Mammography has come a long way since a few radiologists began using it to identify breast cancer in the 1950s.[1] From the development and refinement of screen film technology through the 1980s to digital mammography at the turn of the century and modern low-dose 3-D imaging, the steady march of technological improvements has enabled doctors to identify and treat breast cancer at earlier stages and facilitate better outcomes.[2]

You followed your doctor’s advice and got your annual screening mammogram. You left the imaging clinic feeling good about keeping on top of your preventive health care. A couple of days later, however, you were surprised to get a call from your doctor’s office asking you to come in for follow up. You had assumed you’d get a letter a week later saying everything is fine, but now, you are worried about the possibility of breast cancer. What should you expect?

When you look at mammography or ultrasound images, you might wonder how radiologists make any sense of them. How can they identify potential cancers in those Rorschach tests of gray and white? While even the most advanced imaging technology doesn’t allow radiologists to identify cancer with certainty, it does give them some strong clues about what deserves a closer look. Today we’ll discuss a few things that radiologists are on the lookout for when examining mammography and breast ultrasound images.

No!

Worry is understandable. You were probably expecting the standard letter in the mail saying your mammogram was normal, but instead, you got a call from your doctor. Take a deep breath, and understand that the vast majority of mammography follow up does not result in a cancer diagnosis. In fact, more than one in ten women may be called back after a screening mammogram,^[1] but fewer than one in ten of those women are found to actually have cancer.^[2]

You’ve probably heard that one in eight women develops breast cancer during her lifetime. Steps such as staying active, maintaining a healthy weight, eating a healthy diet, and limiting alcohol consumption can help reduce your risk, but even the healthiest lifestyle is no guarantee against breast cancer. Major medical associations including the American College of Radiology, the Society for Breast Imaging,^[1] and the National Comprehensive Cancer Network^[2] recommend annual mammography screening for women who are at least 40 years old and at average risk for breast cancer.

By now, you’ve probably heard of 3-D mammography, properly called breast tomosynthesis. Unlike traditional mammography, which uses two X-ray images of each breast (one vertical and one horizontal), tomosynthesis uses a series of digital images, which are taken as the mammography machine moves in an arc over the breast. These images are then assembled by computer into a 3-D image that the radiologist can examine in detail. Even though many more images are captured, modern breast tomosynthesis technology can accomplish this using a radiation dose that’s similar to that of a conventional 2-D mammogram.^[1]

In April of last year, Iowa passed its breast density reporting law. As a result, beginning this year, all mammography reports in Iowa are required to include information about the patient’s breast density and, for patients with dense breasts, information about how breast density relates to cancer risk and mammography screening. Here is what you should know about the information you receive with this year’s mammogram results.

Breast masses can take many different forms, some cancerous and some benign. Phyllodes tumors are among the less common types of breast mass.

What is breast density?

Breast density refers the relative proportions of fat vs. fibrous and glandular tissue in the breast. Because fat is less dense than other breast tissues, breasts containing a relatively small proportion of fat are considered dense. While dense breast tissue is more common in younger women and women who are at or below a healthy weight, older women and those who carry excess fat in their bodies can also have dense breasts. The only way to know for sure is by using mammography or other breast imaging technology.

In 1993, the third Friday of each October was designated National Mammography Day in an effort to encourage women to get screening mammograms. Today, we take this opportunity to celebrate the contribution mammography has made to women’s health care. Advances in this technology and in our understanding of breast cancer has helped many women to live longer, healthier lives.