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Frequently Asked Questions

What is a Mammogram?

Is there any preparation for a mammogram?

What is the value of vigorous compression in Mammography?

Does a Mammogram Hurt?

Why should you avoid Caffeine?

What are the limitations of Mammography?

How accurate is Mammography?

How long does it take to detect Breast Cancer?

Why does a x-ray show the Breast Cancer?

What is the importance of Self Examination of the Breasts?

How often should Mammograms be performed?

How often should Mammograms be performed after a woman has Breast Cancer in one Breast?

Is Mammography Safe?

What happens to the Mammogram Films?

What about Symptomatic Patients?

What about the Teenage Patient / Young Patient under 25 years?

What is Digital Mammography?

What is Stereotaxic Breast Biopsy?

What is wire localization of the Breast?

What is MQSA?

Where can I get more information on Mammography and Breast Cancer?

What is an Ultrasound Guided Cyst Aspiration of the Breast?

What is an Ultrasound Guided Breast Biopsy?

What is the Breast Self-Examination?

1. What is a Mammogram?
    A mammogram is an X-ray of the breasts. A basic test with 2 views of each breast is called a Screening Mammogram. A Diagnostic Mammogram is more detailed testing performed when the screening mammogram demonstrates a lump or shows findings that needs clarification. The mammogram is a very important test for the early detection of breast cancer because many times it can detect cancers in the early stages when the cancer is too small to be felt by hand. The test is also used for other breast problems.


2. Is there any preparation for a Mammogram?

      Yes.

  • Get the previous mammograms or tell us where they were performed so we can obtain them for comparison.
  • Please allow 1 and ½ hours for your appointment. This is to allow for paperwork, actual procedure, checking the study for completion and getting in and out of the building. A longer time may be necessary if an additional procedure such as ultrasound has to be performed after the mammogram.
  • Please try to stop or reduce caffeine ingestion, 1 to 2 weeks prior to the mammogram examination. If the appointment is sooner than 1 week, please discontinue or reduce caffeine from the time of appointment until the mammogram is completed. This includes Coffee and Tea, Cola drinks including Diet Cola drinks, Caffeine free cola and decaffeinated coffee is O.K. Avoid Chocolate. Do not go off prescription drugs even if they contain caffeine. You might get a headache if you withdraw the caffeine abruptly. It might be better to go off gradually.


3. What is the value of vigorous compression in Mammography?
  • Compression, while momentarily uncomfortable, helps us to take much better X-rays of the breasts with much less radiation.
  • Compression used for mammography is not dangerous. It does not damage the breast tissue in any way.
  • Compression of the breasts during mammography allows us to see the breast tissue and some breast abnormalities much better than if the mammogram is performed without compression.

      If a temporary discoloration of one or both the breasts is noted after the mammogram, please do not be alarmed. This will go away. Tylenol or buffered aspirin will relieve any transient discomfort, if you are not allergic to these medications.



4. Does a Mammogram hurt?

      A mammogram is not painful for most women. In some women with pre-existent tenderness and pain in the breasts, the compression used for mammography can be painful. If the patient is unable to tolerate optimal compression due to pain, we will compress less, as much as the patient can tolerate. We do not want to prevent you from getting regular mammograms for fear of pain and will work with a patient who has painful and tender breasts.



5. Why should you avoid caffeine?

      Before the mammogram we ask the patient to avoid caffeine, because the methyl-xanthines in the caffeine products affect the breasts and make compression more uncomfortable. Once the mammogram is completed, the patient can resume caffeine, unless her physician specifically advises her against caffeine. Some lucky women are not bothered by Caffeine.



6. What are the limitations of Mammography?

      Although mammography is the single best method of detecting breast cancer, it cannot find all breast cancer. A negative mammogram does not guarantee the absence of breast cancer.



7. How accurate is Mammography?

      Mammography cannot detect all breast cancer. Mammography is about 85 % accurate. In those patients with extreme density of the breasts or in those patients with implants, mammography is probably 75 to 80% accurate.



