What is the difference between a screening & a diagnostic mammogram?
Screening: A yearly exam performed when the patient has no clinical symptom or history of breast cancer. A screening can be done on a patient with a history of breast cancer if the affected breast was removed (Mastectomy) and 5 years have passed since the Mastectomy. The recommendation for baseline screening is at 35 years of age. This can be an insurance issue so have the patient check if they are younger than 35.
Diagnostic: An exam done when a patient has a specific new finding or is being followed at the recommendation of either the radiologist or a surgeon. A diagnostic can also be ordered for any patient with a history of breast cancer. A diagnostic mammogram is always done on patients who have had a lumpectomy and on patients who have had a mastectomy within the past 5 years. A diagnostic mammogram includes the same four standard views as a screening mammogram; in addition, it includes other specialized views. It will be seen by the radiologist while the patient is still in the office.
When and how will the patient get results?
A letter will be mailed to the patient within 30 days giving the final assessment results as mandated by the FDA. A delay can occur when comparison films are not available at the time of service. If the patient is required to return for additional imaging, they are notified by phone.
Why does your office need my previous mammogram films?
One of the most important parts of mammography is proving stability over time. This is done by having the radiologist compare the old exam with the new exam to exclude subtle differences in the breast tissue. The actual mammography films are needed for this, not just the report.
Does the patient have to have an order for a six month follow up even though it was recommended by the Radiologist?
Yes. The radiologist can only recommend that the patient have a follow up appointment. The referring physician still has to provide an order for this procedure to be done.
Does a 6 month follow up need to be a bilateral or unilateral mammogram?
The patient should have a bilateral mammogram only once per year unless there is a clinical finding in both breasts. If a patient has a bilateral mammogram with a finding in one breast, the six month follow up should only be of the affected breast. The patient should then return after another six months for a yearly bilateral mammogram. Baseline mammograms should be bilateral so the radiologist can compare for symmetry of breast tissue.
Should a patient under 30 years old with a breast lump, have a mammogram or breast ultrasound?
In general, patients under 30 with a breast lump should have an ultrasound first. The mammogram will be determined by the radiologist based on the ultrasound findings. In most patients under 30, the breast tissue is very dense and difficult to image effectively. Patients over 30 should have a bilateral mammogram and the need for ultrasound will be determined by the radiologist based on the mammographic findings. Breast ultrasound is used for a specific finding, usually a palpable lump or a mammographic abnormality and is not indicated for screening.
Once a patient has a diagnostic or abnormal mammogram, do their future mammograms always need to be diagnostic?
No. The radiologist will investigate clinical symptoms and will follow any mammographic and/or sonographic findings until they can say that it is either benign or needs to be biopsied. If the patient has a biopsy that is benign, they can return to having screening mammograms at their surgeon’s discretion.
Can a patient have a screening ultrasound if they do not like having mammograms?
Unfortunately, no they cannot. mammograms and ultrasounds image breast tissue differently. Not everything that is seen on a mammogram can be seen on an ultrasound. The standard of care dictates that mammography is the imaging modality of choice for breast cancer screening. Other modalities are used only when there is a clinical indication.
If a patient has implants or had breast reduction, is it ordered as a screening or diagnostic?
It is up to the referring physician to decide between a diagnostic or screening mammogram.