSANDAGENTS/ABOUTMAMMOGRAPHYANDTOMOSYNTHESIS.aspx

What about BSGI or PEM? Are you talking about what if the DCIS is generalized or contained in one spot? Other than MRI, which you have had, I am not aware of any other test that can be done preoperatively to determine the extent of DCIS. DCIS is a condition where non-invasive malignant cells fill up the ducts of the breast in a certain portion of breast tissue. You can see evidence of this by observing microcalcifications on mammogram; however, these DCIS cells don't all produce calcium deposits, so you usually remove a bit more tissue around the cluster of microcalcifications to make sure that all DCIS cells have been excised. However, only the final pathology report, where the tissue is examined microscopically, can prove that all DCIS was removed. I hope that helps explain the surgical situation you now face with your case of DCIS and upcoming lumpectomy.

Mammogram did not save my life-If you have dense breast tissue more often than not it will not show up. That happened to me and I have encountered countless women that the mammogram showed nothing. Digital mammogram which I heard is new technology along with an ultrasound may be better for the dense breast women. I also am not happy with the amount of radiation that is emitting from the mammogram. I am being somewhat forced after my breast cancer treatment to have one every 6months to a year. To me I don't believe the results too much since it never showed up to begin with -I had it done in January 2009 and found my first lump in June 2009 so why should I believe it now? I wish my insurance would help pay for a thermography because I would prefer getting that instead. I am glad it has helped some women but the dense breast women should be told that it isn't entirely reliable. I believe they are if the patient is over 40 and doesn't have dense breasts. With dense breasts an MRI baseline with continued MRI yearly would be the better way to screen, from what I have read.

We usually do not perform mammograms on patients who have had bilateral mastectomies with reconstruction. Since mammography requires that we compress the breast tissue there would be nothing to compress, as there is no breast tissue. We do not compress implants, even in patients who have them for cosmetic reasons. We usually do not perform mammograms on patients who have had bilateral mastectomies with reconstruction. Since mammography requires that we compress the breast tissue there would be nothing to compress, as there is no breast tissue. We do not compress implants, even in patients who have them for cosmetic reasons.

Hi There- Scar tissue should not "keep growing." It usually shrinks with time or stays the same. An ultrasound of the mammographic density and biopsy of any suspicious ultrasound finding or an MRI if ultrasound is not helpful, would be two options to reassure the patient. Hi There- Scar tissue should not "keep growing." It usually shrinks with time or stays the same. An ultrasound of the mammographic density and biopsy of any suspicious ultrasound finding or an MRI if ultrasound is not helpful, would be two options to reassure the patient.

Yes depending on your other risk factors, you may qualify to get a breast MRI. This is typically reserved for women with a lifetime risk of breast cancer of >20%. Ultrasound is also an excellent method for 'looking into' the breast but is typically reserved for a specific finding such as breast pain or a mass. Ultrasound is starting to used as a screening method (examining the entire breast) although standardizing it from patient to patient and from year to year in the same patient has been difficult.
Hi,
Not a doctor but the I believe that the experts agree that MRI (magnetic resonance imaging) and ultrasound are another diagnostic tool for women with dense breasts. Dr. Wendie A Berg, MD, PhD from John Hopkins University stated in a paper I read that the use of these tests increased cancer detections. The data was from a large multicenter trial...ACRIN 6666 study.

All of these points are well taken. Recently, I've been thinking much more about the specific mortality benefit of screening (as opposed to diagnostic) mammograms, and I feel pretty disheartened about it. According to clinical trials screening mammograms do save some lives, somewhere between 10% and 30% depending upon the studies. This suggests that current technologies are not sufficient for the majority of women. Clearly, it's something but as you have each pointed out, screening is just not there yet.

When you consider the Papanicolaou (Pap) smear, which has been called “the best screening tool ever introduced for any cancer,” it not only reduces the incidence of cervical cancer by 90 percent by detecting pre-cancerous conditions but has led to a 70% reduction in mortality in developed countries. An article in the American Journal of Clinical Oncology reported that among women who are screened regularly, the Pap smear may have reduced cervical cancer mortality by as much as 99 percent. Screening mammograms have a long way to go before they will result in anything close to this level of success, but is there any reason to keep the bar low? I wonder what the barriers really are to improving this technology.

In the meantime some women are overtreated, others have cancers that do not show up on the screens, and mass screening fails those whose lives are not saved. It's a thorny situation, and I agree that the balancing act between overtreating and saving lives is not one to be taken lightly. I also think the public has a right to know the real limitations to current technologies in ways that enable people to make meaningful decisions.

TAH asked me include a link to "Mammogram Mania" (http://gaylesulik.com/?p=9550), which looks at the mortality benefit across studies and suggests that much of the hype around screening in advertisements and campaigns is hiding some very important truths about the risks, benefits, and limitations of a one-size-fits-all approach to screening. I'd like to answer this from a different approach. Mamograms save lives and the quality of lives (i.e. caught earlier, less surgery, less toxic treatments). My mother was diagnosed in 95, but it was not a mamo that found her cancer...by time it was found the cancer was not in her breast, it was in her nodes (no breast surgery was done, details uncertain). However, two of her four daughters felt that mamos were not worth the risk. It was not until I was diagnosed with early stage that they could fully apprecitate the benefits of mamogram, as it was mamo that found my cancer. Yes, I do understand and fear radiation, however, the cost is too great to pass up on screening. I am excited that thermography is becoming more widely recognized....hopefully in the future this will be an option for all. Please, I urge you...get screened.

more...Yes, I agree with both of you. I am not certain that early detection always saves lives, and I am sure that in many cases, the body might have been able to elimate the cancer cells naturally, without intervention. So yes, the debate goes on....and coming from a person who often refuses dental x-rays, I look forward to the day that prevention and "cures" do not increase our risk for disease. One thing I will say in support of early detection is that often the remedy does not require toxic chemo and damaging radiation, and the misery and damage that goes along with them. In the meantime, I hope we can guide women to make the best possible choices for prevention and detection.

