Never had a mammogram before? If you're like most women, you know you're supposed to get this breast exam at age 40. You’ve likely heard that a mammogram is a kind of x-ray that helps detect breast tumors early. But beyond the basics, you’ve got a few questions about the test—not to mention a few worries. Does it hurt? Are there risks associated with the test? We asked Dr. D. David Dershaw, Director of Breast Imaging at Memorial Sloan-Kettering Cancer Center in New York City to walk us through the procedure. We think you’ll agree: there’s really nothing to worry about.
Q: What’s so special about age 40?
A: Nothing, really. It’s an easy age to remember and by age 40
women are starting to be at the age where their risk of developing
breast cancer is high enough to start screening for it. Breast cancer
is a disease of aging—the older you get, the more likely you are to get
it. Forty puts you at an age where it’s appropriate to start looking.
Q: Should women be worried about the radiation from the mammogram?
A: There’s very low radiation from the x-ray. The risk of developing
cancer from mammography approaches zero. The breast’s sensitivity to
radiation decreases as a woman ages. By the time a woman reaches 40,
it’s close to zero.
Q: How is the test performed?
A: During a mammogram, you stand in front of a special x-ray
machine and one breast at a time is placed on a flat plate that sits
perpendicular to your body. A second plate is lowered on top of the
breast and compresses it, making the breast flatter. An x-ray is taken
while the breast is compressed.
Q: Why must the breast be compressed?
A: There are a number of reasons. First, breast compression
stabilizes the breast so it doesn’t move while pictures are being
taken. We’re looking for tiny findings and if the picture is blurred,
those findings are lost. Second, the breast is composed of lots of
different structures and as they overlay each other, they can mimic or
hide a cancer. The thinner the breast, the sharper the picture becomes.
Q: Does it hurt?
A: Compression is usually perceived as uncomfortable but it’s
rarely perceived as truly painful. If a woman has pain during her
[menstrual] cycle, she should schedule her mammogram when her breasts
are least tender. Women who experience pain during the exam (or fear
they’re going to) are frequently helped by taking aspirin or Tylenol
beforehand.
Q: How accurate is the test?
A: Mammograms detect between 60 and 85 of breast cancers.
Screenings with mammography reduce the risk of dying of breast cancer
by 25 and 65 percent depending on which study you look at.
Q: Are big breasts harder to read than small ones?
A: No.
Q: How can you make sure you get the most accurate mammogram possible?
A: Don’t wear deodorant or talcum powder on the day of your
exam as they can distort the results. Beyond that, the skill of both
the person taking the mammogram and the person reading it factors into
the equation. Higher volume places that do a lot of breast imaging tend
to have better mammography both because they get a lot of practice and
because people who are better at it want to do more of it so they tend
to work at busy breast imaging centers.
Q: Are digital mammograms better than the traditional ones?
A: The only difference between digital mammograms and film
mammograms is simply the way the image is recorded—like a digital or
film camera. It’s still the same mammogram. Studies have not clearly
indicated an advantage for the general population of one type over the
other.
Q: Anything else women should know?
A: There’s no upper age limit to mammograms. A woman should
have one annually after age 40 for the rest of her life. For women who
are at high risk for breast cancer, the current recommendation is an
optional MRI [magnetic resonant imaging] in addition to the mammogram.
Women should consult their physicians about this.
