Melanie Cole, MS (Host): Have you ever had a mammogram? We're here to tell you what to expect, today on Conversations with MIT Health. I'm Melanie Cole and joining me today is Rachel Winn. She's the Lead Mammography Technologist at MIT Health.

Rachel, thank you so much for joining us today.

Host: So tell us about mammograms. What are the main uses for them?

Rachel Winn: Okay. So the main uses of mammograms is for early detection. it's an X-ray that uses low dose radiation to detect cancers that cannot be felt, lumps that cannot be felt. They are categorized, classified, into two separate categories. There's screening mammograms, and then there's diagnostic mammograms.

Screening mammograms are for patients that don't have any breast symptoms. What does that mean? Patients that have lumps, patients that may have nipple discharge, pain, tenderness, and I'm not talking about tenderness. Sometimes during a woman's cycle, that time of the month, they may feel some uncomfortable feelings, but we're speaking more of consistent areas of pain. You know, any type of abnormality that you may be experiencing, that would be a diagnostic mammogram. Okay? So screening and diagnostic. Diagnostics are for symptoms, as I just mentioned. So it's very important to get to know your body and know how you're feeling and if you are experiencing breast symptoms to connect with your physician right away.

Host: Well, I love that you said to get to know your body, because I do think it's important that we learn because we do have lumps and bumps. And they, you're not supposed to be scared of all of them, right? So it's really important what you just said. At what age should someone start having mammograms? And while you're telling us this, Rachel, are there some people that should be having mammograms before the age of 40?

Rachel Winn: Yes, that's a great question. The American College of Radiology recommends that women at age 40, start regularly screening for mammograms. However, if you're considered high risk, you would want to connect with your physician and they will give you, know, bring you down the path of what age you should start.

Patients that are considered high risk are you have a known BRCA mutation, BRCA1, BRCA2, and you've been genetically tested. Secondly, maybe you haven't been genetically tested, but you're going to be considered high risk because you have a first degree relative, mom, dad, brother, child, sister. And also additionally, I'm always going to go back to if you feel a suspicious lump or bump or having symptoms, you just really want to connect with your physician about it.

So age 40, but if you're high risk, you kind of go into that category where you'd want to connect with your physician immediately. So we can get you on the path.

Host: Is there any prep to be done before a mammogram? And I know that a lot of patients are scared. And as somebody who at 60 years old has had so many of them, I can tell you they're not scary. It's two seconds, you know, it does not last long. But is there anything you as a technologist would like us to know about prepping, not wearing deodorant or powder, what would you like us to do beforehand?

Rachel Winn: What I want you to do is show up. I want you to come and I promise I will get you through it. There's a lot of things you can do. And I think knowing how to prepare for the mammogram is going to calm your nerves. It's going to be less nerve wracking for you. Number one, I want you to skip your deodorant. I want you to avoid all lotions, perfumes, moisturizers under your arms and on your breasts.

The particles in the deodorant, whether it's aluminum free, whatever it is, it can really interfere with the mammogram. It makes it really difficult for the radiologist to view the images. I want you to eat normal, drink normal, whatever you do that day, normal routine, please do it. It's helpful if you wear flat shoes.

I may ask you to lean forward or lean backwards for positioning purposes and the high heels can throw you off balance a little bit. Continuity of care. If at all possible, now let's face it, life gets in the way, you may move, things change. If at all possible, have your mammogram at the same institution every year.

If you can't, it's vital for the radiologist if you can obtain your records. Okay, you want to get your images, ultrasounds, all on a CD, so that when you come here or go somewhere else, you can provide that for the radiologist.

Host: Is there anything we should be telling you at the appointment? Is there any specific, mentioned bringing your old records with you if there's something from another institution, but is there anything you'd like us to make sure to mention?

Rachel Winn: Sure, we'll just have an open conversation about anything that you have been experiencing. If there's any changes that you've noticed from your last mammogram, if there's any pain, if you're pregnant, I need to know right away. If you're breastfeeding, we need to know. If there's any new family history, hopefully not, but if, if something has changed and somebody's been diagnosed in your family, that's something that we definitely want to know.

