I recently had my first mammogram and decided that I would blog about it. Everyone and their mother had always described mammograms has this horrific experience so I conjured up the worst things imaginable, when in all reality a little boob smashing is nothing compared to the dreaded annual pap smear, but hey that’s just my opinion.
Anyway let’s get down to specifics, two years ago my Gynecologist recommended that I have a mammogram done to get a baseline reading for future breast exams. I decided to hold off doing so because it was my understanding that women didn’t have to start getting mammograms until they reach there 40’s. The following year I returned for my annual and this time she wasn’t recommending she demanded I get the mammogram done and wrote out the order to do so. Still I procrastinated till six months after that appointment. I finally got off my lazy butt and got around to doing it to avoid being chastised during next year’s annual visit.
I scheduled my appointment with dreaded anticipation at the Scottsdale Medical Imaging facility located in Gilbert. You can imagine my surprise when I walked into the facility. It was bright and the staff cheery and very helpful. I completed the necessary paper work and was called back for the procedure. I was directed to a changing room nicely decorated in calming hues of purple and lilac, with lockers for my personal belongings, bottled water, and a comfy waiting area. The mammography technician was courteous and informative during the procedure and explained everything to me in detail. She used a mammogram machine similar to the one pictured below.
The machine uses compression plates also known as boobie smashers, to compress the breast and take images. The boobie smashing wasn’t that bad like I said before a pap smear is worse. The technician asked if I would like to wait fifteen minutes or so for the results and I thought what the heck why not. A few minutes later the technician informs me they will need to take additional images of my left breast because they needed to get a better reading. So we made our way back to the boobie smashing machine once again.
I was returned to the waiting lounge somewhat concerned and of course my mind began to conjure up the worst case scenario. The technician returned yet again to inform me that they needed to do an ultra sound because they could not get a sufficient enough reading. I was taken back to the ultra sound lab and delivered to a new technician who I am sure could see the fear start to build up in my eyes. She conducted the ultra-sound. My mind started to wander, I thought the last time I had an ultrasound I was pregnant which was much more pleasant then the reason for the one today. I was brought back to reality when the technician finished up and said not to worry she didn’t see anything scary, but just to be sure she would have the doctor take a peak. She was back in less than five minutes to let me know all was well and everything looked normal. My first thought was THANK GOD, and then I wondered what the heck was going on with my breasts that it took so much work to get a good reading.
I found out that breast exam reports include a standard category reading and an assessment of breast density. Like me you’re probably asking yourself what the heck is breast density, don’t worry you will soon find out. The American College of Radiology (ACR) developed a standard way of describing mammogram findings. The results are sorted into categories numbered 0 through 6. This system is called the Breast Imaging Reporting and Data System (BI-RADS). Having a standard way of reporting mammogram results lets doctors use the same words and terms and ensures better follow up of suspicious findings. Here’s a brief review of what the categories mean:
X-ray assessment is incomplete
Category 0: Additional imaging evaluation and/or comparison to prior mammograms is needed.
This means a possible abnormality may not be clearly seen or defined and more tests are needed, such as the use of spot compression (applying compression to a smaller area when doing the mammogram), magnified views, special mammogram views, or ultrasound.
This also suggests that the mammogram should be compared with older ones to see if there have been changes in the area over time.
X-ray assessment is complete
Category 1: Negative
There’s no significant abnormality to report. The breasts look the same (they are symmetrical) with no masses (lumps), distorted structures, or suspicious calcifications. In this case, negative means nothing bad was found.
Category 2: Benign (non-cancerous) finding
This is also a negative mammogram result (there’s no sign of cancer), but the reporting doctor chooses to describe a finding known to be benign, such as benign calcifications, lymph nodes in the breast, or calcified fibroadenomas. This ensures that others who look at the mammogram will not misinterpret the benign finding as suspicious. This finding is recorded in the mammogram report to help when comparing to future mammograms.
Category 3: Probably benign finding – Follow-up in a short time frame is suggested
The findings in this category have a very good chance (greater than 98%) of being benign (not cancer). The findings are not expected to change over time. But since it’s not proven benign, it’s helpful to see if an area of concern does change over time.
Follow-up with repeat imaging is usually done in 6 months and regularly thereafter until the finding is known to be stable (usually at least 2 years). This approach helps avoid unnecessary biopsies, but if the area does change over time, it allows for early diagnosis.
Category 4: Suspicious abnormality – Biopsy should be considered
Findings do not definitely look like cancer but could be cancer. The radiologist is concerned enough to recommend a biopsy. The findings in this category can have a wide range of suspicion levels. For this reason, some doctors may divide this category further:
- finding with a low suspicion of being cancer
- finding with an intermediate suspicion of being cancer
- finding of moderate concern of being cancer, but not as high as Category 5
Not all doctors use these subcategories.
Category 5: Highly suggestive of malignancy – Appropriate action should be taken
The findings look like cancer and have a high chance (at least 95%) of being cancer. Biopsy is very strongly recommended.
Category 6: Known biopsy-proven malignancy – Appropriate action should be taken
This category is only used for findings on a mammogram that have already been shown to be cancer by a previous biopsy. Mammograms may be used in this way to see how well the cancer is responding to treatment.
Now on to that thing I talked about earlier, Breast Density. Basically, there is a classification of four groups that describe the level of how dense your breast tissue is. The denser your breast is the harder it is for the doctor to see if there is anything going on that shouldn’t be. The four groups are as follows:
BI-RADS 1: The breast is almost entirely fat
This means that fibrous and glandular tissue makes up less than 25% of the breast
BI-RADS 2: There are scattered fibroglandular densities
Fibrous and glandular tissue makes up from 25 to 50% of the breast.
BI-RADS 3: The breast tissue is heterogeneously dense
The breast has more areas of fibrous and glandular tissue (from 51 to 75%) that are found throughout the breast. This can make it hard to see small masses (cysts or tumors).
BI-RADS 4: The breast tissue is extremely dense
The breast is made up of more than 75% fibrous and glandular tissue. This can lead to missing some cancers.
I have BI-RADS level 3 heterogeneously dense which is why they had to do multiple imaging and screening. Based on a recent publication by the Journal of the National Cancer Institute, Women with breasts that appear dense on mammograms are at a higher risk of breast cancer and their tumors are more likely to have certain aggressive characteristics than women with less dense breasts. Once I found out this tid bit of information I thought OH JOY! First PCOS & Hypothyroidism and now I have heterogeneously dense breast to top it all off. The normal reading did put my mind at ease and I now know why it’s so important to have a mammogram done regardless of age. So ladies if you are reading this be sure to get your mammogram done and save your Tah Tahs!
((n.d.)). Retrieved from http://www.cancer.org/treatment/understandingyourdiagnosis/examsandtestdescriptions/mammogramsandotherbreastimagingprocedures/mammograms-and-other-breast-imaging-procedures-mammo-report