The Patient Experience | Secure Physicians Login | Patient Education | Online Bill Pay

New to SMIL? Go to Schedule Online
or call 480.425.5080

Mammogram Education: A 6-part series on Mammography

Every Woman is Unique

- So is Her Mammogram

Destry Jetton is the host of a popular lifestyle show, Arizona Midday on NBC Channel 12. Destry agreed to take us on her personal journey through the mammogram process and share an informative, educational series for viewers to learn and see how the process works plus the options and the questions along the way. Mammograms save lives. This 6-part series on mammography sheds light on exactly how, and also explores the concerns and questions many of us have, about screening and diagnostic testing.

Video 1: Destry Prepares For Her Mammogram “What to expect and why no deodorant?”

Video 2: Destry’s Mammogram “Is this going to hurt?”

Video 3: Live Mammogram Q&A “Which guidelines? Radiation? Implants?”

Video 4: The Results “What’s a ’Call Back’? What is Nurse Navigation?”

Video 5: Mammograms and Your Personal Risk of Breast Cancer “Angelina’s story. What is genetic risk and what can I do about it?”

Video 6: In Depth Mammogram Q&A “False positives? Diagnostics? Early detection?”

Destry Prepares For Her Mammogram


Destry: Today – we’re starting a six part series on Mammograms. They are one of the most important screenings a woman can get – but many are afraid or even complacent about getting one. Breast Cancer is the most common form of cancer in the U-S – and early detection from mammograms is key! Dr. Denise Reddy with Scottsdale Medical Imaging is here to help us from the beginning! Dr Reddy, When should women start getting mammograms? And what are the current guidelines?

 

Dr Reddy: If you're 40 or older and have an average risk of breast cancer, yearly screening mammograms should be part of your healthcare. Scottsdale Medical Imaging agrees here with the American Medical Association, the American College of Obstetricians and Gynecologists, the American College of Radiology, the American Cancer Society, the National Cancer Institute, and the National

Comprehensive Cancer Network; all have issued guidelines saying that all women should get screening mammograms starting at age 40. In 2009 the U.S. Preventive Services Task Force questioned the value of screening mammograms, and did so again recently, recommending that women at average risk for breast cancer should start screening mammograms at age 50 every other year. That recommendation to start much later remains very controversial and hasn’t been universally adopted. However all sides agree that if you are at increased risk for breast cancer you should talk with your doctor about a breast screening plan that makes most sense for you, which means all women should learn as much as they can about their own personal risk. You can learn more about personal risk on SMIL’s website.

Destry: What should I bare in mind as I research where to get my mammogram and what questions should I ask?

Dr Reddy: Facilities are required to be accredited by the American College of Radiology (ACR) — quality is critical. Accreditation means you can be reassured that the radiologists and technicians are specially trained and certified in mammography and that the equipment meets standards and is inspected regularly.

Choose an accredited center based on the reputation of the radiologists, their teams and the quality of the equipment — the location should be secondary. All mammograms are best performed by experienced staff and physicians (radiologists) who are specialized in breast cancer detection. Like other fellowship-trained breast imagers, I read screening and diagnostic mammograms, 3D mammograms, breast ultrasound, and breast MRI. You may want to look for a facility that offers a full range of procedures in case it's necessary to get a more information from additional procedures.

You might ask how many mammograms are performed there each day. More is generally better. I would think twice about going to a facility that is not prepared to explain what service you are having and you should always have the opportunity to speak to the radiologist if you want to, even if that happens after you had the mammogram.

Destry: What is a 3D mammogram?

Dr Reddy: SMIL offers 3D mammograms and was involved in the original trials for FDA approval so we’ve had a lot of experience with 3D from day 1. You may also hear 3D described as breast Tomosynthesis. Breast Tomosynthesis helps solve the challenge of overlapping breast tissue during imaging because the camera moves over the breast taking images from multiple angles. These images are combined into a three dimensional picture of the entire breast. Breast Tomosynthesis allows SMIL’s radiologists to manipulate the images to see areas of concern from all angles and provides more images for radiologists to review as they screen for breast abnormalities and breast cancer.

