Mammograms & Dexa scans

[maxaroni]

We have recently moved to Delaware, coming from South Jersey. Have never lived anywhere but NJ up to now, so many things we are adjusting to.

This morning I had both my mammogram & dexa scan done, another of the different things in Delaware. Looking to see how things are done where you live. Generally, when I make my appointments for these 2 procedures, I will get some instructions such as don’t use deodorant or lotion for the mammogram and no zippers or metal for the dexa scan. Also, no calcium supplements for 24 hours prior to dexa scan. When I made the appointments here, nothing was said. I know they have deodorant wipes at the radiology facility.

So, for my mammogram this morning (3D which I have had for many years), I was only positioned 2 ways and she barely squished the breast. I questioned this as usually it hurts to be very squished and the reply was ”you are fine”. The reason I questioned it as I have had a mammo done where the technician didn’t squish too much because I said “ouch”. Geez. What happened was needing to be rushed into Philly for a needle biopsy as they saw something. Go for the biopsy and had the mammogram done for needle placement and nothing was there. That’s when it was determined that I was not compressed enough because I said ouch and it created a fold in the skin. I usually have 2 different positions on each breast, facing front and sideways with my arm draped over the machine. I usually get positioned with the tech having me really close to the machine with my arm draped to get all the side in the film. Today, I had only 1 position on each breast, the one where my arm is draped on the machine. She barely pulled it all in trying to get as much in there as she could and didn’t compress to hard.

As far as the dexa scan goes, in the past I was told to take off my bra as it has metal in the back. If wearing pants with a zipper, pants off and use a gown. Today I was able to wear my bra and they were okay with the zipper, just having it unzipped. Also, only 2 views of my one hip as I have had hip replacement on my other hip. In the past, they have included wrist and several views with my knees up and a foam piece under my knees for positioning purposes. I questioned the metal and was told there is no reason to take them off.

Edit to add: My covid booster was 3.5 weeks ago and I did alert them. They said no problem and hadn’t asked about timing at all. The only question was if I had the vaccine. I had the appointment for the mammogram and had forgotten about it when I went for the booster.

What have your experiences been?

 

[Christine]

It's been a while since my Dexa so I can't comment.

Just had a mammogram, 3D, and I had the usual 4 views taken. I booked my appointment online and it probably said something about the deoderant, etc., but I can't remember and no one asked me a thing when I got there and they haven't for a few years (I've done the same place for 20 years now). They did require you to wait 6 weeks after the COVID vaccine. Real specific about that.

 

[Skippy918]

I’ve gotten the 3D mammos and it’s 2 images per side. I asked about deodorant and apparently it’s not an issue for the 3D machines.

 

[anniemae]

My place does both 3d and traditional 2d and I believe it is 2 images per side (2d can be done at the same time as the 3d, you just have to hold still a bit longer). They never say anything about deodorant, perfumes, lotions etc. They just have a box of wipes and tell you to use them if you have deodorant on.

 

[easyas123]

We have recently moved to Delaware, coming from South Jersey. Have never lived anywhere but NJ up to now, so many things we are adjusting to.

This morning I had both my mammogram & dexa scan done, another of the different things in Delaware. Looking to see how things are done where you live.

Well, I live in Maryland but often get my mammogram in Delaware because my dr. is up at Christiana....although I have had them in Maryland (Kent County) as well. Haven't noticed any difference in terms of one state over another.

 

[HangWithMerida]

