Breast Cancer Awareness: Mammogram Questions Answered by Margaret Keuffer, RTRM

As you've probably deciphered from the presence of pink ribbons and media attention on the subject, October is National Breast Cancer Awareness Month. This is a time to remember those affected by breast cancer, raise awareness on the topic, and remind people everywhere the importance of breast health.

Early detection is a key to surviving breast cancer, and mammograms are the best screening tools to do just that. Most women realize the importance of mammograms, but many don't understand the specifics of the procedure.

In an effort to spread mammogram and breast health education, Margaret Keuffer, a registered technologist in radiography and mammography, has agreed to an interview. Keuffer has 35 years of experience on the topic, including experience as a director of radiology and as a speaker for breast health/mammogram seminars.

Z.J.: What kinds of breast cancers can mammograms detect? Can they detect other things besides cancer?

Keuffer: There are many different types of breast cancer that mammograms can detect, and which stage the cancer is at when found is also important. The most common types are listed here.

Screening Mammograms also find many non-cancerous or benign structures in the breast. The most common are fibroadenomas, or fibrocystic breast tissue. These benign tumors are composed mostly of fatty tissue and feel lumpy-bumpy in the breast. There are various types of benign cysts as well. Post menopausal women have a less chance for these findings. They are most common in younger women.

Z.J.: What breast issues, if any, can they not detect?

Keuffer: Some breast cancers that show as suspicious findings on a Screening Mammogram are better visualized with the aid of ultrasound. Other breast cancers, usually containing tiny calcifications, are better visualized with additional specialized views called a Diagnostic Mammogram.

Z.J.: You mentioned that sometimes findings can be visualized on an ultrasound. Why are mammograms preferred over ultrasounds?

Keuffer: Often times, patients who have been called back for a follow up to their screening mammogram for an ultrasound show up for their next annual screening mammogram and demand to have an ultrasound only because they don't want the compression for each screening view. Unfortunately, ultrasound is a very useful tool only for cystic, or fluid filled structures. A screening mammogram is the best screening tool currently available to visualize the entire breast.

Z.J.: High risks groups aside, when should women begin getting mammograms and how often?

Keuffer: In the U.S.A., medical facilities and practitioners follow the American Cancer Society's guidelines for screening mammography. While there has been controversy over the years, it is strongly recommended to have the first screening mammogram performed at age 35. This will be the baseline mammogram. Then annual screening mammograms start at age 40 (unless family history or physical findings indicate earlier).

Early detection is the best protection. Why wait more than 1 year for your next mammogram?

Z.J.: Another well-known detection tool is a self breast exam. Would you like to share any tips on these?

Keuffer: Performing monthly breast self exam should begin at age 20. Perform this exam 7 - 10 days after the menstrual period. For post menopausal women, choose the same day each month. Have a physical breast exam performed by your practitioner every 1 - 3 years or sooner if you find something during your monthly self exam.

Ask your doctor to instruct you in the correct technique. The object is to remember you're not on safari looking for breast tumors! MEMORIZE what your breast tissue feels like, so when a change occurs, you'll know. YOU are on your own front lines; be a partner with your doctor.

Z.J.: What should women expect when they get their first mammogram?

Keuffer: When having your first baseline mammogram, expect to have four standard views total performed; two views each breast. If the breast is larger than the image receptor, more than one exposure will be necessary to obtain one full image of all the breast tissue.

Z.J.: What can women do to best prepare for the examination?

Keuffer: To prepare for your mammogram it is recommended the patient schedule her mammogram when her hormone level is at its lowest. This would be 7 - 10 days after her menstrual period ends. The breasts are less tender at this time.

Do not wear any deodorant, lotions, powders, creams or talcs on the chest, breasts or armpits, and especially do not wear any perfumes with glitter in them! Minute particles in these products embed in the skin pores and appear as positive findings on your mammogram, giving you a false positive report. If you forget, tell the technologist what product you wore and where, and she will have you wash yourself.

Also, stop ingesting caffeine for three days prior to your scheduled mammogram as caffeine causes breast pain in many women.