There is slightly higher radiation dose from 3D but this is still well within safety limits. The benefits can include earlier detection of small breast cancers that can sometimes be hidden during 2D mammography. It can also be more accurate pinpointing size, shape and location of abnormalities. On a national scale, 3D is reducing the number of “call backs” where women are asked to have additional tests when something wasn’t clear from their first mammogram. But at this time there really aren’t enough data to show specifically which women get more benefit from 3D mammograms than from 2D mammograms.

Destry: What is my radiologist going to look for?

Dr Reddy: We are looking for any signs of abnormality, for example: asymmetries (something on one side that's not on the other), irregular areas of increased density, clusters of small calcifications, any area of skin thickening. If you’ve had a mammogram before we’ll want to compare them to look for any changes.

Destry: How should I prepare for my mammogram and how do I schedule it?

Dr Reddy: On the day of your mammogram at SMIL, you will need to undress from the waist up, so a two-piece outfit is recommended. Do not wear deodorant, talcum powder, perfume or lotion under your arms or on your breasts on the day of your exam. These products sometimes contain ingredients that can appear on the images. Some women bring deodorant and perfume with them so they can apply it after the exam and go about their day as usual.

If you experience patterns of sensitivity in the breasts, for example at certain times of your cycle, you might want to schedule your mammogram when your breasts are least sensitive. You will experience slight pressure on the breasts during the exam. Some women ask if they can get a routine mammogram if they have breast implants and the answer is usually yes, depending on the type of implant, but we can always help you with that question.

At SMIL we ask that you have an order from your doctor for your mammogram and you can schedule by calling us. Better still SMIL now gives you the option to schedule online at eSMIL.com. This means you don’t have to call us during business hours but you can schedule your appointment at any time right from your computer iPad or smartphone. We are very excited to be one of the first women’s imaging groups in the country to offer this not only because it’s super convenient but also because it’s part of our commitment to remove all the barriers we can that stop a woman from getting her mammogram. Mammograms are the only kind of early detection screening that has actually been shown to decrease a woman's risk of dying from breast cancer. With more women screened more cancers will be detected at a very treatable stage and more women’s lives will be saved.

Destry: Thank you, Dr Reddy. Coming up in our series I go through the journey of getting my own mammogram and Dr Reddy will help us with the answers to more questions. Remember there’s additional information on anything we cover in this series at eSMIL.com where you can also schedule your mammogram on line.

Destry’s Mammogram


Destry: Many people believe getting a Mammogram can be a scary thing and, they feel it is time consuming and inconvenient. But, Mammograms are the only kind of early detection screening that has actually been shown to decrease a woman's risk of dying from breast cancer. I'm in the same boat many of you are - with a mammogram due right now.

That's why I decided to go through the process with Scottsdale Medical Imaging to show you step by step how it works in part two of our special series.

Colleen Willson – Manager of Mammography Services Scottsdale Medical Imaging. For a routine screening mammogram the options are 3D (Tomosynthesis) or 2D. When you come to one of our SMIL centers we will review the exam you are going to have with you, review your medical history and answer any questions to be sure you are completely comfortable.

Destry: Colleen Willson takes me through the process. I'm getting a 3-D mammogram - the latest technology to screen for breast cancer.

Colleen Willson: 3D is a new kind of breast exam that SMIL has a lot of experience with. It looks and feels like a 2D exam and takes a few seconds longer for each view. That’s because the machine moves in an arc over your breast gathering enough information to create a 3D image. Now the doctors can see and search through the tissue in very thin individual layers almost like turning pages in a book. For the extra clarity it brings, your x-ray exposure is only a little more than a 2D mammogram and well under the safety limits set by health authorities.

Destry: The process isn't painful - a little uncomfortable- but very quick.

Colleen Willson: There is some compression regardless of the size of the breast. Communication and working with the patient to make sure they are comfortable is important and we always make sure we ask the patient how they are doing throughout the procedure.

Destry: After, I'm done - I meet with Dr Denise Reddy Head of Women’s Imaging at Scottsdale Medical Imaging and also my mammography doctor. She explains when women can get results.