Breast imager here.
1. Screening mammogram includes at a minimum 2 views of each breast. One compressing from above and below, and another compressing side to side. Sometimes, a technologist will include additional angles if there are folds or tissue at the edge of the film not included on the standard views. If you have implants, the standard exam is 4 views of each breast, with each angle performed both including the implant and pushing it back.
2. Compression is important. It helps eliminate false positive findings from overlapping tissues, makes real findings easier to see, and decreases the radiation dose of the study. It sounds like you have had a few mammos so you have a benchmark for what that compression feels like. If you feel like you weren't really compressed, you probably weren't compressed enough. A good technologist will work to pull you in as close to the machine as possible so that as much of the breast tissue as possible is included on your mammogram. A radiologist cannot find a cancer that isn't included on the images. Again, you have a benchmark here. If you feel you were not pulled in well, you probably weren't.
3. Deodorant/lotions/powders: With the tomosynthesis/3D, deodorants and the like cause less of an issue. However, we still recommend not wearing or removing them with wipes. Some of these products can cause an artifact that looks like calcifications. On a 3D exam, it is easier to see that the fake calcifications are in the skin, but they are distracting and the cleaner an image is the easier it is for the radiologist to notice new or subtle findings that could turn out to be cancer.
4. COVID vaccine info: We ask this because some people will get short-term enlargement of the lymph nodes under their arms after receiving the vaccination. With widespread vaccine efforts underway, the piece of info can help avoid unnecessary additional imaging or biopsies in patients who have a reason for some plump lymph nodes. The exact timing is less important than just knowing if someone has received the vaccination since the entire population is still in a several month window of when they were vaccinated. Moving forward, we will have to see if this is something we continue to see if annual vaccination becomes standard.
5. DEXA - removing metal is important. All the extra images you described are not always necessary but sometimes are also included.

In short, I don't think the differences you are describing are due to the state being different. It sounds like maybe you came from a center that did high quality imaging and unfortunately landed somewhere that may not be doing as good of a job. You can always consider trying out another place.

 

[LuvOrlando]

I've had them at well run breast centers and also at half trying facilities at general places, big difference all the way around.
I'd find another breast center & if you get any pain or discomfort at all tell your Dr and they should do a diagnostic mammo, which is basically a do over at a specialized center. Actually, I discovered the breast centers when I reported a pain.

 

[anniemae]

Breast imager here.
1. Screening mammogram includes at a minimum 2 views of each breast. One compressing from above and below, and another compressing side to side. Sometimes, a technologist will include additional angles if there are folds or tissue at the edge of the film not included on the standard views. If you have implants, the standard exam is 4 views of each breast, with each angle performed both including the implant and pushing it back.
2. Compression is important. It helps eliminate false positive findings from overlapping tissues, makes real findings easier to see, and decreases the radiation dose of the study. It sounds like you have had a few mammos so you have a benchmark for what that compression feels like. If you feel like you weren't really compressed, you probably weren't compressed enough. A good technologist will work to pull you in as close to the machine as possible so that as much of the breast tissue as possible is included on your mammogram. A radiologist cannot find a cancer that isn't included on the images. Again, you have a benchmark here. If you feel you were not pulled in well, you probably weren't.
3. Deodorant/lotions/powders: With the tomosynthesis/3D, deodorants and the like cause less of an issue. However, we still recommend not wearing or removing them with wipes. Some of these products can cause an artifact that looks like calcifications. On a 3D exam, it is easier to see that the fake calcifications are in the skin, but they are distracting and the cleaner an image is the easier it is for the radiologist to notice new or subtle findings that could turn out to be cancer.
4. COVID vaccine info: We ask this because some people will get short-term enlargement of the lymph nodes under their arms after receiving the vaccination. With widespread vaccine efforts underway, the piece of info can help avoid unnecessary additional imaging or biopsies in patients who have a reason for some plump lymph nodes. The exact timing is less important than just knowing if someone has received the vaccination since the entire population is still in a several month window of when they were vaccinated. Moving forward, we will have to see if this is something we continue to see if annual vaccination becomes standard.
5. DEXA - removing metal is important. All the extra images you described are not always necessary but sometimes are also included.

In short, I don't think the differences you are describing are due to the state being different. It sounds like maybe you came from a center that did high quality imaging and unfortunately landed somewhere that may not be doing as good of a job. You can always consider trying out another place.

Out of curiosity, why do they ask you to hold your breath when imaging? I am standing in the vice, head back, shoulder back, trying to stay still and she says, "stop breathing". I feel like I'll mess it up somehow LOL. At the place I go to, I believe they do both 2d and 3d at the same time.

A good imager is worth her weight in gold IMO. I actually like it when they are particular, and maneuvering me around and pushing and pulling to get me in the right spot. I also tell them to "do what they need to do" in terms of my comfort with the compression. I can stand the discomfort if it means no call back!

