It’s a simple message – get your annual mammogram to detect breast cancer at its earliest stage. But you may be surprised to hear there are two types of exams.
Doctors who devote their practice to empowering patients want women to know the differences and when to advocate for additional tools.
Dr Sonya Bhole is focused on women’s health, especially when it comes to educating her patients.
“I think there are so many people don’t understand the difference,” she said.
The Northwestern Medicine radiologist reads dozens of mammograms a day, the images are the result of screening and diagnostic exams.
“So a screening mammogram is a routine surveillance tool that we use for asymptomatic women, so women who do not have any symptoms, that are coming to find if they have breast cancer at a point that it can’t be felt,” Bhole said.
That’s the majority of women. During a screening mammogram, a technologist gathers two views of each breast. The exam, which is regularly covered by insurance, is quick – about 20 minutes or so. Patients should receive results within 30 days in the mail or sooner through their online portal. Even women with dense breast tissue – that’s 50 percent of the population – benefit from a screening exam but also may be offered supplemental tools such as ultrasound or MRI.
“So this is a great example of a screening mammogram … This is a patient who has dense breast tissue,” she said. “These are the two views we talked about on a screening mammogram … These are the ones we’re taking from top to bottom, and this is side view from side to side. … It’s the only modality that can show calcifications which are the earliest form of breast cancer.”
So, no symptoms – go with a screening mammogram. But “if you truly have a new symptom a screening mammogram isn’t sufficient,” Bhole said.
That’s when a patient needs a diagnostic mammogram.
“So we’re using it to really investigate symptoms such as someone feeling something new in their breast or new nipple discharge,” Bhole said.
A diagnostic exam takes place in the same room using the same machine.
A diagnostic exam is longer — plan for two to three hours to allow time for the technologist to take additional views of the breast, some with magnification. An ultrasound is often added to the exam to explore specific areas; patients need a referral from a doctor; and insurance may not cover the test, so expect some out-of-pocket costs. Radiologists read the images in real time and patients receive their results the same day.
“The misconception here is that the diagnostic examination is the better test, it’s not and actually if you came in as a diagnostic appointment but you were asymptomatic you would get the exact same four pictures on your breast that you would get as a screening examination,” Bhole said.
A diagnostic exam is also used when doctors are closely following a breast anomaly or if something is found during a screening exam. That’s called a call back.
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