When implants are placed for breast enhancement, mammograms are still performed as drbreastsurgery noted above. However if a mastectomy with implant reconstruction is performed, mammograms generally are not performed. MRI examinations are sometimes done in this situation to make sure there is no recurrence of cancer on the chest wall or muscle, and to check the implants (if they are silicone) to ensure that there is no leakage. it shouldn't make it more difficult, as mammograms can be performed well with implants. the techs have techniques to move the implants slightly, to allow the breast tissue to undergo mammography.

The American Cancer Society recommends yearly screening mammograms and MRIs for women with an approximately 20–25% or greater lifetime risk of breast cancer, including women with a strong family history of breast or ovarian cancer. (http://caonline.amcancersoc.org/cgi/content/full/57/2/75)

When you speak to your physician about this, it is important that you understand the benefits, limitations, and harms of different screening strategies and the degree of uncertainty about each. You may also want to speak to your physician about ultrasound as an option.

Since you have such a strong family history of breast cancer, if you haven't already, you may want to consider genetic testing for BRCA-1 and BRCA-2. This may impact some of the treatment decisions you make in the future.
The American Cancer Society recommends yearly screening mammograms and MRIs for women with an approximately 20–25% or greater lifetime risk of breast cancer, including women with a strong family history of breast or ovarian cancer. (http://caonline.amcancersoc.org/cgi/content/full/57/2/75)

When you speak to your physician about this, it is important that you understand the benefits, limitations, and harms of different screening strategies and the degree of uncertainty about each. You may also want to speak to your physician about ultrasound as an option.

Since you have such a strong family history of breast cancer, if you haven't already, you may want to consider genetic testing for BRCA-1 and BRCA-2. This may impact some of the treatment decisions you make in the future.

Screening mammograms check for lumps in the breast when there no signs or symptoms of breast cancer. Two X-rays are taken of each breast to determine if there have been any tissue changes compared to previous mammograms and look for tumors and microcalcifications.

Diagnostic mammograms are used to help diagnose or rule out breast cancer. Diagnostic mammograms are given after a lump or other sign or symptom of the breast cancer has been found. For diagnostic mammograms, more x-rays are taken to obtain views of the breast from several angles. Suspicious areas may be magnified to produce a detailed picture. The purpose is to locate and analyze potentially cancerous tumors or cells. Screening mammograms check for lumps in the breast when there no signs or symptoms of breast cancer. Two X-rays are taken of each breast to determine if there have been any tissue changes compared to previous mammograms and look for tumors and microcalcifications.

Diagnostic mammograms are used to help diagnose or rule out breast cancer. Diagnostic mammograms are given after a lump or other sign or symptom of the breast cancer has been found. For diagnostic mammograms, more x-rays are taken to obtain views of the breast from several angles. Suspicious areas may be magnified to produce a detailed picture. The purpose is to locate and analyze potentially cancerous tumors or cells.

Molecular imaging is a fancy work for nuclear medicine in the radiology field. It's not good for looking at anatomy, but is great at looking at function of cells. Any nuclear med study uses x-ray or ultrasound to help locate the areas that are of concers, in other words, it's never the only study you need. According to this article on Sep 14th, 2010 (http://www.auntminnie.com/index.aspx?sec=spt&sub=mbi&pag=dis&itemID=91901) Michael O'Connor, PhD, a professor of radiologic physics at the Mayo Clinic says:
"Right now it's used as a secondary diagnostic tool." O'Connor explained. "You would not look at this technology to replace mammography for women who do not have dense breasts, because for them mammography does very well."

From the research that I have done it appears that there are numerous clinical trials in progress to determine the effectiveness of MBI versus other breast cancer screening methods (such as mammograms, MRI, etc.) as well as various breast cancer scenarios.
http://www.genewscenter.com/content/Detail.aspx?ReleaseID=10424&NewsAreaID=2
http://clinicaltrials.gov/ct2/show/NCT00591864
http://clinicaltrials.mayo.edu/clinicaltrialdetails.cfm?trial_id=101270

The main study that I have found that has been completed focused on detecting tumors in dense breast tissue.
http://www.mayoclinic.org/news2009-mchi/5203.html

It appears the approach that was taken with this innovation was they were looking specifically for a solution for the short-comings of mammography. We will see in the future how effective MBI can be. It looks to me like there is a lot of potential.

Mammography = Xray of the breast tissue
Gammagraphy = Gamma images of the breast tissue (nuclear medicine) Mammography = Xray of the breast tissue
Gammagraphy = Gamma images of the breast tissue (nuclear medicine)

What happens next if mammogram is abnormal?
If an abnormality is found, it may or may not be something that needs treatment. The next step would be another "imaging" test like an ultrasound. This is a painless test that will allow the radiologist to better understand what was seen on the mammogram. Another imaging test that is used is an MRI. If the radiologist feels that the abnormality needs further study, a biopsy may be recommended. A mammogram is an x-ray of the breasts. It is used for both breast cancer screening and diagnostic purposes.

For screening, it may detect breast cancer before it can be felt in a physical examination. Two views are usually taken for a screening mammogram.

For diagnosis, multiple views of the breast are taken to determine the size and location of the abnormality as well as learn more about the surrounding tissue and lymph nodes.