8. How long does it take to detect Breast Cancer?

      Cancer of the breasts is usually detected on the mammogram when the cancer has been present in the woman's breast for an average of 6 years. A cancer of the breast may become palpable after it has been present in a woman's breast for 6 to 8 years.



9. Why does an x-ray show the Breast Cancer?

      The reason the breast cancer is demonstrated on the mammogram is because it is a water density and generally shows up as an area of increased density (white spot). If the x-ray characteristics of the cancer is similar to breast tissue, the cancer can be invisible on the mammogram.



10. What is the importance of Self-Examination of the Breasts?

      The patient and her physician are important to continue good breast care. Regular careful monthly breast self examinations, annual mammography, and prompt medical attention are the most important methods in the detection of breast cancer. All women after age 20 years should perform self examination of the breasts at least once a month. A complete clinical examination of the breast by a physician or health care provider should be performed at intervals as recommended by her physician.

      We have a 10 minute videotape on breast self examination at the office. We strongly recommend that the patient watch the tape before or after the mammogram. A brochure describing self examination of the breasts is also given to the patient.



11. How often should Mammograms be performed?

      We recommend the American Cancer Society Guidelines for routine mammography:

  • Baseline Mammogram between age 35 - 40
  • Mammogram every year after age 40.

      Earlier baselines between age 30 and 35, and annual mammography from age 35 may be necessary in those patients with a strong family history of breast cancer, depending on the degree of risk and ease of physical examination of the breasts.



12. How often should Mammograms be performed           after a woman has Breast Cancer in one Breast?

      A mammogram is recommended 6 months after lumpectomy and radiation therapy to serve as a new baseline. Subsequently annual mammograms should be performed. Mammography is helpful to detect the development of a new cancer in the other breast or the same breast. In a patient with mastectomy on one side, mammograms should be obtained annually on the other breast. There is a high risk of developing breast cancer in the normal breast for a woman who already had breast cancer in the other breast.



13. Is Mammography Safe?

      Yes. Mammography is a safe medical diagnostic test. The low dose of radiation used in mammography places this test in a safe range. In a certified mammography facility, the mammogram delivers less than 1 rad to the breast. Generally, the benefits of mammography outweigh any potential risks.



14. What happens to the Mammogram Films?

      We keep the DICOM images of digital mammography safely as required by Texas Law and the MQSA (Federal law). Screen film mammography is no longer performed at this practice but the former films of screen film mammography are also safely retained as required by Texas Law and the MQSA (Federal law). The original mammograms are part of the permanent records at this office. If the patient has undergone a mammogram at our office and the referring physician or surgeon needs her/his films, the mammograms will be released to the doctor or the patient after the patient has signed a consent/release form.



15. What about Symptomatic Patients?

      We need to obtain or be provided a pertinent physical examination, history and relevant medical and surgical information on patients who have breast symptoms or other problems. These generally include the presence of pain, discharge, palpable lump or lumps, redness, itching, deformity, previous surgeries, etc. If the mammogram reveals dense tissue or a finding, additional X-ray views and/or ultrasonography may be necessary and will be performed after orders are obtained from the referring physician..



16. What about the Teenage Patient / Young Patient under 25 years?

      It is usually not necessary to obtain a mammogram on a teenage patient or a patient under 25 years of age. In a symptomatic patient under the age of 25, most of the patient's lumps, discomfort, and pain go away when she discontinues caffeine ingestion and is reevaluated by her physician or surgeon after the next menstrual period. An ultrasound of the breast is a useful initial examination in a teenage or young patient. However, a mammogram may be used onvery rare occassions on patient under 25, when there is a suspicious lump. The lumps in teenage patients and young patients are usually fibroadenomas, and fibrocystic masses, which are benign lumps.



