What to expect during your first mammogram

Kerry-Lynne Marais, a senior mammographer, takes us step-by-step through the procedure of a mammogram.

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Going for a mammogram is always a stressful outing, whether it’s your first time or your 21^st time. The reason is obvious: mammograms are designed to pick up one thing only, breast cancer. And breast cancer is a really scary prospect.

At your first mammogram appointment you have the added anxiety of not knowing what to expect, not to mention the fear that the mammogram procedure will be painful.

However, the benefits of early diagnosis, definitely make it worth it. The peace of mind a normal mammogram gives you is priceless. 

Arrival

As with all medical procedures, there’s paperwork to do when you arrive. In addition to personal details and medical aid numbers, there is a questionnaire about your breast history and any breast cancer in your family. You will also be asked about any current symptoms, for example, a palpable lump.

Time to meet the mammographer 

Mammographers take the mammogram pictures. Besides that, they will also guide you through the process and explain everything along the way. You will then go to the changing rooms where you put on a gown; bra and top off. 

Next stop, the mammogram room 

Standing in front of the machine, the mammographer will gently position your breast between the two plastic paddles. Mild compression of the breast is necessary so that a clear mammogram can be captured. At most, it’s a bit uncomfortable. Mammograms are generally not painful. Two pictures are taken. One from on top (craniocaudal (CC) view) and one from the side (mediolateral oblique (MLO) view). Taking the pictures is very quick once you are properly positioned. The whole procedure will take five to 10 minutes. Once the mammogram is performed, you will either return to the change room, or be directed to the ultrasound (sonar) room.

The ultrasound

The purpose of the additional ultrasound exam after the mammogram is to identify any lumps that may have been hidden by dense (thick) breast tissue on the mammogram pictures. Ultrasound is also an excellent way to differentiate harmless from worrying lesions.

The radiologist (X-ray doctor) will look at your mammogram before coming to do the ultrasound. For the ultrasound, you lie flat on your back with your hands behind your head. Once the doctor has told you what was seen on the mammogram, they will do the examination. Gel is squirted onto your breasts and the doctor moves the ultrasound probe around each breast to get a picture. This is also a good time to tell your doctor about any breast concerns or to ask some questions.

The result

The radiologist will usually tell you straight away whether the ultrasound and mammogram are normal or whether something further is needed.

If all normal, you are done. You can get dressed and be on your way. The report will be sent to your doctor.

If a lesion looks harmless but it’s your first time, you may need to be reassessed in six months’ time. If something abnormal is found, the doctor will recommend a biopsy. 

This only happens to about one in 15 patients. Of the biopsies, about one in four show cancer. 

Biopsies are procedures where a needle sample is taken from the area of interest and sent to the pathology lab for diagnosis. They are minor procedures that are painless since local anaesthesia numbs the skin and breast tissue. Biopsies are most often performed on another day.

How often should you have a mammogram?

Mammograms should be done on a regular basis to be effective. Once every one to two years is recommended from age 40.

Patients with a higher risk are advised to start earlier, at 30 or 35. In women younger than 35 who need to be assessed, the mammogram is usually left out and only the ultrasound is performed. The reason is that the small amount of radiation from a mammogram poses a slightly higher risk to young breast tissue. Plus, young women tend to have very dense tissue that makes mammograms less effective.

Header image by Adocbe Stock