So, knowledge is power. So the more you can tell me related to your, you know, breast and your family history, the better.

Host: Rachel, tell us a little bit about the appointment itself. As I mentioned earlier, they're not that scary and they don't hurt, but I'd like you as the technologist to tell the listeners, the viewers, what it's like, what is this machine doing, what is it looking for, how does it look? Tell us a little bit about it.

Rachel Winn: I'm happy to hear that you don't think it's that bad, which is wonderful. Some different strokes for different folks. Some of my patients have a really difficult time and I understand and I have a lot of empathy. It can be uncomfortable. It can be uncomfortable, but I assure you that it's super quick.

Excuse me, I want to go back to that other question about how you can prepare. If you're wearing a dress, it can make it a little bit uncomfortable because you have to take everything off from the waist up. So it would be better to wear two pieces.

That way you only have to take off your top and you'll feel less exposed. So you can expect to come in and we will compress your breast for a minimum of four routine pictures. We may or may not need additional. We want to make sure we're getting all of your breast tissue. Compression is vital for the radiologist.

We need to really visualize your breast tissue, okay? So the compression flattens out your breast, and under compression sometimes give you a false positive.

Host: So Rachel, you've given us so much great information. Now, who reads the mammogram? When do we get results? And I remember that feeling, that feeling inside, what if you get called back? Tell us a little bit about why someone might get called back. How soon do we get those results? How long do we have to wait?

Rachel Winn: One of the great advantages to having your mammogram here at MIT is the radiologist turnaround time is extremely fast. You will have the results of your mammogram within 48 to 72 hours. If you have access to the patient portal, the radiologist will release the results to your physician here at MIT Health and they'll be readily available for you on your portal.

You will receive a letter, the radiologist's report, in the mail to your home address within seven days. If, for any reason, the radiologist wants you to come back, now that would be considered a diagnostic mammogram, we would notify you via telephone to schedule the appointment so that you could come in when the radiologist is here to supervise the examination.

You had asked me what would warrant a callback. If it is your first time having a mammogram, that would be considered your baseline mammogram. It could be common to be called back. Reason being is we don't have any priors to look at. The radiologist can't compare any of your images to others.

So, that could be common. Secondly, the radiologist might have missing breast tissue, maybe the image didn't come out clear and they want some more information. The radiologist may see some calcifications or a mass, which could be a cyst or something, also things may have just changed in your breast from the last mammogram.

There may be an area that looks different than the other part of the breast and they want some additional imaging. I know it's easier said than done, but I always try to tell my patients, please do not panic if you're called back. It's easier said than done, but a lot of times if we bring you back, for a diagnostic mammogram, and we focus on that area that the radiologist is questioning, usually, it's not going to be cancer, But, you know, we have to be very careful. The radiologists are extremely, extremely diligent, and they have to, if anything has changed, we're bringing you back. We just want you to be healthy.

Host: And there are so many benign conditions, papillomas and cysts. I mean, they're breasts and there's a lot of lumps and bumps, as we said. And you have 3D technology that these radiologists are reading, right? So can you just explain that and give us your key takeaways, what you would really like us to know about getting mammography, making sure we get that baseline and then continue on every year after that?

Rachel Winn: Yes, we absolutely have the, the Hologic three dimensional machine here. We've had it for many years. I believe MIT has had the machine since 2013. So 2D versus 3D is just a whole different ballgame. You know, we're giving you a whole nother dimension for the radiologists to view. And my takeaway is, you know, the most important thing about mammograms is to get one.

It can save your life. Early detection is key and I know it can be very fearful and frightening, but I promise we'll get you through it.

Host: We know you will. Rachel, thank you so much for joining us. And we'd like to reiterate, one simple test can make a life saving difference. And at MIT, we want to ensure that you are healthy. Routine screenings can save lives. Thank you so much for joining us. And that concludes this episode of Conversations with MIT Health.

Please visit our website at health.mit.edu for more information and to get connected with one of our providers. I'm Melanie Cole. Thanks so much for joining us today.