Breast health experts Kim Dittus, MD, and Michelle Sowden, MD, of UVM Medical Center’s Breast Care Center join Mammography Team Leader Brittani Trombley, of UVM Health Network – Central Vermont Medical Center, to answer the 11 breast care and preventive health questions they’ve heard from their patients. 

1. Does a mammogram hurt?

Many patients come in having heard stories about how painful mammograms are. However many of those stories stem from mammograms performed on much older machines. Thankfully, there have been many upgrades to the mammography units over the years to improve patient comfort, shorten the length of the exam, reduce radiation dose and improve the quality of imaging. 

That said, we still need to use compression to help spread out the overlapping fibroglandular (dense) tissue in the breast. We use a small single-use thin foam pad on our units which helps alleviate discomfort from the compression. The compression on a mammogram should feel like pressure and may be uncomfortable for a short period of time, but shouldn’t be painful. Every patient’s tolerance of the compression varies and the technologists will work with the patient to keep them as comfortable as possible while achieving quality diagnostic images. 

2. I’m embarrassed to be naked in front of the technologist. What do you recommend?

First, you only need to change from the waist up, we have a wrap gown that you change into for your mammogram. The technologists that perform mammography are all female and are very professional. If you are more comfortable being covered, you’re welcome to leave the side we aren’t imaging covered. 

3. Why can’t I wear deodorant during a mammogram?

Certain ingredients in deodorants and powders can show up on the mammogram and can look very similar in appearance to calcifications. Even though calcifications are very common in the breast in the majority of women, they can also have a very similar appearance to a pre-cancer called DCIS that would require further follow up. Long story short, we ask patients to remove deodorant and powder from under the arm and breast to prevent unnecessary additional imaging. 

4. Do I really need a mammogram every year? If so, why?

There are varying recommendations for the appropriate age and frequency of mammograms. It is always wise to speak with your provider and review any factors that may put you in a higher risk category for breast cancer. Insurance will always cover a screening mammogram every year starting at 40 years old. Radiologists compare images from your prior mammogram imaging and look for changes in your breast tissue, so when mammograms are performed annually it makes it easier to catch small cancers at the earliest stage; it also reduces the chance of being called back for additional imaging. 

5. What do you wish patients knew about getting their mammograms?

Getting called back does not necessarily mean that a cancer was found. Any time radiologists see a change they need to ensure it is a normal change within the breast tissue. 

If this is your first mammogram, you may be called back for additional imaging. Since your breast imaging history is new to the radiologists, they have no prior imaging to compare to and are therefore very cautious as they determine what is your normal tissue. You may get called back to further evaluate an area that could be completely normal for your breast. 

If you have signs or symptoms (lump, pain, nipple discharge) then you should reach out to your provider to have a diagnostic exam scheduled. A diagnostic exam is when additional imaging is performed beyond the normal views. Depending upon the sign or symptom, an ultrasound will be scheduled to follow the mammogram. The radiologist reviews both the mammogram and ultrasound imaging and will give you results before you leave. 

However, it is also a good idea to reach out to your insurance provider to avoid any unexpected bills. Even though screening mammograms are fully covered, diagnostic exams can be put towards your deductible depending on insurance coverage. 

With screening mammograms, you will receive results within three to four business days at the latest. Results will appear on the patient portal, MyChart, much more quickly than they will arrive in the mail. If you see that additional imaging is needed, one of our technologists will call to schedule additional imaging.

The Vermont Mammography Registry paperwork is very important. It is important to complete this paperwork every year as it is used in the reading of a mammogram. The radiologists reference these forms when reading mammograms to check for any new procedures that have been performed, new family history, medication changes or any new signs or symptoms you may be experiencing. 

6. I have small breasts. Do I have enough breast tissue for a mammogram?

Imaging small-busted patients is something we commonly deal with. We have various sized compression paddles that we use to help with the positioning for smaller-breasted patients. Sometimes patients can have a sternum or ribs that protrude a little more and it is a good idea to make the technologist aware of this, but they will also look for this as well.

7. I have large breasts. How does a mammogram work?

We also very commonly perform mammograms on patients with large breasts. We have various sized compression paddles to accommodate positioning for different breast sizes. Sometimes patients have larger breasts than the largest positioning paddle we have, which is okay as well. We just take pictures of the breast in sections, to ensure that all of the breast tissue is imaged. It is common for patients with larger breasts to have more sensitive skin underneath the breast that can tear easily. If you have sensitive skin, let the technologist know, so she can be more aware when positioning your breast. 

8. Can I still have a mammogram if I have a pacemaker or port?

Yes, you can still have a mammogram. The machine will not hurt either device. Please let the technologist know, especially if the device is new since your last mammogram. The placement of the device will determine whether the pacemaker/port ends up in the mammogram. If it does, the technologist will just use less compression and may do an additional image on that side. Depending on the location of the device, the technologist may do an image of the full breast with the device and then an image of the breast tissue below the device, to get an image with better compression.

9. If I have breast cancer, must I have my breast removed?

Breast surgery has evolved a lot in the past 40 years and now there are several options for your breast if you have cancer. If the cancer is small enough, it can be removed with a “lumpectomy” and the rest of the breast is left intact. If the cancer is large, it may still require a mastectomy (breast removal). But often this is often done in conjunction with reconstruction so that you can still have a breast mound to match your other side. The survival rate between lumpectomy and mastectomy is the same.

10. Do all patients with breast cancer require radiation and chemotherapy?

No, treatment depends on the characteristics of the breast cancer and the type of surgery pursued. Each patient’s experience is unique. Our oncology experts work collaboratively with patients to develop a care and treatment plan that addresses a patient’s specific needs and wishes.

11. Why is early detection and treatment important?

Early detection has the potential to catch cancer while it is still contained within the breast and before it has spread. At this stage the breast cancer is easier to treat successfully. Regular mammograms are the most reliable way to find breast cancer early.

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