A mammogram is an X-ray picture of your breasts. You might have had one done because you or your doctor thought it was time for you to have it (this is called a screening mammogram), or because you had a problem with your breasts that made your doctor decide you needed one. The mammogram is read by a radiologist, who is a specialist interpreting X-ray pictures. When they see "something" in one or both breasts, they are most commonly talking about either a spot within the breast which looks different than the normal breast, or about calcium deposits. A spot can also be called "a density", or it can be called "an area of asymmetry", or it can be called "a mass," or it can be described in several other terms. Calcium deposits are commonly reported as "microcalcifications," or they are described according to how they look on the mammogram. Finally, the radiologist gives the mammogram a code number, which is called a "BIRADS" code. For example, the radiologist might say that the findings merit a "BIRADS 4" classification, or a 3, or any one of seven (from 0 to 6) categories. The BIRADS code summarizes what the radiologist thinks about the findings. So, a BIRADS 4, for instance, means the radiologist thinks the spot seen on the mammogram should be biopsied.
At this point, then, you probably will be referred to a physician, usually a surgeon, who will examine you and explain to you what he/she thinks needs to be done. The physician who checks you can be one your doctor is referring you to or someone you choose. You may also choose to make an appointment with a doctor from the list you will find in this website. Remember that the mammogram report not always coincides with the decisions your surgeon might suggest. This means that sometimes, for example, the doctor might suggest waiting even when the mammogram suggests a biopsy, or the opposite: you might be asked to proceed with a biopsy while the mammogram suggests waiting.
An ultrasound is a picture of your breasts obtained using sound waves which cannot be heard by the human ear. Most commonly, an ultrasound is done after a mammogram has shown something that needs further evaluation, although this is not always the case. An ultrasound study may be done instead of a mammogram because the patient is fairly young, for instance. This may be the case because a mammogram is not as useful when the breast tissue is very dense, as is usually the case in young women.
Most commonly, an ultrasound is done to help the physician decide if what was seen in the mammogram is solid or cystic. If it is cystic, the concern level goes down, because cysts are very common and usually harmless. However, there are variations on this theme and your physician will explain about cysts in further detail after you are evaluated.
When the radiologist reads your mammogram, he or she might find something in the X-rays that requires more detailed imaging. When that is the case, the radiologist will want additional pictures, to help decide if what they see is of concern. Many times, the area of interest seen on the X-rays is not a real finding. This can happen, for instance, because normal breast tissue overlaps and shows on mammogram as an abnormal area. After more pictures are taken, the radiologist can decide one way or the other. If an abnormality is really present, the radiologist can have a better idea of what the problem might be and suggest a course of action.
When the X-rays of your breasts show calcium deposits, the radiologist will look carefully at the characteristics of the calcium before reporting his/her opinion. Calcium deposits are more common in older women and post-menopausal patients. They can show up in the breasts for many reasons: commonly, patients have some type of fibrocystic condition that attracts calcium. So, calcium can be seen in patients with cysts, in patients who have had previous breast surgery, and so on.
Calcium deposits can be large or small. When they are large, they might show like white dots in the mammogram. They can also show along the veins and arteries of the breast. In these cases, the radiologist will usually report the calcium deposits as benign (which means non-harmful).
Sometimes, the calcium shows up in small clusters with irregular shapes. This type can suggest cancer, so it is common that your doctor will want to sample the tissue that contains this type of calcium. The probability that this type of calcium deposits is cancerous is approximately 25%, which means that 75% of the time these suspicious findings are actually benign.
If you want to know how these deposits are sampled, read the section about a biopsy. To do that, scroll down to the section titled "I was told I might need a biopsy."
The normal breast usually feels lumpy, because the glandular tissue is grouped in clusters called "lobes." So when a patient is checked by the doctor because she has a lump in the breast, the first thing the doctor does is to decide if the lump is part of the normal lumpiness of the breast, or if the area in question is different from the rest of the breast tissue. If the doctor feels an area that is different from the rest of the breast, he/she will describe that area as "a dominant lump," meaning that the lump he/she feels is real. Sometimes, the examining physician will describe an area of thickness, rather than a lump.
When a real lump is found, the physician will want to determine what kind of lump or thickness it is. The doctor can, for instance, run a mammogram, or an ultrasound, or both, to see what kind of lump it might be. For instance, an ultrasound might show that the lump is only a cyst. It is possible that the physician will choose to place a small needle in the lump, which he/she can do by feel, or under the guidance of an ultrasound machine, for example. Most of the times, if the lump is not a cyst, the physician will choose to do a biopsy, which nowadays if usually done with a needle and fnot with an incision.
Nowadays, breast biopsies are most commonly performed using a needle instead of an incision. In general, the type of needle used is one that allows the doctor to take samples of tissue. Sometimes, the physician will use a fine needle that only allows removing cells for analysis, rather than actual tissue. The biopsies that remove only cells are called "fine needle aspiration biopsies," while the ones that remove actual tissue are called "core biopsies."
Because a biopsy is done without an incision, you will hear that they are referred to as "minimally invasive" biopsies. This means that the patient really goes through a fairly simple procedure, despite the complex machines used to perform these kinds of biopsies.
These "minimally invasive" biopsies refer mostly to two different types: one which is called a "stereotaxic biopsy," and another which is called "ultrasound guided mammotome biopsy."