Virginia Commonwealth University Breast Imaging

Woman on a porch.

Screening Mammography

We recommend annual screening mammography for women age 40 or older who have no signs or symptoms suggestive of breast cancer or starting at age 30 for women with a significant family history (two first-degree relatives with breast cancer, particularly if the breast cancer was diagnosed before menopause or involved both breasts).

Please note that if you are having a breast-related problem, you should request a diagnostic mammogram. Do not schedule a screening mammogram, as this may delay our ability to address your specific concern

Why Get a Screening Mammogram?

Multiple studies (randomized controlled trials) of screening mammography have been done and all have shown a benefit for women who undergo screening mammography routinely. The early detection of breast cancer has been shown to decrease mortality rates from breast cancer by 33 percent to 50 percent. Early detection also increases treatment options and renders the treatment more effective.

Preparing for a Screening Mammogram

To prepare for a screening mammogram:

  • Do not use deodorant, as some deodorants can mimic deposits of calcium in the breast. A spray deodorant is available in the dressing rooms for your use at the completion of the study.
  • Although you are provided a gown, consider wearing a two-piece outfit, since you will be asked to remove your clothing from the waist up.
  • You can eat and take any medications prior to your study.
  • If you are pre-menopausal and have breast pain related to your menstrual cycle, you may want to schedule your mammogram for the week following your menstrual period when breast tissue may be less tender. If possible, avoid scheduling a mammogram the week before your period.
  • Let the technologist know if you are breast-feeding, if there is any chance you could be pregnant or if you are having any breast-related symptoms.
  • If you have had previous mammograms at another facility, it would be helpful if you could bring a list of the places and dates of those studies.
  • You will also be asked to provide information on your family history of breast and ovarian cancer, as well as your personal history of prior breast surgery or treatments. It would be helpful if you could bring a list of prior breast surgeries with dates and places.

About the Procedure

During a screening mammogram, images of each breast are obtained using low-dose radiation. We start by taking two views of each breast: the craniocaudal view, or CC, is a top-to-bottom picture of your breast, while the mediolateral oblique view, or MLO, is a side-to-side image of your breast. For some women, additional views are needed to ensure a complete, technically optimal study. Compression is used for several seconds as each view is taken to keep the breast from moving, reduce the amount of radiation used for the exposure and spread the tissue, making it easier to find small cancers. Compression can make the difference between finding and missing a cancer.

After the four images are taken, the technologist reviews your pictures to make sure they are technically acceptable and that as much tissue as possible is included on both sets of views. The study is then submitted for interpretation by one of our breast imaging radiologists.

You should plan on the procedure taking 20 to 30 minutes.

Your Results

In an effort to provide you with the best possible care, we interpret screening mammograms under optimal conditions that minimize the likelihood of disruptions and distraction. We want our attention focused on looking for potential abnormalities, such as tiny deposits of calcium or masses, and comparing the current films to your prior studies.

If your mammogram is normal or there are benign findings not related to cancer, you will receive a letter in the mail within a few days following your study.

If a possible abnormality is detected on your screening mammogram, we will call you directly. If we are unable to reach you by phone, we will send you a certified letter requesting that a diagnostic mammogram be scheduled.

Approximately 5 percent of our patients are called back for additional studies following a screening mammogram. Most patients who are called back do not have breast cancer; in some women, breast tissue superimposes, simulating the presence of a lump on the initial images. When additional views are taken by applying a small (spot) compression paddle over the area of concern, the tissue may be characterized as normal. Alternatively, in some women, ultrasound can be used to characterize a lump as a fluid-filled cyst.

When you return for the additional studies, one of our breast imaging radiologists will oversee your diagnostic evaluation and discuss results and recommendations with you before you leave our facility.

It is important to emphasize that although mammography is an excellent screening test that can demonstrate most breast cancers, it is not a perfect test. In some women with breast cancer, mammograms may be normal. It is for this reason that you should notify your doctor, or us, if you notice a change in your breast or if you feel a lump or an area of thickening in either breast.

A mammography machine.

The patient stands in front of the mammography machine and a technologist positions the breast for the craniocaudal and mediolateral oblique images. The breast is placed on the bucky (large single arrows), which holds the film or digital detector for recording the image. After the breast is placed on this surface, the compression paddle (small double arrow) is lowered to compress the breast. A face shield is present (small single arrow). Since the X-ray tube (large double arrow) can rotate, the breast can be imaged from all different sides.

Right and left craniocaudal views.

Right and left craniocaudal — or top to bottom — views of the breasts are placed back to back, as shown here for evaluation. Breast tissue is white and fatty tissue is gray. We are specifically looking for masses, microcalcifications, distortion or diffuse changes.

Right and left mediolateral oblique views.

Right and left mediolateral oblique — or side to side — views of the breasts are placed back to back as shown here for evaluation. The chest wall, or pectoral, muscles are seen on the MLO views (single arrows). Lymph nodes — normal structures under the arms — are often seen as round densities superimposed on the pectoral muscles (double arrow). Breast tissue is white and fatty tissue is gray. We are specifically looking for masses, microcalcifications, distortion or diffuse changes.

Virginia Commonwealth University Medical Center VCU Breast Imaging