Raleigh Radiology is committed to providing patients with the most advanced mammography technology available. Digital Mammography with CAD (computer aided detection) is the best tool available to help detect breast cancer in its earliest stages – when it has the best chance of being cured. In clinical studies, digital mammography screening detected up to 28% more cancers than film screen mammography in women under the age of 50, premenopausal and perimenopausal women, and all women with dense breast.
Raleigh Radiology was the first radiology practice in Wake County, NC, to offer digital mammograms to Raleigh, NC, patients, and now offers this service at seven convenient outpatient locations. All of our offices are accredited by the American College of Radiology and certified by the FDA. In addition, all mammography exams are read by board-certified radiologists, many of which have earned additional sub-specialized training in breast and women’s imaging.
Screening Digital Mammography
A screening mammogram is a low dose x-ray of the breast used to detect abnormal changes in the breast tissue. This type of routine mammogram is for women who have no signs or symptoms of an abnormality. Women are encouraged to have a baseline mammogram between the ages of 35-39, and begin annual exams at age 40. Screening mammography should be used in conjunction with a clinical breast exam performed by your physician and monthly self breast exams.
The exam is performed in an upright position, usually standing. The mammography technologist will instruct you while they place your breast tissue in the best position to achieve maximum results for your exam, and typically two views of each breast will be obtained. The breast tissue is compressed between two plates on the machine. Compression spreads apart the tissue to give the radiologist better visualization of the anatomical structures within the breast. The applied compression will be held in place only a few seconds during the exposure, and then automatically released.
Mammograms make it possible to detect tumors that cannot yet be felt, and also microcalcifications (tiny calcium deposits) that can sometimes indicate the presence of cancer. To reduce discomfort if you have sensitive breasts, schedule your mammogram in the first two weeks following your menstrual cycle when your breasts are less tender.
Upon completion of your screening exam, the mammography technologist will review the images for quality. The radiologist will interpret your exam and send the results to your referring physician or provider, and we will notify you of the outcome as well. If there is an area that raises any question for the radiologist that needs further clarification, they may recommend you return for additional imaging.
Diagnostic Digital Mammography
A diagnostic mammogram is also a low dose x-ray examination of the breasts, but used to evaluate potential problems within the breast. If you have one or more of the qualifying symptoms, you may need a diagnostic mammogram, instead of a screening:
- Personal history of breast cancer
- New lump or mass
- New breast pain that is focal (localized to a specific point or area in the breast)
- New nipple inversion
- Bloody discharge from the nipple
- Short-term follow up recommended by a radiologist from a previous mammography examination
- Screening mammogram revealed a finding that needs further investigation or clarification
With a diagnostic evaluation, the technologist usually obtains the same images as with a screening exam, but also performs specially customized views under the direction of the radiologist. This may include the use of special, smaller compression paddles, the use of magnification techniques, and/or breast ultrasound to focus on the area of interest or concern. Because this exam is more customized, it often requires more images be taken (as compared to a screening study), and also means that diagnostic exams from patient to patient may not be exactly the same. Also, diagnostic mammography is not considered a preventive care service by most insurance companies, and may be subject to deductibles and co-insurance. Please contact your insurance provider with questions concerning your coverage.
To complete your breast imaging evaluation, the radiologist may recommend a breast ultrasound at the time of your diagnostic mammogram appointment. This is an imaging technique that uses sound waves to look at anatomical structures within the breast and can supplement a mammogram evaluation by helping the radiologist characterize the tissue he or she is evaluating. The use of ultrasound helps the radiologist to avoid recommending unnecessary surgical procedures and make a comprehensive diagnosis. While breast ultrasound is often used as a supplemental diagnostic tool, it is not an adequate screening option and should not be used to replace mammography.
Frequently Asked Questions
What is the difference between a screening & a diagnostic mammogram?
Screening: A yearly exam performed when the patient has no clinical symptom or history of breast cancer. A screening can be done on a patient with a history of breast cancer if the affected breast was removed (Mastectomy). The recommendation for baseline screening is at 35 years of age. This can be an insurance issue so have the patient check if they are younger than 35.
Diagnostic: An exam done when a patient has a specific new finding or is being followed at the recommendation of either the radiologist or a surgeon. A diagnostic can also be ordered for any patient with a history of breast cancer. A diagnostic mammogram is always done on patients who had a lumpectomy. A diagnostic mammogram includes the same four standard views as a screening mammogram; in addition, it includes other specialized views. It will be seen by the radiologist while the patient is still in the office.
When and how will the patient get results?
A letter will be mailed to the patient within 30 days giving the final assessment results as mandated by the FDA. A delay can occur when comparison films are not available at the time of service. If the patient is required to return for additional imaging, they are notified by phone.
Why does your office need my previous mammogram films?
One of the most important parts of mammography is proving stability over time. This is done by having the radiologist compare the old exam with the new exam to exclude subtle differences in the breast tissue. The actual mammography films are needed for this, not just the report.
Does the patient have to have an order for a six month follow up even though it was recommended by the Radiologist?
Yes. The radiologist can only recommend that the patient have a follow up appointment. The referring physician still has to provide an order for this procedure to be done.
Does a 6 month follow up need to be a bilateral or unilateral mammogram?
The patient should have a bilateral mammogram only once per year unless there is a clinical finding in both breasts. If a patient has a bilateral mammogram with a finding in one breast, the six month follow up should only be of the affected breast. The patient should then return after another six months for a yearly bilateral mammogram. Baseline mammograms should be bilateral so the radiologist can compare for symmetry of breast tissue.
Should a patient under 30 years old with a breast lump, have a mammogram or breast ultrasound?
In general, patients under 30 with a breast lump should have an ultrasound first. The mammogram will be determined by the radiologist based on the ultrasound findings. In most patients under 30, the breast tissue is very dense and difficult to image effectively. Patients over 30 should have a bilateral mammogram and the need for ultrasound will be determined by the radiologist based on the mammographic findings. Breast ultrasound is used for a specific finding, usually a palpable lump or a mammographic abnormality and is not indicated for screening.
Once a patient has a diagnostic or abnormal mammogram, do their future mammograms always need to be diagnostic?
No. The radiologist will investigate clinical symptoms and will follow any mammographic and/or sonographic findings until they can say that it is either benign or needs to be biopsied. If the patient has a biopsy that is benign, they can return to having screening mammograms at their surgeon’s discretion.
Can a patient have a screening ultrasound if they do not like having mammograms?
Unfortunately, no they cannot. Mammograms and ultrasounds image breast tissue differently. Not everything that is seen on a mammogram can be seen on an ultrasound. The standard of care dictates that mammography is the imaging modality of choice for breast cancer screening. Other modalities are used only when there is a clinical indication.
If a patient has implants or had breast reduction, is it ordered as a screening or diagnostic?
It is up to the referring physician to decide whether it is a diagnostic or screening mammogram.
Do not wear deodorant, talcum powder or lotion to your exam. Moist wipes are available to remove these products if you did apply them.