Radiology Services

Newspaper Column

Mammogram Followup: Should we be worried?

My wife gets a mammogram every year. She had to go back this last time for another view to follow up. Should we be worried?

Screening mammogram programs have been devised to find breast cancer at the earliest time possible in order to obtain the high cure rates we can now observe. Screening studies are for women over forty years of age with no symptoms, no lumps or bumps which they or their doctor can feel, and no previous history of breast cancer or surgery. In other words, if you have no problems now or surgery in the past, you can schedule a yearly mammogram, advising us of the physician to receive the report, and get your report soon after.

But there are a variety of reasons a patient may need to be recalled for added views. Most of the time, it is just to clear away any question of some very subtle change we want to verify as being benign.

Sometimes we call a patient back for additional views because of an area that just is not well seen on a particular view as we would like. Occasionally, there may be a finding of a hazy area or an actual nodule that appears on a screening mammogram that was not there on the previous study. Tiny calcifications newly present on the mammogram must be differentiated between benign and malignant disease. These require special views not included in screening. If the question involves tiny “microcalcifications”, we will need to do magnification views. Hazy areas of increased density require special compression views.

Another tool we use for diagnosis is Ultrasound. Some of the abnormalities we find are simply benign cysts. These cysts are easily differentiated from solid masses, and can help us decide whether biopsy might be needed.

One of the most important methods of breast cancer detection is in your own hands….

Literally!! Make sure you examine your own breasts at least monthly. There are some excellent descriptions of the best methods to do this. You can find them on the internet, or just call the American Cancer Society for one of their excellent pamphlets.

At the time of your annual check-up in the doctor’s office, another physical examination will back up your monthly self-checks. But never wait till your annual checkup to see your doctor about suspicious findings you may have discovered. Any mammogram ordered by your doctor will be considered a “Diagnostic Mammogram”.

Diagnostic mammograms are for patients with pain, suspicious physical findings, prior surgery, or history of breast cancer. If you are getting a diagnostic mammogram, you may be detained to get additional views or ultrasound studies at the time of your visit.

It may surprise you, but there are a number of men who get mammograms. These are all diagnostic mammograms, because they all have symptoms or abnormal physical findings. Most are benign, but occasionally men can have malignant breast disease as well.

Arguments about mammograms causing breast cancer because of radiation have been pretty well discounted, as we now have equipment that uses a minimum of x-ray to achieve better image detail than was thought possible even a few years ago.

Medicare made screening mammograms available under that program after they realized that providing coverage only to symptomatic patients was missing a chance to make early diagnosis on disease that had not yet become known to the patient. Medicare covers one screening mammogram a year. Be very careful about the dates. They will not cover any study done less than 365 days since the last one.

Medicaid programs may also provide assistance in obtaining mammograms. The state of Arkansas provides assistance through the “Breastcare” program. Check with your county health department for any additional resources. Private insurance may also cover screening, but may vary upon stated coverage