Monday Medical: A closer look at mammography
October 15, 2012
For women ages 40 and older, having an annual screening mammogram is the best method of detecting breast cancer in its earliest, most curable stage.
Those of us who have experienced this exam know what it feels like, but how much do we really understand about the procedure? Let's go behind the scenes to hear from two women at Yampa Valley Medical Center who truly know mammography.
Women's Imaging Coordinator Julie Isaacs is an experienced, certified mammographer and an excellent communicator. With warmth and assurance, she tells women exactly what to expect during and after the exam on YVMC's GE Essential full-field digital mammography equipment.
"The first thing our patients notice is the new cotton robes. They're fabulous and women love them," Isaacs said. The robes were donated by the YVMC Auxiliary with proceeds from the Rubber Ducky Race.
Next comes an explanation of "the big squeeze" — you know what I'm talking about. Compression is vital to capturing two detailed images of each breast. Quite simply, radiation passes more easily through a flattened breast. The benefits are twofold: more detailed images and a lower dose of radiation.
The mammographer places a textured fabric on the compression pad, which warms up and softens the surface while holding the breast in place. This helps to consistently position the breast and minimize the potential for motion, which would produce a blurry image.
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Other factors that may compromise an image include deodorant, lotion or powder under the arms or on the torso. That's why it is important to avoid using these substances on the day of an exam.
While the patient still is in the exam room, the mammographer reviews the images for position and clarity.
"We explain that we will call with summarized results in one to two days, except on a weekend," Isaacs said. "A letter also goes to every patient, while their health care provider will receive the technical results with more detail."
YVMC has three full-time, board-certified radiologists who interpret the images. As lead interpreting radiologist for mammography, Dr. Malaika Thompson oversees the annually accredited program. She completed a one-year fellowship at the University of Colorado Hospital, studying body imaging and dedicated breast imaging.
When Thompson is viewing breast images, she sits in a very dark room and stares at several large and expensive monitors. The level of lighting for the room and monitors is federally regulated.
During an uninterrupted block of time, she intently searches for many factors, such as asymmetric tissue, changes in density, architectural distortion, abnormal lymph nodes, thickened skin, nipple retraction and calcifications.
"We're looking for about 10 things in every square millimeter of each breast," Thompson said. "One of the most important things is comparing this year's mammogram to previous images, sometimes going back 10 or more years, checking for subtle changes.
"Breasts come in all shapes, sizes and densities," she said. "The digital technology we use makes it easier to find cancers, especially in denser breast tissue. Dense tissue shows up as white on mammograms, and so do cancers, but we can easily adjust the contrast of the digital images to bring out subtle differences in tissue density."
If YVMC radiologists have a particularly challenging mammogram, they confer with one another or contact subspecialist partners in Denver.
"Sometimes, we call patients back for additional images because something caught our eye, and we want to see more," Thompson said. "In most cases, the additional views just reassure us that everything is okay.
"But we are looking closely for changes happening from year to year because we want to find cancer in its earliest stage when there is the greatest chance of cure.
"Breast cancer is one of the few types of cancers that you can screen for in the general population," Thompson said. "The power of being able to find cancer before it causes any symptoms, when the likelihood of cure is at its highest, is precisely the reason why mammography is such a valuable diagnostic tool."
Christine McKelvie is a writer/editor for Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.