Breast Cancer is the second leading cause of death in women. To bring attention to the disease, October is designated as Breast Cancer Awareness month.

According to the Center for Disease Control, in 2022, 42,211 females died from breast cancer.

Survival, however, is higher when breast cancer is found before it has spread to other parts of the body, which is why having regular mammograms is imperative.

But some women may be hesitant or fearful of a screening, because they don’t know what to expect. To provide information about screenings and what they may entail, Merit Health River Region mammography technician Julie Lee answered questions posed by The Vicksburg Post reporter Terri Cowart Frazier in an effort to educate and inform women as to the importance of having a mammogram.

Q and A

At what age should a woman begin having mammograms?

As recommended by the American Cancer Society, women should start screening by age 40.

What type of screening/imaging does River Region offer?

We offer screening and diagnostic mammography, as well as diagnostic ultrasounds.

Can you explain the differences and how each is performed?

If a patient is having no problems, it is considered a screening mammogram — regardless of if it is their first or their yearly exam. The breast is laid on the mammogram machine so the ribs will be touching it. We pull as much breast tissue forward to get from the nipple to the chest wall on the image. Then a compression paddle is lowered down to spread out the breast tissue. I like to describe it to my patients like this: “Your breast is like a bag of marbles, so we are trying to spread the ‘marbles’ apart like on a cookie sheet so that the breast tissue can clearly be seen.” We compress the breast so that the “marbles” don’t bunch up on top of each other because that can mimic a mass. The compression is so important because you can get called back if there isn’t adequate pressure on the breast to spread the tissue apart. We take four images or more if the breast is larger. And during the procedure the patient will stop their breath for just a few seconds while the exposure is made. This is to ensure a clear image — as breathing can blur the image from motion. Each exposure lasts about six or so seconds. After all images are checked by the technologist for motion and to make sure all of the required anatomy is on the image, the patient gets dressed and leaves.

If the patient is feeling a lump, area of thickness, having any pain or tenderness, nipple discharge, or their physician has felt something during a clinical breast exam, a diagnostic mammogram should be performed. After the screening mammogram is performed, the radiologist may recommend further imaging to evaluate areas like calcifications, cysts, lymph nodes, or general dense areas of breast tissue. The patient is then scheduled to come back for a diagnostic mammogram at a later date. At this appointment additional images are taken that may be slightly different from those done at the screening. These images give the radiologist more information on the area of concern. With areas of dense breast tissue, sometimes simply more compression may clear up a questionable area. As stated earlier, that is why proper compression is so important when you do the mammogram. With calcifications, magnification imaging is performed to look at the size, shape, number of calcifications and then if they layer. This information determines if there is a need for biopsy versus the six-month interval following. If there is a questionable mass or cyst, an ultrasound is done at the same time to show if the area of concern is a solid or fluid filled cyst, lymph node, or just an area of dense tissue that did not compress clearly on the screening. The radiologist will determine at this point if the area will need to be biopsied versus a follow-up in six months.

When will a patient hear back with results?

The exam is read on another day (than from the day of the screening) and a lay letter is sent to the patient with the results within 7 to 10 days. The ordering provider will get a faxed copy of the report as soon as it is dictated and transcribed on the same day as it is read by the radiologist.

I understand sometimes a woman who is getting a mammogram for the first time may be called back for additional screening to better access a baseline.

Not everyone is called back from their first screening. It is common, however, to get called back because the radiologist that reads the study has never seen the tissue before and may see some questionable areas that they feel may need to be looked at further and there are no comparison studies to confirm if something has been there.

Should a patient be worried if he or she gets a call back?

Worrying about something is not going to change the outcome and is a waste of precious time. I want people to know that it does not necessarily mean it is something bad if they do. Just something that needs to be looked into a little more closely.

If someone has a history of breast cancer in their family, should they be screened earlier? If so, why?

Depending on how close the family history is to the patient, it is recommended that people screen early. For example, if your mother was diagnosed in her 40s, the patient should consider getting screened beginning in her 30s.

Do you ever age out of having to get a mammogram and if so, why and at what age?

That is a touchy subject to me. I get that question all the time. I have seen breast cancer in patients in their 20s and I have seen it diagnosed at 86.  My honest answer, as long as you are taking care of yourself, can get around and go to the doctor, come get a mammogram. Cancer has no age limit or time when it can show up.

What would you say to a woman who fears getting a mammogram?

I hear daily women that say they have been scared to come in for years and say when it’s done, “I cannot believe I waited so long. This was not as bad as I thought it was going to be.” It truly is not. The machines have greatly improved since the first mammograms were done. The exam is more comfortable. You still have compression, but it should not be a pain, just a slight pressure that we control at all times. The technologists will not put more pressure than you can stand therefore communication is key because we don’t know if something hurts you unless you say something.

How important are self-breast exams?

Self-breast exams are crucial because not all providers do them. The key is to get to know how your breasts feel by doing self-exams on a monthly basis.  Use the pads of your fingers and go in a pattern like a circular pattern to cover your entire breast. Never just pinched a group of breast tissue together because you are bunching up those “marbles” and may falsely think something is there. It is done best in the shower with soap, but you can do it lying down in your bed with your arm raised. The more familiar you are with the way your breasts feel, the easier it is to notice a difference.

If a woman were to find something suspicious or started having breast pain, what should she do?

Call your health care provider immediately. Never take any issue with your breasts lightly.