What to expect at you mammogram

Mammograms are one of the best tools we have for detecting breast cancer. These tests can often find cancer in the early stages when it’s easier to treat. Doctors recommend that all women get screening mammograms every year, starting between the ages of 40 and 45.

At Advocate Health Care, we offer no-referral screening mammograms. With multiple convenient locations throughout the Chicago metro area and online scheduling, we make it easy to get the care you need.

How to prepare for a mammogram

You usually don’t need to do anything special to prepare for a mammogram, but a few tips can make the appointment go more smoothly. You may:

• Bring deodorant to apply after your appointment
• Gather and bring records of previous mammograms, if you’ve had the test at another facility
• Wear pants or a skirt, as you will need to undress from the waist up

What should you not do before a mammogram?

Avoid applying deodorant, lotions, creams or perfumes to your underarms and breasts before your mammogram. Many of these products can show up as white spots on your mammogram, which may be difficult to tell apart from other white spots that could be solid masses.

You may want to bring deodorant to your mammogram appointment if you’re not going straight home after the test. You may also bring a cleaning wipe to remove deodorant if you’re coming to your appointment in the middle or end of the day.

What happens during a mammogram?

When you arrive for your mammogram, you complete paperwork that details your medical history and your family’s medical history. Be sure to tell your technologist if you:

• Are breastfeeding
• Are pregnant or think you could be
• Have breast implants
• Have difficulty standing or holding still without a walker or cane
• Have experienced recent changes in your breasts

When it’s time for the test, you undress from the waist up, and we give you a gown to wear. During the mammogram, the technologist:

1. Positions each breast on the bottom plate of the mammography machine
2. Lowers the upper plate (compression paddle) of the machine to compress your breasts
3. Takes X-ray images of each breast. You may be asked to hold your breath for several seconds while the machine moves in a small arc around your breast and takes
   the X-ray.

How long does a mammogram take?

You should plan for a screening mammogram appointment to take about 30 to 45 minutes. The actual time your breast is under compression is only about 10 to 15 seconds per image. Women with an average risk of breast cancer usually need two images per breast.

A diagnostic mammogram appointment will take longer, depending on how many images the technologist needs to take.

What happens during a mammogram if I have breast implants?

Tell your technologist if you have breast implants before your mammogram. Women with breast implants need eight pictures instead of the typical two.

We take four images with the compression paddle placed slightly on top of your breast. This gives your radiologist a full view of your breast to rule out any possible visual leakage. The next four images are push-back (Eklund) views, in which your skin is pulled forward and the implant is pushed back. This allows your technologist to compress your breast tissue to maximize visualization.

Is mammogram screening painful?

Many women describe mammograms as uncomfortable, and some experience pain. Some women even avoid mammograms because they fear the discomfort of breast compression.

But the compression, or "squishing," is crucial for a higher quality, more accurate image. Compressing the breast helps to:

• Decrease radiation to other parts of your body
• Increase detail by bringing your breast close to the imaging device
• Prevent movement, which reduces blurriness and lowers the chances of needing additional imaging
• Provide uniform thickness to all of your breast tissue
• Reduce radiation dose
• Separate the breast tissue, allowing for a clear view of masses that could be obscured by other tissue

How to minimize pain during a mammogram

Although mammograms may be uncomfortable, it’s important to remember that the compression time will last less than a few minutes. Tell your technologist if you’re in pain, and they may be able to adjust the compression slightly.

You may also follow a few tips to minimize pain, such as:

• Avoid scheduling the mammogram around times when your breasts may be tender, such as the week leading up to your period
• Limit your salt and caffeine intake, which can make your breasts more tender
• Practice calming techniques, such as taking deep breaths or visualizing a peaceful environment
• Request gradual compression, which may be easier to tolerate than all-at-once compression
• Take an over-the-counter pain reliever up to 60 minutes before your mammogram

Mammogram results

Your mammogram is interpreted by a radiologist, a doctor who specializes in diagnosing and treating diseases using medical imaging. An important part of interpreting your mammogram is comparing it to previous mammograms. This helps your radiologist detect small changes that could be signs of cancer.

Your mammogram can show:

Breast density

Breast density refers to how much fibrous and glandular tissue you have in your breasts compared to fatty tissue. Dense breasts are normal, but they have been linked to a higher risk of breast cancer.

Fibrous and glandular tissue shows up as white areas on a mammogram, making it harder to detect solid masses that could be cancerous. Your provider may recommend additional breast cancer screenings if you have dense breasts.

Calcifications

Calcifications show up as small white spots on a mammogram. They are tiny mineral deposits that may or may not be cancerous. There are two types of calcifications:

• Macrocalcifications are larger mineral deposits. They often occur because of inflammation, old injuries or aging. About half of women over 50 have macrocalcifications, and about one in 10 women under 50 has them.
• Microcalcifications are tiny specks of calcium. They are more concerning than macrocalcifications but are not always cancer. Your radiologist analyzes the shape and pattern of microcalcifications to decide whether they need to get a closer look through a biopsy. In a biopsy, your radiologist removes a small breast tissue sample to evaluate under a microscope.

Masses

A mass is an area that looks abnormal on your mammogram. Noncancerous and cancerous masses tend to look the same on a mammogram. It’s important to remember that finding a mass on your mammogram doesn’t necessarily mean you have breast cancer.

A mass may be a:

• Cyst, a fluid-filled sac that is usually benign (not cancer)
• Noncancerous tumor
• Cancerous (malignant) tumor

Comparing previous mammograms to current ones is important for determining whether a solid mass is likely to be cancer. For example, a mass or calcification that hasn’t changed for several years is unlikely to be cancer. Your radiologist may also recommend other tests, such as a biopsy, MRI or ultrasound, to get a closer look.

How long does it take to get mammogram results?

At Advocate Health Care, we provide most mammogram results on the same day as your appointment.

You’ll receive same-day results if you have your mammogram before 2 p.m., Monday through Friday, and have a LiveWell account. Your radiologist also needs access to your previous mammograms to deliver same-day results. If you have your mammogram after 2 p.m. or on Saturday or Sunday, you’ll receive your results the next business day.

What does it mean if I get a callback for additional testing?

While callbacks after a mammogram are common, they don’t automatically mean you have cancer. You may get a callback for further testing if your mammogram shows new breast lumps or suspicious lesions. You may need additional mammography images or other tests such as ultrasound or MRI.

It’s also common to get a callback after your first mammogram. Mammogram readings are largely based on changes from your previous mammogram. If you’ve never had another mammogram, you may need more tests to establish a "baseline."