Dr Reddy: At each of SMIL’s 8 breast imaging centers we have program called Same Day Answers and women have an option to wait about 10 minutes so they can get their results at the time of their exam This helps reduce unnecessary anxiety, and also gives the advantage of being able to perform any necessary follow up immediately or schedule that follow up immediately. How a woman feels about her mammogram experience is a significant factor in whether she will continue to get regular breast cancer screenings. A negative experience will sometimes even discourage her from getting extremely important follow-up or “diagnostic” imaging. Nationwide about 9% of women who have something abnormal in their first mammogram results do not report for follow-up – programs like Same Day Answer can help address this.

Destry: We then look at my images.

Dr Reddy: Each woman’s mammogram may look a little different because every woman is unique. When I am looking at any mammogram I am looking for a couple of things. For example: calcifications, which look almost like little grains of salt sprinkled on the exam; I am looking for little masses, little nodules and what shape they might be; I am looking for things that might be different from one breast to the other; and then we also like to compare from year to year which helps us look at subtle changes. This means it is important to have any previous mammograms available. If you are new to SMIL we can help you get your previous images for comparison.

Destry: Breast density is important.

Dr Reddy: Women’s breasts are a mixture of dense breast tissue and fatty tissue (which is less dense). Breast density tends to vary over a woman’s lifetime and dense breast tissue is very common, not abnormal and not a reason to become alarmed. Breast density cannot be determined in a physical exam, only by imaging. Even with the best screening digital mammography, dense breast tissue can be hard to “see through.” This means that the ability of mammography to find cancers may be reduced in women with dense breast tissue. Experts do not agree on whether a woman with dense tissue should have supplemental screening and so if you have dense breasts, you should talk to your doctor about your personal risk for breast cancer risk. Every woman is unique and your doctor may recommend you consider supplemental screening tests based on your risk. The bottom line is that extra vigilance is needed in women with dense breast tissue. SMIL has long believed that a woman should be informed, in plain language, about her breast density and now around the country many States are catching up and making this a requirement.

Destry: Overall – it takes very little to get my annual mammogram and that's the message Dr Reddy wants women to know.

Dr Reddy: For all women it is important to begin getting mammograms at age 40 and to get one every year. The reason why we recommend every year is because that way we can find cancers when they are very small, and when they are small and when we detect them early, we have a better chance of treating them successfully and we increase the chances of survival from breast cancer. The only tool we have for early detection of breast cancer is a screening mammogram and this is the only tool that has been shown to decrease a woman’s chance of dying from breast cancer and so it is absolutely important to get a mammogram every year.

Destry: Two hours of your day that could save your life. Remember for more information or to schedule your own mammogram on line you can go to eSMIL.com.

Live Mammogram Q&A


Destry: We’ve been working on demystifying the process and procedure of getting a mammogram and you have submitted your questions. Today we are going to answer some of those questions and to help us we have Dr Denise Reddy with Scottsdale Medical imaging.

I love this because these are real questions from real people. Our first question starts with “I want to thank Destry for doing this series” which I did, and you guys encouraged me to get as mammogram on the air which I think was important and did show people how it all works.

The question is, “Destry chose a 3D mammogram what’s the difference and is it more expansive?”

Dr Reddy: Some women are choosing 3D mammograms and the reason they are doing that is because some studies have shown 3D mammograms detect more cancers and has less false alarms. SMIL was involved in the original trials of 3D so we’ve had a lot of experience with 3D from day 1. A very large study of over 400,000 women showed 3D found more cancers and also reduced false positive results. A false positive result means seeing an abnormal area that looks like a

cancer but before it’s treated, more tests are done and it turns out to be normal. So 3D does look more and more promising. It is approved by the FDA for all women and we do them at SMIL. That being said there are no national guidelines for 3D and so we can’t say if 3D should be used in all women. We recommend you talk to your own doctor. Some doctors are now recommending 3D for women with dense breast tissue (seen on previous annual mammograms) or women with a strong family history of cancer. Because there aren’t guidelines some insurance companies pay for it, others consider it an optional upgrade and they do not cover it. Research continues and 3D isn’t yet the standard of care for breast cancer screening.

