Dear Alice,

What exactly happens during a mammogram, and does it hurt?

Dear Reader,

Mammography is a low-dose breast X-ray that lets clinicians find breast lumps that are still too small to be felt. Regular mammography is the most effective method of detecting breast cancer while it is still at the earliest and most treatable stage. For this reason, the American Cancer Society (ACS) recommends that women age 40 and older should get a mammogram every year. Women who have a family history of breast cancer need to discuss with their health care provider starting mammography at an earlier age.

The first mammogram a woman receives is usually known as a screening mammogram — this mammogram gets a baseline reading of what your healthy breasts look like and will be compared to later mammograms to look for any changes in the breast tissue that could signal the early development of breast cancer or other problems.

Here's what happens at every stage of the mammogram:

Scheduling: If you're not sure of whom to call or which facilities in your area offer mammography, the U.S. Food and Drug Administration (FDA) provides a list of certified facilities. If cost of the mammogram (usually between $60 and $100) or lack of health insurance coverage is an issue, perhaps these facilities can provide a free or low-cost mammogram. When you call to schedule a mammogram, you may be asked questions about your family history of breast cancer, as well as personal information (e.g. Have you had breast implants? Are you nursing? Have you had any past breast pain or problems?). Because mammograms require that your breasts be examined by the clinician, it is usually best to schedule the mammogram for the part of your menstrual cycle during which your breasts are least likely to be bloated or tender. For most women, this is the week after their menstrual period. However, if a woman has irregular periods, this time may be difficult  to determine. Some women schedule mammograms with a friend, for mutual support, company, and even lunch afterwards.

The Mammogram: When you arrive for your mammogram, you will be asked to undress from the waist up and be given a gown to wear. The mammogram technician will place one of your breasts on a platform of the X-ray machine (it looks like a shelf positioned at chest height). Your breast will be compressed between the platform and a clear plastic cover. This pressure (which only lasts for a few seconds and is not harmful) spreads out the breast tissue so that the X-rays can penetrate and create an image of the entire thickness of the breast. Compression of the breast, though uncomfortable, is necessary to obtain the most accurate reading of breast tissue, and allows the technician to use a lower dose X-ray during the mammogram. This compression can cause discomfort or pressure, so women with sensitive breasts may want to take an over-the-counter pain reliever before the appointment. After both breasts have been compressed and X-rayed, the technician will check the clarity of the X-rays, and do "retakes" if necessary. Additional X-rays do not mean that s/he found a lump. It may be that you moved at the moment the X-ray was taken. Then, you can take a deep breath! The mammogram is over. The entire procedure typically takes about half-an-hour. You may want to bring a book or magazine, as the waiting time between steps may take some time.

The Results: Federal law requires that all mammography facilities contact women with their results within 30 days. If you do not get your results within a month of your mammogram, be sure to follow-up with the facility or your health care provider. Don't assume that no news means no problems. About five to ten percent of women who get mammograms will need additional screening or follow-up mammograms to further investigate an abnormality that was found on the first mammogram (most of these findings are benign, such as calcium deposits, cysts, or spots of dense tissue), or because the first set of films was not clear. Additional mammograms to further evaluate a potential trouble spot are known as diagnostic mammograms, which focus on the area in which the abnormality was found.

    Although regular mammography is an important step in early detection of breast cancer, the ACS still recommends monthly breast self-exams (BSE) starting at age 20. Performing BSEs allows women to become familiar with their breasts and identify any changes that happen between regularly scheduled mammograms, or occur in areas that are harder for the mammogram to detect, such as the upper breast and underarm regions.


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