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Understanding Breast Changes: A Health Guide for Women

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Finding Breast Changes

Here are some ways your health care provider can find breast changes:

Clinical breast exam

During a clinical breast exam, your health care provider checks your breasts and nipples and under your arms for any abnormal changes.

Ask your health care provider at what age and how often you should have a clinical breast exam. During the visit, it's important to share your personal medical history and your family medical history. This includes problems or diseases that you or family members have had.

Mammogram

A mammogram is an x-ray picture of your breast tissue. This test may find tumors that are too small to feel. During a mammogram, each breast is pressed between two plastic plates. Some discomfort is normal, but if it's painful, tell the mammography technician.

The best time to get a mammogram is at the end of your menstrual period. This is when your breasts are less tender. Some women have less breast tenderness if they don't have any caffeine for a couple of days before the mammogram.

After the x-ray pictures are taken, they are sent to a radiologist, who studies them and sends a report to your health care provider.

Both film and digital mammography use x-rays to make a picture of the breast tissue. The actual procedure for getting the mammogram is the same. The difference is in how the images are recorded and stored. It's like the difference between a film camera and a digital camera.

  • Film mammography stores the image directly on x-ray film.
  • Digital mammography takes an electronic image of the breast and stores it directly in a computer. Digital images can be made lighter, darker, or larger. Images can also be stored and shared electronically.

A research study sponsored by the National Cancer Institute (NCI) showed that digital mammography and film mammography are about the same in terms of detecting breast cancer. However, digital mammography may be better at detecting breast cancer in women who are under age 50, have very dense breasts, or are premenopausal or perimenopausal (the times before and at the beginning of menopause).

Talk with your health care provider to learn more about what is best for you.

Mammograms are used for both screening and diagnosis.

  • Screening mammogram
    A screening mammogram is the kind of mammogram that most women get. It is used to find breast changes in women who have no signs of breast cancer.
  • Diagnostic mammogram
    If your recent screening mammogram found a breast change, or if a lump was found that needs to be checked, you may have a diagnostic mammogram. During a diagnostic mammogram, more x-ray pictures are taken to get views of the breast tissue from different angles. Certain areas of these pictures can also be made larger.

Mammograms and breast implants

When you make your appointment, be sure to tell the staff if you have breast implants. Ask if they have specialists who are trained in taking and reading mammograms of women with breast implants. This is important because breast implants can make it harder to see cancer or other abnormal changes on the mammogram. A special technique called implant displacement views is used.
  • If you have breast implants for cosmetic reasons, you may have either a screening mammogram or a diagnostic mammogram. This will depend on the facility that does the mammogram.
  • If you have breast implant(s) after having a mastectomy for breast cancer, talk with your breast surgeon or oncologist to learn about the best screening test for you.

MRI

Magnetic resonance imaging, also called MRI, uses a powerful magnet, radio waves, and a computer to take detailed pictures of areas inside the breast. MRI is another tool that can be used to find breast cancer. However, MRIs don't replace mammograms. They are used in addition to mammograms in women who are at increased risk of breast cancer.

MRIs have some limits. For example, they cannot find breast changes such as microcalcifications. MRIs are also less specific than other tests. This means that they may give false-positive test results—the test shows that there is cancer when there really is not.

Sometimes doctors recommend MRI for women who are at increased risk of breast cancer due to:

  • Harmful changes (mutations) in the BRCA1 or BRCA2 gene
  • A family history of breast cancer
  • Your personal medical history