Destry: This question from a viewer asks: “There’s a lot in the news about a Task Force giving a green light to putting off your first mammogram until age 50. I am 42. Should I wait for my first mammogram?”

Dr Reddy: In 2015, the government-sponsored U.S. Preventive Services Task Force (USPSTF), a panel of experts, revisited its guidelines for breast cancer screening. They have said that women should get mammograms every other year from ages 50 to 74. They have said that women in their 40s benefit from mammograms but that those benefits don’t outweigh the risks. The reason why this is so controversial is because the American Cancer Society along with many other organizations and SMIL recommend that women should get a mammogram every year starting at age 40. The task force has been criticized because they based their decision using some studies that used old technology that is not as up to date as the 3D mammogram and other technologies we use today.

Destry: The next question from a viewer says: “My sister had to wait over a week for her results but Dr Reddy said SMIL gave Same Day Answers. Are Same Day Answers as reliable as the results you get when you wait?”

Dr Reddy: At some mammography centers around the country it is very typical for women’s exams to be read in a day or so and then a letter is sent out. This means women can be waiting a week or more for their results. At SMIL we saw this as creating unnecessary anxiety and worse, potentially delaying any important follow up imaging that might be needed. We made a conscious decision to create a new standard. Our goal is to have your mammogram visit completed in well under an hour. If you choose Same Day Answers you can expect to wait an additional 15 minutes for your results from a 2D mammogram, 30 minutes for results of a 3D mammogram. The exam and interpretation haven’t changed it is simply that we designed processes and communication systems at all 8 of our centers to be able to do this. You will also receive the traditional letter later in the mail and your report is also sent electronically to your doctor’s office. We have been doing this for 2 years now at SMIL and the advantages are clear – less anxiety and also, if needed, we can schedule any important follow up there and then before you leave.

Destry: Another question, “What kind of radiation dose does a woman get from a mammogram and can’t that cause cancer anyway?” Dr Reddy: Mammograms require very small doses of radiation. The risk of harm from this radiation exposure is extremely low and no women have been shown to develop breast cancer as a result of mammography.

A mammogram exposes a woman to 0.4 millisieverts. That’s about the amount of exposure a person would expect to get in about 7 weeks from what’s called “background radiation” from our natural environment.

Women will be asked if they are pregnant and should always let their health care provider and the x-ray technician know if there is any possibility that they are pregnant, because radiation can harm a growing fetus. While everyone should always talk with their health care providers about the need for an imaging exam, it is very safe to say that the benefits of mammography nearly always outweigh the potential harm from the radiation exposure.

Destry: What about cosmetic surgery? This viewer asks, “I have breast implants. Will a mammogram still work? Can it damage my implants?” That’s a good question.

Dr Reddy: That’s a very good question. Mammograms are the only screening tool we have for all women even women with breast implants. The only difference is that breast implants can sometimes hide some of the breast tissue and this makes my job a little bit harder. So, what we do is we have special views that we take for women with implants. These are called Eklund views or implant displacement views and we gently push the implant back and gently pull the breast tissue forward so we can see the tissue. While the compression could potentially cause an implant to rupture, it is extremely uncommon and I have never seen it happen. Women with breast implants should continue to have mammograms. You should choose a facility that is experienced in performing mammography on women who have breast implants. At SMIL we are. The special technique can sometimes require a little extra time and it is important to let our staff know about your breast augmentation when you schedule your mammogram.

Destry: Our final question: “My friend’s breast cancer was found on a sonogram, not her mammogram. Can I get a sonogram instead of a mammogram?”

Dr Reddy: A mammogram isn’t perfect and will never be able to detect 100% of breast cancers but it is still the most effective screening tool available today and the only tool, which have been shown to decrease a woman's risk of dying from breast cancer. Breast sonography or ultrasound isn’t routinely used for screening by itself because they can miss some of the cancers that can be seen on mammograms.

Breast ultrasound is more of a problem-solving tool and most often used as another way to look at certain kinds of abnormal areas found from a screening mammogram. For example, ultrasound can often “see” if a breast mass that looks suspicious on a mammogram is actually solid like a tumor or filled with fluid like a cyst. Adding ultrasound to a screening mammogram can also be helpful for some high-risk women with dense breast tissue. Ultrasound provides an additional way of “seeing” through very dense tissue.

