Transcription:

Caitlin Whyte: Mammograms are essential to a woman's health, saving lives every day and catching breast cancer at early stages even before you feel a lump. To tell us more about these screenings is Linda Marryat. She is the mammography coordinator at New Hanover Regional Medical Center,

This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. I'm Caitlin Whyte. So Linda, let's get right to the topic at hand. Why are mammograms so important?

Linda Marryat: So mammograms are important for us to detect breast cancer at an early stage.

Caitlin Whyte: Now, getting a mammogram can be intimidating for first timers. What are some of the most common questions you hear?

Linda Marryat: I think there's a misnomer from a lot of patients in that they think it's going to hurt. It's going to be painful. Mammograms have come a long way over the years, especially now with 3D mammography. Unfortunately, we still need to compress the breast tissue, but it shouldn't hurt. It may be uncomfortable because we want to compress the tissue out for the radiologist to see through the dense tissue. Certainly, I always tell my patients, if it hurts, you need to relay that to the technologists and they'll reposition you or work with you.

For most patients, it's a very quick and easy exam and should not be painful. So they need to talk to the technologist if they have any uncomfortableness or if they're known to, you know, have just painful breasts, take an Advil before they come.

Caitlin Whyte: All right. So once I decide I need a mammogram, what should I expect when I show up to an appointment?

Linda Marryat: Well, when you come in, you'll be registered at our front desk and then a female technologist will bring you back. They'll have you change into a gown from the waist up. So from the waist up, you'll remove your bra and your clothing. We ask you not to wear any deodorant because some deodorants can show up on the mammogram and look like calcifications or other things. So we don't want anything showing up on that mammogram that's not actually there. So we ask the patient to either not wear deodorant or we have wipes, they can, you know, wipe off when they get here.

The female technologist will bring the patient into the room, ask them some breast history questions, whether or not they've had surgery, any family history and go over that with the patient. And then we position the patient for the imaging. We take two pictures of each breast, top to bottom, side to side. And the reason why we do that is because sometimes in one view the breast tissue may not spread out really well for the radiologist to see through, so we want to always look at it in two planes.

Caitlin Whyte: Now, of course, a procedure like this always gets me thinking about payment. Is this covered by insurance?

Linda Marryat: Screening mammograms are covered by all insurance companies at a hundred percent and then diagnostic exams, which are a little bit different may go towards the patient's deductible, but that would be something a patient would have to discuss with their insurance company, but all screening mammograms are covered at a hundred percent.

Caitlin Whyte: So what are my options? I know there's 3D mammograms, 2D mammograms, ultrasounds. What's the difference between all of these?

Linda Marryat: Well, a 3D mammogram is the new standard that we do for mammography. Years ago, they used to do only 2D digital mammograms. Nowadays, we do 3D imaging and the type of technology we have here at New Hanover, we do 3D imaging and we have a 2D image that's a reconstructed view. So the radiologists are still comparing apples to apples. In other words, if last year you had a 2D mammogram, you come back this year and you get a 3D, we're still doing that 2D, so the radiologist can compare.

An ultrasound would be done in correlation with a mammogram to review, for the radiologist to look at areas of abnormalities they might see on a mammogram, whether they might look at an area that is a cyst. Is it fluid-filled? Is it solid-filled? Does it have blood flow? So an ultrasound would be used in correlation with a mammogram to get the radiologist more information. It would never be used in place of a mammogram because there are things that will show up on a mammogram that don't show up on an ultrasound. So we'd never do the ultrasound over the mammogram. We do it in correlation with the mammogram.

Caitlin Whyte: What about if I'm a new patient at New Hanover? Maybe I just moved to the area, can I just start getting new screenings or do I need to send you all my old images?

Linda Marryat: The best thing to do is to bring your images with you, not just the report. It's important for you to bring your prior images with you because the radiologist, what they look for is differences in the breast tissue. So they want to look at your prior mammograms to see if there's a change between last year or the last time you had a mammogram and this time. If you don't bring those prior images with you, for example, like if the right breast has an area of density in it, but the left breast does not, then the radiologist may call you back for additional imaging of that area. For you, it may be normal breast tissue, but unless we do different types of pictures, we have no way of actually knowing that.

So if you bring those priors, the radiologist would look at the prior imaging, see, "Oh yeah, it's been there before. It's just normal breast tissue for her. So, she's good to go. We can see her again in a year." But it's important for the patient to actually bring the images. A lot of times, they think when they moved to the area and they have their records transferred to their new provider here in town, that those images are sent to them also, which is typically not the case. The reports are sent to the provider, but not the actual images. And what we need to be able to compare are the prior images. And the turnaround time for the current imaging is a lot faster, um, if the patient gets those ahead of time and brings them with them. Otherwise, we usually wait to get the priors and then the radiologists will dictate the report.

Caitlin Whyte: Now that I have all of this great information, how do I go about scheduling a mammogram?

Linda Marryat: Well, at New Hanover, there's a couple of ways you can schedule and you can call our central scheduling department at (910) 667-8777. If you have an active MyChart account, you can go through your MyChart account. At New Hanover, we also do not require an order for a screening mammogram, as long as the patient has a provider that they've seen within the last year. So, patients can also self-request for a mammogram and then follow up with their provider afterwards to go over the results with them.

We have five outpatient sites that the patient can go to from one end of the county to the other. We have Brunswick Forest, the Medical Mall, Military Cutoff, Health and Diagnostic North and Rocky Point. So there's multiple facilities the patient can go to. And all within the network, we have the same imaging equipment. And if their priors are done locally, we have access to those for the radiologist to compare.

Caitlin Whyte: And then afterwards, how do I get my results?

Linda Marryat: As a patient, if they have an active MyChart, the results go directly to their MyChart account. So they would get a patient lay letter from us and they also get the actual results that is sent to their doctor. So they would get that through MyChart. If they don't have an active my chart, then they would get a lay letter from us in the mail sent to them within two days of the report being finalized.

Caitlin Whyte: Great. Well, Linda, is there anything else that you want people to know that we didn't touch on?

Linda Marryat: If a patient is called back for additional imaging, for a patient coming in for her baseline, I always like to explain to my patients that it's important for them to know that it's not uncommon for a patient when they come in for a baseline to get called back for additional pictures. It doesn't necessarily mean that there's anything wrong with the pictures. It's just that because the radiologist doesn't have anything to compare it to, sometimes there's areas we need to investigate further to determine whether or not it's just normal breast tissue for them. So we have to take different types of pictures, maybe using a smaller compression paddle, maybe doing an ultrasound, maybe using what we call a magnification stand to kind of blow those pictures up to see an area better.

When the patient comes back for the callback process, the radiologist -- we've used all the images right then and there -- determines if more imaging is needed and then can finalize the report. So sometimes, you know, there's an area that needs further investigation, which is why the patient is called back for additional imaging. Not necessarily that there's anything wrong that the patient needs to be concerned about because the breast tissue does change over time. So we want to just determine if that's normal change within the breast for the patient or not or something further needs to be investigated, but that's why typically a patient is called back for additional imaging.

Caitlin Whyte: Well, thanks so much, Linda, for breaking down mammograms for us and taking the time to be with us. Find the imaging location nearest you and learn more about mammography at NHRMC at NHRMC.org/imaging. This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. I'm Caitlin Whyte. Stay well.