Z.J.: Women often complain because of the compression. Why is such compression necessary and what can women do to alleviate the pain?

Keuffer: Breast compression is vital to obtain the best possible image. Mammography is not 3D, so structures overlying each other are often hidden. Compression spreads the tissues apart and allows the radiologist interpreting your images the most amount of information. Visualize a bowl of Jell-o with different types of fruit inside it; looking straight down, you have no idea how many pieces of fruit are hiding underneath each other. Compression allows these structures to spread apart.

To help yourself during the compression portion, allow all your upper body muscles to go limp. The technologist often tells you to relax. Through gritting teeth and stressed muscles the patient yells," I AM RELAXING!"

Tense, stressed, taught chest, arm and hand muscles make the compression HURT. Drop the shoulders limp, breathe, drop the fists limp, and don't GRAB the bar. Grabbing the bar causes the muscles from the hand all the way to the chest wall muscle tense.

Don't "assist" the technologist by sticking your chest out, or lifting your own breast onto the image receptor. Positioning of your breast is crucial, and the technologist is the expert.

Don't keep trying to "look" at your breast during positioning and compression, it pulls the breast away from the image receptor and the technologist will likely have to repeat the image. Nobody wants repeats.

Allowing your muscles to go limp, listening, and obeying the technologists instructions will make your mammogram faster and pain free. If you happen to be a patient with painful breasts, talk to your doctor beforehand and ask if you should take Tylenol, Motrin, etc. to help yourself before you arrive.

Z.J.: What effect do breast implants have on mammograms? Do women with breast implants have additional risks as far as the compression is concerned? If a woman does have implants, what should she tell her doctor?

Keuffer: Women who have breast implants always get two complete set of mammogram exams. One set as you are, and the second set with the implants displaced forward, compressing only your breast tissue. The first set is to check for the integrity of the implants. The second exam is to visualize your breast tissue. Because of the force impressed upon the natural breast tissue by the implants, it is seldom possible to visualize all of your natural breast tissue, which can lead to missing a breast cancer.

Compressing the implant will never cause it to break. The implants are made to withstand far more pressure than the necessary amount of compression exerts.

If you go to a different facility year to year for your mammograms, always contact the prior facility and request those past mammograms. You need them for the radiologist to compare the new exam to.

Z.J.: Do you have any additional tips or information about mammograms you'd like to share?

Keuffer: It's important to arrive early for your mammogram appointment. You have to fill out history information every year. Most facilities today allow 15 - 30 minutes per patient; if you are late, don't be surprised if you are told you need to reschedule. It isn't fair to make all the patients scheduled after you wait.

Z.J.: Personally, why do you believe spreading information about mammograms is so important?

Keuffer: When mammography technology started improving greatly in the 1980's, they also started collecting data on breast cancers found. Back then, the statistics were 1 in 10 women will develop breast cancer sometime in their life span, most of these post menopausal.

Today, the statistics are 1 in 7 women. This isn't because there are more breast cancers out there; it's because we have done a better job getting women in to have their screening exams done. We must continue getting women in, dispelling the fears of compression and the fears of cancer. So many improvements have been made in treatments because the cancers are being detected at earlier stages then prior decades. Women are not only surviving, but living longer. Early detection is the best protection.

Z.J.: Finally, what aspect of your job would you say is the most rewarding?

Keuffer: The most rewarding part of being a mammographer is being an integral part of the team that does the screening and diagnostic mammograms, the ultrasounds, and assists the radiologist performing the biopsies. Catching these breast cancers at their earliest stages is the best part. Performing the positioning and compression is an art as well as a science. Mammographers learn to see the internal breast structures in 3D in their mind's eye, allowing more creativity in obtaining the utmost best images when the patient is not physically able to participate in the procedure due to physical disabilities and other reasons.

I'd like to send out a huge thanks to Margret Keuffer for her participation in this interview. Her thorough answers not only shine a light on the details of the procedure, but they also illustrate the importance of the exam. Hopefully this interview has answered many of your mammogram questions.

For more information on breast health and Breast Cancer Awareness Month, please visit National Breast Cancer Awareness Month. Org.