Ultrasound is painless and very safe but many cancers, including early cancers, can be seen on a mammogram but cannot be seen on ultrasound. For some women breast ultrasound can be a valuable tool to use along with mammograms but its value depends on the operator’s experience and skill at capturing the best possible image for the physician (a radiologist) to interpret. Every woman is unique and whether breast ultrasound is right for you or not it is a good idea to choose a breast imaging facility with experts in breast ultrasound and which has radiologists who specialize in the complete range of breast imaging options.

Destry: I feel like I have learned so much from these first three programs. Thank you so much, Dr Reddy for answering our viewers’ questions. We will have more questions answered in upcoming episodes of this series. Remember for more information on anything we have talked about or to schedule your mammogram on line you can go to eSMIL.com.

The Results


Destry: We are continuing our 6-part series on mammograms. We have taken you through the process, answered some of your questions and now it’s time for results. We are here at Scottsdale Medical Imaging along with Dr Denise Reddy and Pam Turgeon, a Nurse Navigator at SMIL. We all want to hear the all clear but what happens when you get results that say “wait a second, you have to come back and do something more”? I know this can be a potentially very frightening time for women.

Dr Reddy: That’s what we call a “call back”. What that means is there was a finding on your mammogram and we need to do some additional tests to find out if it is a problem or not. About 1 in 10 women are called back for more tests but

something that looks suspicious on your screening mammogram does not mean you have cancer.

A suspicious finding may be just dense breast tissue, a cyst, or even a tumor that isn’t cancer. Sometimes, it’s simply that your screening mammogram isn’t showing us everything we want to see and we want additional views.

Callbacks are very important. You've got to come back; but if you get a call back take a deep breath. It's not likely to be cancer. The majority of time the further testing shows the suspicious area is harmless.

SMIL’s Same Day Answers program makes a big difference because we can take care of callbacks the same day as your screening mammogram or schedule your call back at that time.

Destry: You get a Diagnostic Mammogram correct? What exactly is that?

Dr Reddy: Your diagnostic mammogram is still an x-ray of your breasts, but it’s done for a different reason. More pictures are taken during a diagnostic mammogram so that any areas of concern can be carefully studied. A radiologist is on hand to advise the technologist (the person who operates the mammogram machine) of any special views we need.

Destry: Do you add additional tests like an Ultrasound?

Dr Reddy: Yes, in some cases we’ll also use ultrasound to look more closely at any areas of concern found on a mammogram. Ultrasound can be a great problem-solving tool uses sound waves to create a computer image of the tissues inside your breasts. For this test, you will lie on a table while your SMIL ultrasound technician applies some gel and places a “transducer” – a small instrument that looks like a microphone – on your skin.

The test doesn’t hurt at all, and does not expose you to radiation. The gel that the technician puts between the skin and the transducer feels a little cold and wet but that’s about it.

Ultrasound can often “see” if a breast mass that looks suspicious on a mammogram is actually solid like a tumor or filled with fluid like a cyst. Ultrasound can also be helpful for some women with dense breast tissue because it provides an additional way of “seeing” through very dense tissue.

Destry: What’s a biopsy?

Dr Reddy: If you need a breast biopsy, it doesn’t mean you have cancer. Most biopsy results show the suspicious area is not cancer, but a biopsy is the only way to find out.

During the biopsy, a tiny amount of tissue is removed and looked at under a microscope. There are several different types of biopsies – most use a very fine needle. The only difference is the type of imaging equipment the radiologist uses to guide the needle into the area that needs to be biopsied. The type you have depends on things like how suspicious the tumor looks, how big it is, where it is in the breast, how many tumors there are, other medical problems you might have.

The tissue sample will be sent to a lab where a specialist, called a pathologist, will look at it. It will take a few days, for you to find out the results. Your doctor will go over them with you. Sometimes a SMIL Breast Nurse Navigator will also go over the results with you.