 

[HangWithMerida]

Out of curiosity, why do they ask you to hold your breath when imaging? I am standing in the vice, head back, shoulder back, trying to stay still and she says, "stop breathing". I feel like I'll mess it up somehow LOL. At the place I go to, I believe they do both 2d and 3d at the same time.

A good imager is worth her weight in gold IMO. I actually like it when they are particular, and maneuvering me around and pushing and pulling to get me in the right spot. I also tell them to "do what they need to do" in terms of my comfort with the compression. I can stand the discomfort if it means no call back!

Despite the compression, breathing causes more movement of your chest and therefor your breast tissue than you probably realize. Taking an image only lasts a few seconds, but if the tissue moves during that time, the image can be blurry. Blur might not limit a radiologists ability to see something large, but the small things, like calcifications, or more subtle findings can easily be blurred out completely. Since our goal is early detection, we want all the detail!

Mammogram positioning feels really awkward and can certainly be uncomfortable. The most important thing patients can do to help a technologist get a good image in as few tries as possible is relax and let the technologist do the work. They will rotate you, pull a little more, tweak the positioning to line things up and fix things they can see, like folds or tissues being excluded. Those extra steps can vastly improve the image that you get.

 

[HangWithMerida]

I've had them at well run breast centers and also at half trying facilities at general places, big difference all the way around.
I'd find another breast center & if you get any pain or discomfort at all tell your Dr and they should do a diagnostic mammo, which is basically a do over at a specialized center. Actually, I discovered the breast centers when I reported a pain.

Finding a center with good technologists and attention to detail can make a huge difference in the quality of breast imaging.
Regarding breast pain, pain during a mammogram is not necessarily abnormal. It can certainly hurt while in compression. The breast is one of the few places in your body where pain is generally a good thing. Patients are often reassured to hear that breast cancers don't generally hurt unless they are large or involving other structures, like skin or underlying muscle. Almost all women will experience some form of breast pain over the course of their lives and it is probably the most common symptom that women cite when coming in for a mammogram. If you have a new lump, skin changes/dimpling, nipple inversion associated with the pain, definitely go in. Pain by itself, especially if it is both breasts or comes and goes, is a benign symptom. If you have a new area of focal pain, meaning pain in a single location that you can point to with one finger, and it sticks around for a few weeks, that may be worth a visit to get things checked out. Especially if you haven't had your mammogram in the recent few months.

 

[piglet1979]

Out of curiosity, why do they ask you to hold your breath when imaging? I am standing in the vice, head back, shoulder back, trying to stay still and she says, "stop breathing". I feel like I'll mess it up somehow LOL. At the place I go to, I believe they do both 2d and 3d at the same time.

I can't breath anyways when they do mine. I hold my breath as a way to stop the pain. I m pretty sure when they have me compressed I can't move, breath or concentrate at all.

Despite the compression, breathing causes more movement of your chest and therefor your breast tissue than you probably realize. Taking an image only lasts a few seconds, but if the tissue moves during that time, the image can be blurry. Blur might not limit a radiologists ability to see something large, but the small things, like calcifications, or more subtle findings can easily be blurred out completely. Since our goal is early detection, we want all the detail!

Mammogram positioning feels really awkward and can certainly be uncomfortable. The most important thing patients can do to help a technologist get a good image in as few tries as possible is relax and let the technologist do the work. They will rotate you, pull a little more, tweak the positioning to line things up and fix things they can see, like folds or tissues being excluded. Those extra steps can vastly improve the image that you get.

Thanks for all this explanation. I am on the younger side and have only had 3 of them.

 

[HangWithMerida]

Happy to do it! Anything else you're wondering about? I have found that people get a lot of misinformation around mammograms and breast imaging in general.

 

[piglet1979]

Happy to do it! Anything else you're wondering about? I have found that people get a lot of misinformation around mammograms and breast imaging in general.

I have been told that mine are dense. Is there a better one to have? I typically have 2D I think. Should I ask for a 3D or something else?

 

[Owlpost23]

Happy to do it! Anything else you're wondering about? I have found that people get a lot of misinformation around mammograms and breast imaging in general.

