Your Top Mammogram Questions: Straight Answers From A Breast Radiologist

Not sure when to get your first mammogram? Confused about a report that says you have dense breasts? Wondering what a callback really means?

Sheela Konda, MD, breast radiologist and medical director of the Breast Imaging Center at Franciscan Health Munster and Dyer, hears these questions every day. Here are her answers to some of the most common asked questions about mammograms.

When Should I Get My First Mammogram?

If you’re at average risk for breast cancer, you should start getting annual mammograms at age 40. “That’s the current recommendation from major medical groups like the American College of Radiology and the American College of Breast Surgeons,” Dr. Konda said. If you have a family history of breast cancer or other risk factors, your doctor might want you to start sooner.

What Does It Mean If I Have Dense Breasts?

Getting a report that says you have dense breasts is common, more than 50 percent of women do. Dr. Konda explains that there are four levels of breast density:

1. Fatty: fat makes up most of your breasts
2. Scattered density: your breasts have fat and a little bit of tissue
3. Heterogeneously dense: your breasts have more breast tissue than fat
4. Extremely dense: the greatest amount of breast tissue with very little fat

If your report says “heterogeneously dense” or “extremely dense” (categories 3 and 4), it means your breasts have more tissue than fat.

“I tell my patients it’s like trying to spot a snowball in a snowstorm,” Dr. Konda said.

Dense tissue shows up white on a mammogram, just like some cancers, which can make it harder to spot changes.

If you have dense breasts, you still need annual mammograms.

“Mammograms are still necessary because they help us spot abnormalities,” she said.

Your doctor might also suggest an ultrasound, MRI or contrast mammograms to get a better look.

What Happens During My First Mammogram?

Most women say a mammogram is easier than expected.

Here’s what to expect:

• When you arrive, you’ll answer a few questions about your health history, family history and any symptoms.
• You’ll change into a gown and remove deodorant, since it can look like calcifications on your images.
• The technologist will position one breast at a time on the machine and gently compress it to get clear pictures — usually two images of each breast (side and top-down).

Dr. Konda explained that the machine gently squeezes your breast to get the best possible images.

“The more compression, the better the pictures,” she said. “It takes less radiation to get through thinner tissue, and there’s less movement, so I can see tiny changes more clearly.”

You can let the technologist know what feels comfortable for you during compression. Each picture only takes a few seconds. After finishing one breast, they’ll move to the next.

“The whole appointment takes about 15 minutes, but the imaging only takes a few minutes — usually two to four minutes,” Dr. Konda said.

What Does A Callback Mean?

First things first: try not to panic. A callback doesn’t mean you have cancer.

“Out of 1,000 mammograms I read, about 10 percent of women get called back,” Dr. Konda said. “Of those, about 80 percent turn out fine after extra images. Only a small number need a biopsy, and even fewer have cancer.”

A callback means the radiologist needs a better look. Extra images help the radiologist get a more thorough view and decide whether anything needs further testing.

Can I Get A Mammogram While Breastfeeding?

Yes, you can get a mammogram while breastfeeding, but it’s a little trickier.

“Breastfeeding makes your breasts look denser on a mammogram, which makes the scan harder to read,” Dr. Konda said.

If you’re over 40 and due for your regular mammogram, go ahead and get it. Dr. Konda recommends that you breastfeed or pump right before your appointment to help clear the milk and improve the pictures. The best time for a routine mammogram is about six months after you stop breastfeeding. This is when your breast tissue has returned to its normal density.

If you’re under 40, we usually don’t do routine mammograms unless you have symptoms.

“If you feel a lump or something changes while breastfeeding, no matter your age, don’t wait. We don’t put off a mammogram if there’s a concern,” she said. “We want to check it as soon as possible.”

Do Tattoos Or Implants Change The Results Of A Mammogram?

Sometimes. If you have tattoos, especially large ones on your chest, back or arms, they can sometimes show up on a mammogram.

“I look closely at the lymph nodes,” Dr. Konda explains. “Tattoos can make the lymph nodes look a little bigger or even show tiny white spots that look like calcifications.”

Calcifications can also be a sign of cancer, so if the radiologist isn’t sure, you might need extra images or even a biopsy to be certain.

Implants can change how your mammogram looks, too. If you have implants and one breaks, the silicone can move to nearby lymph nodes, which may need a closer look.

Does Hormone Therapy Or Menopause Affect My Mammogram?

Yes. As you go through menopause your estrogen drops and your breasts usually get less dense. But not always.

“Some women in their 80s or 90s still have dense breasts,” Dr. Konda said.

Weight gain also plays a role in breast density.

“As we go through menopause, we tend to gain more weight, and some of that fat gets deposited in the breasts,” she said. “Typically, breasts get less dense with age and menopause, but that’s not true for everyone.”

Hormone replacement therapy (HRT) can affect breast density.

“I’ve seen breasts get much denser after someone starts HRT,” Dr. Konda said. “When they stop, the density goes back down.”.

These changes are normal and something your radiologist watches for carefully.

What If I Had A Mastectomy?

If you had a full mastectomy (removal of breast tissue), you likely don’t need routine mammograms. However, if you had a mastectomy on one side and have a breast or implant on the other side, you’ll still need screenings for that breast.

If you feel a lump after mastectomy, your doctor may recommend an ultrasound or MRI instead of a mammogram.

“We can sometimes image if there’s any remaining breast tissue, but we usually do a diagnostic exam, not routine screening,” Dr. Konda said.

Is Pain After A Mammogram Normal?

You shouldn’t feel lasting pain after a mammogram. But timing matters.

“It’s best to schedule your mammogram when your breasts feel least sensitive, usually about two weeks after your menstrual cycle,” Dr. Konda said.

If your breasts feel tender or sore, taking Tylenol before your appointment can help. Compression lasts only a few seconds during imaging, and any discomfort usually goes away soon after.

How Do Doctors Know If Cancer Has Spread To A Lymph Node?

It can be hard to see lymph nodes clearly on a mammogram, which is why the technologist works to position you just right.

“We look at the size and shape and whether there’s anything unusual inside the node, like calcifications or changes in shape,” Dr. Konda said.

If a lymph node looks unusual, you’ll get a callback for an ultrasound. Sometimes, you’ll need a biopsy to confirm whether it’s inflammation, caused by a tattoo, infection or cancer.

Do Men Get Breast Cancer?

Yes, men can get breast cancer. It is rare, though.

“When men do get breast cancer, it’s often more advanced because they don’t expect to get it and may ignore symptoms,” Dr. Konda said.

Family history, genetics or even a history of prostate cancer can raise a man’s risk. If a man notices a lump or changes in his breast area, he should see a doctor right away.

No matter your situation, Dr. Konda wants you to know your care team is here to answer every question and guide you with expert care. “Mammograms save lives, and we’re here to make the process as clear and comfortable as possible.”

Schedule Your Mammogram

Ready to schedule your mammogram or 3D mammogram? Find a Franciscan Health Breast Imaging Center near you and make an appointment. Your care team is here to answer questions and make the process clear and simple.