4 out of 5 biopsies are negative for cancer. If your results show no signs of cancer be sure to ask the doctor whether you need any additional follow-up, and when you should have your next screening mammogram.

If the biopsy shows there are atypical or cancer calls present, your doctor may refer you to a breast surgeon or other breast specialist. At this point some women opt to work with SMIL’s Breast Nurse Navigator program.

Destry: Pam, we have heard from Dr Reddy about SMIL’s Breast Nurse Navigator Program. How does it work?

Pam Turgeon: The SMIL breast nurse navigator program is available through any of our 8 SMIL breast-imaging centers and is staffed by experienced nurses, nationally certified by the National Consortium of Breast Centers.

A positive biopsy is frightening. Many women experience strong emotions including disbelief, anxiety, fear, anger, and sadness during this time. Our SMIL breast nurse navigators have many years of experience and training and, along with SMIL radiologists and team we offer personalized, caring services to our breast care patients. Working in partnership with your physicians, our breast nurse navigators can help you schedule follow up appointments, can explain your tests and results and can be a link to connect you with appropriate breast health resources and care.

The key to successful breast nurse navigation is working with each breast care patient as an individual. The breast nurse navigator acts as a liaison between the patient and all other members of her healthcare team. In some instances it can be as simple as helping answer questions about results or providing information for a woman and her family. Other patients may need the support of her breast nurse navigator to help coordinate her treatments and understand the different, sometimes complicated, options available to her. Caring communication is crucial during what can be a very stressful and confusing time.

Destry: Are other similar programs available?

Pam: To understand if a program is right for you or someone you care for, it’s a good idea to learn who provides the assistance. Are they volunteers, cancer survivors, social workers, registered nurses, other healthcare professionals? Are the navigators certified? What types of assistance does the program offer (transportation, counseling, care coordination etc.)? When does assistance begin (pre-diagnosis, diagnosis or at another time) and when does the support stop for example when you get into treatment, at the end of treatment, does it follow into survivorship? It is perhaps worth pointing out that some breast nurse navigators receive quite limited training while other programs like SMIL’s require their navigators to be nationally certified.

Destry: What does a breast nurse navigation program mean for a patient?

Pam: Breast nurse navigators make a huge difference for women facing a diagnosis of breast cancer and for their families. Breast cancer patients needs vary - sometimes it is resources, schedules and goals that a breast cancer patient wants. Other times, breast cancer patients want help charting a course and fully understanding options on the journey to recovery; and sometimes the most important thing is having someone just be there by your side during an uncomfortable procedure, someone ready to reach out and hold your hand.

Destry: Thank you. I want to remind viewers you can find out more at eSMIL.com where you can also schedule your mammogram online.

Mammograms and Your Personal Risk of Breast Cancer


Destry: We are continuing our series on mammograms with Scottsdale Medical Imaging and Dr Denise Reddy. Dr Reddy, there have been news stories saying that women at high risk for breast cancer should get more screening or start mammograms earlier. What does high risk mean?

Dr Reddy: When we talk about risk what we mean is a woman’s chance of developing breast cancer during her lifespan. At SMIL we talk about this as a woman’s risk number and that every woman should know her risk number. First let’s be clear, a high breast cancer risk number doesn’t mean a woman will certainly get breast cancer and a low breast cancer risk number does not mean it’s impossible. For most women the average lifetime risk of developing breast cancer is 12 percent to 13 percent. A risk of 15 percent to 20 percent is “moderately

increased” and above 20 percent is described as “high risk.” It’s a good idea to understand your breast cancer risk number now. The absolute best advice is to discuss your personal breast cancer risk with your own doctor.

There are some simple ways to find out about your risk number. For example Cancer.gov offers an excellent Breast Cancer Risk Assessment tool and you can also find an easy to use online calculator on eSMIL.com when you click on Breast services.

Destry: Are there different mammogram recommendations depending on your personal risk?

Dr Reddy: At-risk women are different and knowing your personal breast cancer risk number will help you make important breast health choices. American Cancer Society SMIL radiologists and many others all recommend starting mammograms every year at age 40. If you are at “moderately increased” risk then American Cancer Society recommends you ask your doctor about adding breast MRI (magnetic resonance imaging). If you are at “high risk” the clear recommendation is that you get a mammogram plus an MRI every year.