A man invented that machine,right?

 

[anniemae]

I have been told that mine are dense. Is there a better one to have? I typically have 2D I think. Should I ask for a 3D or something else?

I am not a mammogram tech, but from what I understand 3D is better. One tech I had described it as looking at a loaf of bread vs. looking at a loaf of bread that is sliced. Obviously with the sliced loaf of bread you can see more. I guess not all insurance covers 3D and not all places offer it. I do think it is becoming more standard though. This is my understanding, but the real tech can chime in though!

Here is something I found:
The best way I’ve heard it explained is to imagine you have a loaf of cinnamon-raisin bread. When you do the 2-dimensional mammogram, you’re probably going to see a bunch of raisins and stripes of cinnamon, but the raisins can be overlapping and hide something underneath.
However, when you do the 3D mammogram, you are analyzing the loaf of bread “slice by slice”. And maybe that time, you find a stray walnut. Finding that walnut is like finding a breast cancer.

 

[HangWithMerida]

A man invented that machine,right?

Dr. Stafford Warren is credited with being the first to use mammography. Before that, you just went to surgery and have a portion of your breast removed, or even the entire breast and a pathologist would look at the tissue. So, a lot of women had surgeries for normal benign things, like mastectomies for fibrocystic change.
I know you were joking, but, that mammo sounds a lot better now that you know what came before it, right?

 

[maxaroni]

Thanks to all. I didn’t mean to infer that it was a state vs state issue. It was more that lived in one area my whole life and for the mammograms/dexa scans always went to the same place and used to the procedures and detail. Moving and having to find new places for everything is indeed stressful at times.

It seems to b be the consensus that 2 views of each breast is the norm and I did not have that. Also, did not have much compression or pulling and manipulating to get as much tissue in the scan.

 

[HangWithMerida]

I have been told that mine are dense. Is there a better one to have? I typically have 2D I think. Should I ask for a 3D or something else?

Breasts are made up of glandular tissue and fatty tissue. Breast tissue density refers to the amount of breast glandular tissue you have relative to the amount of fat. When women are younger, their breasts tend to be denser then become less dense over time, especially after menopause. Having dense breasts is normal. About 40% of screening age women (40 years or older) have dense breasts. Studies have shown that dense breast tissue can obscure or hide smaller masses.
I recommend the 3D (or tomosynthesis) mammogram for patients, not just those with dense breast tissue. 3D mammogram works by taking a series of low dose images through the breast tissue that the radiologist scrolls through much like a CT scan. This can remove some overlapping tissues and make it easier to see small masses or areas of distortion. It gives us more information in the same number of pictures and at a similar radiation dose. Always get the 3D!

 

[maxaroni]

I have fatty breasts which I have been told is easier to pick up on any abnormalities

I will look for a different place for next year. I was not at all happy with what I went through. I asked the tech and was told it was fine. Not in my mind.

 

[HangWithMerida]

I am not a mammogram tech, but from what I understand 3D is better. One tech I had described it as looking at a loaf of bread vs. looking at a loaf of bread that is sliced. Obviously with the sliced loaf of bread you can see more. I guess not all insurance covers 3D and not all places offer it. I do think it is becoming more standard though. This is my understanding, but the real tech can chime in though!

Here is something I found:
The best way I’ve heard it explained is to imagine you have a loaf of cinnamon-raisin bread. When you do the 2-dimensional mammogram, you’re probably going to see a bunch of raisins and stripes of cinnamon, but the raisins can be overlapping and hide something underneath.
However, when you do the 3D mammogram, you are analyzing the loaf of bread “slice by slice”. And maybe that time, you find a stray walnut. Finding that walnut is like finding a breast cancer.

The raisin bread analogy is great!
In the US, all insurance plans will cover a 3D mammogram as a screening mammogram once a year at 100%. If you have a diagnostic mammogram, you will be covered the same with a 2D or 3D but obviously, that coverage will vary based on your plan. While there are places that don't use 3D at all, it is rapidly becoming the standard of care and unless you are super remote, there is probably a center you can access with a 3D machine.