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Screening Mammography

A mammogram is a very safe X-ray exam that uses low doses of radiation to detect changes in the breast that may be too small or subtle to be felt during breast self-exams.

When should I start having mammograms?

Women who prefer to maximize life-extending benefits and seek improved treatment options for breast cancer should choose annual screening starting at age 40. They should continue as long as they are in good health.

Get the facts about your options for starting mammograms, with this decision aid on our Dartmouth-Hitchcock Healthwise® Health Encyclopedia website.

You do not need a referral for a screening mammogram. Contact us to schedule an appointment.

Screening mammography helps find early-stage cancer earlier

Screening mammography is used to find early-stage cancer before it grows large enough that you can feel it and before it has a chance to cause symptoms or spread outside of the breast.

Early-stage breast cancer is usually curable and is more easily treated with less invasive and less toxic therapy than is late-stage cancer. Approximately less than 10% of routine mammograms are interpreted as possibly abnormal and require additional breast imaging with mammography and/or breast ultrasound.

Out of 1,000 women who have a routine mammogram, the number called back for additional imaging is less than 100 and the number needing a minimally invasive biopsy is 10. Ultimately, two cancers will be found in that group of 1,000 women. It is very important to undergo the additional diagnostic imaging to know which of the abnormal routine exams are truly worrisome. These are separate exams and are billed separately in addition to the routine mammogram.

Your primary care provider may help decide if supplemental imaging is recommended for you based on your personal and family history. However, you are welcome to ask the mammography technologist and radiologist if you have questions about the most appropriate exam for you. How often you have a mammogram may depend on your age, family history, risk for breast cancer, and overall health. Screening mammography does not require a physician referral and is covered by most insurance companies.

Mammography exams are performed at by our technologists, who are certified through the American Registry of Radiologic Technologists (ARRT).

Types of mammograms

Dartmouth-Hitchcock offers the latest breast health services and mammography breast exams including 2-dimensional (2-D) digital mammography and 3-dimensional (3-D) digital mammography tomosynthesis.

2-D digital mammography

In 2-D digital mammography, a low dose X-ray beam shines through the breast and creates a digital image receptor, similar to the working of a digital camera. This image is viewed on a computer monitor by a mammography technologist in a matter of seconds. The images are then sent electronically for the radiologist to interpret. The exam takes 15 to 20 minutes. 2-D digital mammography is the standard breast exam for most women.

3-D digital mammography tomosynthesis

3-D digital mammography (also known as breast tomosynthesis), is a breast imaging exam that improves the accuracy of mammography. In women having screening, 3-D digital mammography may be done along with a traditional 2-D digital mammography exam. Sometimes, 3-D mammography may be used to evaluate an abnormality like a breast lump.

The 3-D mammogram is very similar to a 2-D mammogram. With 3-D mammography, however, the X-ray tube moves and a series of mini X-ray exposures are obtained, creating a digital data set, which is then reconstructed into 1-millimeter thick slices (or layers). The radiologist views each individual layer of the breast rather than a shadow of the entire breast. As a result, radiologists can detect breast cancer that was hidden by overlying tissue and that may mimic cancer and lead to a false alarm or unnecessary callback.

The benefits of 3-D mammography include:

  • Earlier detection of breast cancers that may otherwise be hidden by overlying tissue.
  • Greater accuracy in identifying the shape and location of abnormalities.
  • Fewer callbacks and helps distinguish harmless abnormalities from real cancers.

Steven P. Poplack, MD; Daniel J. Abbis, DO; and Todd A. Noce, DO, discuss the benefits of 3-D Digital breast mammography tomosynthesis.

Your mammogram appointment

Before your mammogram

  • If you have had mammograms elsewhere, please call that facility and have your results sent to us before your appointment—these tests will be needed for comparison.
  • Please do not bring your children with you—the mammographer cannot watch your children and give you her full attention.
  • Try to schedule your mammogram for the week following your menstrual period, when your breasts are less tender.
  • Wear a two-piece outfit to the examination, so you will only have to remove your top.
  • Don't apply powders, ointments or creams to your chest area the day of the exam, because these products can show up on the X-ray images and can make it difficult to interpret.
  • If you wear deodorant, please apply it sparingly, as you will be asked to wash it off before your mammogram.

During your mammogram

You will be asked to undress from the waist up and put on an examination gown. You will then stand in front of the mammography unit, which a special type of X-ray machine. The mammographer will place a breast between two plastic plates and gradually compress for a few seconds. (Compression causes a slight flattening which helps creates a clear picture while reducing X-ray dose.) The mammographer takes two images of the breast, one from the top and one from the side. The examination is then repeated for the other breast.

After your mammogram

Your mammogram will be read by one of our specialty-trained radiologists, who will send the results to your physician. You will receive a written summary of the report.

If you have not received this summary within two weeks, contact your physician or the Radiology Department.

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