Mammograms

I’m 38 years old now, and my mother has been after me to get a mammogram for three years. So, me being me, I started calling around and ended up speaking with Anita LaBreque, director of mammography at Imaging Health Care Specialists in San Diego (866-558-4320, imaginghealthcare.com).

“There are three modalities for evaluating the breast,” explained LeBreque. “Mammograms, ultrasound, and MRI — magnetic resonance imaging. The way a patient advances through those procedures depends on personal and family history. Each one helps to enhance the image the radiologist works with to evaluate the breast for signs of breast cancer. We’re looking for minute things, things like calcifications that might be the size of a few grains of salt or mass densities that might be an early form of cancer.”

Most people start with mammograms. “Women between the age of 35 and 40 should get a baseline — first — mammogram, and after the age of 40, every woman should have a mammogram once a year.” LeBreque was sensitive to the hesitation a woman might feel. “It’s one of those procedures where you come in with absolutely no problems and can end up having something. So, it can be a scary exam. I spend time with women, especially first-timers, explaining the exam and making sure they are comfortable. Number one, I want to make sure they come back. And, number two, this isn’t something they should fear. It really is a good thing; if we do find something the size of a few grains of salt, there is a very, very good cure rate.” (LeBreque also noted that monthly self-e xams are also important. “We provide information on how to do this at the center. It plays a key role because when you note changes in your breast is when you should get in touch with your doctor.”)

LeBreque described the mammogram procedure for me. “First, we ask that you not wear any powders, lotions, perfumes, or deodorants, since they can create artifacts on the images. The procedure itself is relatively painless. You’re asked to undress from the waist up, and then you go into the mammography room and your breast is gently placed on a platform, which is called a detector. Then a compression paddle comes down and compresses the breast.”

Compression of the breast tissue is critical, said LeBreque, “because of the way it flattens out the structures within the breast,” allowing for a clearer view of abnormalities. “We do go for an adequate amount of compression so that the breast is taut, which yields an optimal exam. It is uncomfortable for a few seconds,” granted LeBreque. “Different women react differently. I talk to my patients as I compress,” so that they can give feedback. “Some women’s breasts are very, very tender, and we’re not going to get what we want. But my goal is not to get this maximum mammogram. If you can tolerate it, that’s wonderful, but I’ll stop compression when you want because I don’t want you to say, ‘Those are horrible exams. I’ll never have one again.’ ”

The radiologist gets help in clarifying the resulting image through computer-aided detection (CAD). “We incorporate a computer program that looks for regions of interest, to help draw the eye of the radiologist. Things like intersecting lines, which would be known as architectural distortion. It’s not a substitute for the radiologist’s eye, but it is an aid.”

I wondered about risks involved, and LeBreque was sympathetic. “But the benefits certainly outweigh the risks. Radiation is involved, and it’s specific to the person. Someone who has a very thin, fatty breast is going to need less radiation than someone who has a very large, dense breast.” In the latter case, “More radiation is needed to penetrate the tissue. But we can find cancers that are only millimeters large, and that kind of early detection can save lives.”

Mammograms are either screenings (a checkup with no prior symptoms reported) or diagnostic exams (patient is presenting with a problem: pain, a lump, or discharge). Screenings at Imaging Health Care Specialists are $175, and they can bill your insurance (referring physician required).

Another option: Mammography Screening Center in Hillcrest (619-234-3918). The cost for a basic mammogram is $115 without breast implants, $155 with breast implants. While no insurance is accepted, they will give you forms to submit to your insurer. A physician’s referral is required for the procedure, and results are given before you leave.