Destry: can you explain more about MRI?

Dr Reddy: MRI scans use powerful magnets and radio waves to create detailed pictures of the breast. For this test, you lie on your stomach on a table that slides into the MRI machine, which is shaped like a narrow tube. The exam itself is painless but it can be a little uncomfortable for people who don’t like enclosed spaces. The machine makes loud buzzing and clicking noises and the technologist may give you headphones to mask this noise. MRI is very good at catching some cancers very early, which is why it is helpful for high-risk women, but it also has its own limitations. Its technology can’t see some cancers visible on a mammogram so it is recommended only in combination with a mammogram. Also because it is so highly sensitive MRI does show more false positives, which you’ll remember from our earlier show, means something that looks suspicious but with further testing turns out to be harmless. If MRI were used on everyone more women would end up having unnecessary biopsies. All good reasons why MRI is usually reserved for high risk women.

Destry: We have all heard so much Angelina Jolie’s decisions because of her family risk of getting cancer. Can you explain more about genetic risk for breast cancer and what we should do about it?

Dr Reddy: A small percentage of women inherit a harmful mutation of the BRCA1 or BRCA2 gene. The mutation significantly increases your lifetime risk of developing breast cancer or ovarian cancer. Angelina Jolie has done a lot to bring this to the public’s attention. BRCA mutations alone do not explain all inherited risk of the breast cancer. Continued research has discovered mutations in other genes that also create problems. In total, known 'breast cancer genes' can explain 25-30 percent of breast cancer cases when risk seems to have been inherited.

At SMIL we care for thousands of women each month for their screening mammograms and realized we could help those women identify if they may benefit from testing. If so, we could put them in touch with expert genetic counseling and testing services. When you go for your annual mammogram at SMIL you are already asked some questions about your medical history. Included are 4 or 5 questions about your family history. These simple questions are a screening tool designed specifically to help determine your own risk for BRCA-related cancer. The SMIL physicians are not geneticists but can use this tool to see if you might benefit from genetic testing. If you do, we will recommend you get in touch with your primary care provider or go see a genetic counselor for more detailed evaluation. Over 90% of women have absolutely no reason to be tested, and testing them would be inappropriate. But if you do have the mutations, your risk for developing breast and ovarian cancer is very high. If you are at risk it’s really important to understand the risk, your options and how to accurately interpret genetic testing results. This is why SMIL recommends talking with a skilled genetic counselor. Working with women, their physicians and now with genetic counselors SMIL is striving to give the most reliable picture of risk for every woman so she can decide what’s best for her.

Destry: A lot of great information again today, thank you so much. In episode 6 of our series we will answer more of the questions that have been sent in by our viewers. Remember for more information on anything we have talked about or to schedule your own mammogram on line you can go to eSMIL.com.

In Depth Mammogram Q&A


Destry: This is the final show in our 6 part series on mammograms. We have gone through every step of the process from making your appointment to actually getting a mammogram to getting your results and understanding more about risk. Again, we are joined by Dr Denise Reddy from Scottsdale Medical Imaging, and today we are looking at a final set of questions that have come from our viewers during the course of this series. Here is the first question: “I’ve read online that mammograms lead to “over-diagnosis” and “false positives”. What does this mean?”

Dr Reddy: Modern screening mammograms are very good at finding early cancers that can now be successfully treated. However, they can also find cancers that will never cause symptoms or threaten a woman’s life. This is what’s described as

"over-diagnosis" of breast cancer. The problem here is that although there have been huge advances in mammography and breast cancer detection in the past decade, at this time even the very best technologies and techniques often cannot distinguish between cancers that are life threatening need treatment from those that are not life threatening and don’t need treatment do not. Sometimes this is described as the difference between the cancers you will die “from” and the cancers you will die “with”. As a result almost all have to be treated. We really have little alternative. Some breast cancers can develop so quickly that waiting to see what the cancer does is usually regarded as not a good option.