17. What is Digital Mammography?

      Digital mammography is the imaging of the breast by utilizing digital computer and x-ray technology. The FDA has approved Digital Mammography for clinical use as its resolution has equaled that of conventional Mammography. The difference between the former screen-film and the new Digital Mammography is roughly the difference between the old film photography and the new Digital Camera. We have high resolution Digital Mammography at this office.



18. What is Stereotaxic Breast Biopsy?

      This is the use of a special device or mammography machine to help the Radiologist and the Surgeon select the co-ordinates to locate the abnormal area in the breast to obtain a sample. This small amount of tissue will be sent to the pathologist to see if the abnormal area is a cancerr not.



19. What is wire localization of the Breast?

      When a lump or abnormal area is seen on the mammogram that requires an excision biopsy, a wire is introduced in the breast by using a mammography machine, in the Mammogram room. There is a hook at the end of the wire to hold it in the breast and also the radiologist can inform the surgeon where the lump is in relation to the wire. This is usually an easily performed procedure prior to the operation and helps the surgeon to remove the suspicious area to send to the pathologist for diagnosis.



20. What is MQSA?

      MQSA is the Mammography Quality Standards Act. This is the Federal Law that governs how mammography can be performed in any facility in the country. It authorizes the Food and Drug Administration to inspect every mammography facility in the country and issue a Mammography Certificate. This certificate should be displayed prominently where patients can see it in every facility performing mammograms.


21. Where can I get more information on Mammography and Breast Cancer?

      Some of the excellent online resources for information on Mammography, Breast Cancer diagnosis and related subjects are through the websites of the the American Cancer Society, the American College of Radiology (www.acr.org), The Texas Department of State Health Services, The National Library of Medicine (www.nlm.gov), Pubmed etc.


22. What is an Ultrasound Guided Cyst Aspiration of the Breast?

      This is an extremely common procedure performed almost every day in a facility specialized in Mammography and Ultrasound. The Radiologist aspirates the fluid in the breast cyst by using the ultrasound machine to see where the cyst is and utilizing a fine needle. The aspirated fluid thus obtained is sent to the pathologist for diagnosis. Ultrasound Guided Breast Aspiration is frequently performed in those patients with cysts to confirm that a lump seen on the mammogram and the sonogram is indeed a cyst filled with fluid. It is also performed if the patient has a painful cyst to relieve the pain.



23. What is an Ultrasound Guided Breast Biopsy?

      This is a procedure usually performed on the breast by the Radiologist or a General Surgeon by positioning a needle utilizing ultrasound of the breast. A sample of tissue is aspirated manually in a syringe or by a small device called a biopsy gun. Usually local anesthesia is used on the skin so the patient will not feel any pain, only the pressure of the fingers on the skin.


24. What is the Breast Self-Examination?

      This is an examination that every woman over the age of 20 should perform every month for the purpose of detection of breast cancer and other abnormalities. This examination should be performed in three positions --

  1. Lying down flat on the back, raising first one arm above the head and examining that side breast and feeling the breast with the first three fingers of the other hand. Gradually move the fingers in larger and larger circles and smaller and smaller circles until you have thoroughly covered the breast. When completely done, raise the other arm and repeat the palpation with the first three fingers on the other breast. Be sure to examine both armpits for lumps.
  2. Stand up in front of a mirror; inspect both breasts to see if there is any asymmetry, change of the nipples, dimpling, puckering or skin changes on the breast. Press hands on the hips and look for any abnormalities.
  3. Standing up, usually in the shower, feel for lumps in the breast

      Monthly self-examination of the breasts is best performed after the menstrual period every month is completed in those women who have periods. In women who had a hysterectomy or in women after age 50 or in women who d not have periods, the breast examination is best done on the first of every month. The idea is to examine the breast the same time every month.

      The breast glandular tissue normally feels lumpy. With regular practice you will be able to tell the normal from an abnormal hard lump or lumpy area.

      Men should be aware of breast examinations because 1% of breast cancer occurs in men. Additionally, the husband, partner or boyfriend finds many times the woman's breast cancer.

 
 
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