Mammography Q&A with Katherine Lee, MD, and Preya Ananthakrishnan, MD

Q: What are the current recommendations for mammograms? I heard there were some changes.

Dr. Lee: At the Cleveland Clinic, we recommend baseline mammograms at age 35 and then annually starting at age 40. If you are at high risk, mammograms may be performed earlier.

Q: What is the difference between a screening mammography and a diagnostic mammography?

Dr. Ananthakrishnan: Screening mammograms are your standard four views: two of each breast. Diagnostic mammograms are performed when you have a problem and usually indicate more specific imaging at the area of concern.

Q: I've been told that both ultrasound and mammography can be used as screening devices for breast cancer. What is the difference? Is one method more effective?

Dr. Lee: Mammograms are tests using X-rays to detect breast cancer. Ultrasound is a sound wave test used to determine what type of lump you have. Ultrasound is not usually used for screening but instead for diagnostic purposes.

Q: Can you tell me more about the use of MRIs [magnetic resonance imaging] in breast cancer detection?

Dr. Lee: MRIs are 3-dimensional tests that have a high sensitivity for detecting breast cancer. They look at blood flow and can pick up cancers not seen on mammograms. Currently, MRIs are used as a screening tool in women who carry the genes for breast cancer.

Q: Is it safe to get breast implants? How about breast reductions?*

Dr. Ananthakrishnan: It is relatively safe to have implants and breast reductions. Like any surgery, there are risks of bleeding and infection. Also, implants were not meant to last forever. Before any type of breast surgery, it is important to make sure that you mammograms are up-to-date. Silicone breast implants have been FDA approved. There are also saline implants available. You can have a mammogram even if you have implants.

Q: During a self-exam, I detected a lump in my breast. I have an upcoming appointment, but I’d like to know what percentage of lumps is actually cancerous. I am very worried.*

Dr. Lee: Most lumps that are detected are not cancer, but it is important to have an exam and a mammogram if a lump is detected.

Q: Can calcifications in the breast turn into cancer?

Dr. Lee: Most calcifications are benign. About 20% can be a sign of an early breast cancer.

Q: How do you make the determination if the calcification are benign or an early sign of breast cancer?

Dr. Ananthakrishnan: The radiologists are trained to look at both the type of calcifications, configuration of the calcification, and whether they are new.

Q: If you have fibrocystic breasts, are you more at risk for developing breast cancer?

Dr. Ananthakrishnan: Not necessarily, but dense breasts can make it more difficult to detect abnormalities on a mammogram.

Q: I am on my fourth mammogram and ultrasound because they cannot get two views to do a needle biopsy, and I was told that I’m too heavy for the stereotactic table until I lose some weight. I don’t want to hurt the physicians’ feelings by getting another opinion, but breast cancer runs in my family.

Dr. Ananthakrishnan: First and foremost, your health is most important. Different facilities have different options for imaging capabilities. Definitely seek a second opinion and take your previous mammogram films with you for the appointment.

Reviewed by a Cleveland Clinic medical professional.

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