Over-diagnosis is different from false-positive results. False positive means a radiologist sees something in your mammogram that appears abnormal and needs you to come back in for additional testing (diagnostic mammograms, ultrasound, perhaps a biopsy) to rule out cancer. False-positive mammograms inevitably create anxiety but when something looks abnormal additional testing is essential.

Destry: Our next viewer is asking about the different types of mammogram. She wrote: “I’m not sure I understand the difference between a screening mammogram and a diagnostic mammogram?”

Dr Reddy: Screening mammograms, like the one you had, Destry in program 2, are performed in “asymptomatic” patients; that is women who have no signs or symptoms of breast cancer. Two views of each breast are obtained during the exam. These are interpreted by the radiologist.

A diagnostic mammogram is still an x-ray of your breasts, but more pictures are taken during a diagnostic mammogram and it’s done for a different reason. For example we perform diagnostic mammograms for follow-up on a screening mammogram that looks abnormal. We’ll also do a diagnostic mammogram with women who have a past history of breast cancer or with women who are “symptomatic” meaning a breast exam has shown things such as a lump that can be felt, nipple discharge, abnormal skin changes.

Destry: This next question goes along with that. The question asks: “I was called back for a diagnostic mammogram last time. Everything turned out fine but does this mean I’m now at higher risk for breast cancer?” This is a good question.

Dr Reddy: It is a good question and no, it does not mean you are at higher risk for breast cancer. About 10% of women will be called back for additional imaging and for the majority of women once we have additional images we will find there is no abnormality there and they can just return to routine screening without any worries.

Destry: This is really good news from somebody watching our segments and she wrote, “After watching Destry get her mammogram she’s convinced me to get my first mammogram. Do I need a doctor’s order?”

Dr Reddy: At SMIL we do ask you to first get an order from your physician. There is always a chance that your mammogram will show something that needs urgent follow up care and we want to be sure you have a clinician in place first, just in case. If for some reason you can’t do that then there are some facilities that allow self-referral; call ahead to make sure your facility accepts them.

Destry: Our final question today: “My mother had breast cancer and didn’t know until it spread to other organs. What do I need to do to catch it earlier?”

Dr Reddy: First let me say how sorry I am to hear about your mother.

Let’s start with all women: All women should know how to do monthly breast self-exams (BSE) starting at age 20. There’s helpful information on this at eSMIL.com. The American Cancer Society (ACS) also recommends women should also have a clinical breast exam (CBE) done by a healthcare professional every three years between the ages of 20 and 40 and then every year starting at age 40. It’s also at age 40 that the American Cancer Society, SMIL and others recommend you start annual your mammograms.

However if you have a first-degree relative, your mother or sister for example, diagnosed with breast cancer should start getting screening mammograms earlier. To decide when they should start, we take the age at which your relative was diagnosed with breast cancer and start screening 10 years earlier than that. For example, if your mother was diagnosed with breast cancer at age 40, you should start annual mammograms at age 30.

If you are at high risk the American Cancer Society and the American College of Radiology recommend annual mammograms plus a screening MRI.

There are some simple ways to find out about your risk number. For example Cancer.gov offers an excellent Breast Cancer Risk Assessment tool and you can also find an easy to use online calculator on eSMIL.com when you click on Breast services.

It’s a really good idea to learn as much as you can now about your personal breast cancer risk now. The absolute best advice is to discuss your personal breast cancer risk with your own doctor so that your screening plan can be individualized.

Destry: Thank you so much for taking us through this 6-part journey and showing us how it all works. Do you have any final thoughts for women watching this series?

Dr Reddy: I know for a lot of women we are so busy taking care of everyone else in our lives that we can sometimes put our own health to the side. We really need to make sure that we take care of ourselves, get our mammograms every year and talk to our doctors about our personal risk for breast cancer. Women should understand their own risk so they can individualize their screening plan.

Destry: Thank you again Dr Reddy for helping us with this important series. Remember for more information on anything we have talked about or to schedule your mammogram online you can go to eSMIL.com.


Achieving world-class quality through clinical and operational collaboration on a national scale.
© 2017 Scottsdale Medical Imaging LTD.
Notice of Privacy Practices
Notice of Nondiscrimination