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Prakash Chandran: When's the right time to get a mammogram? What exactly is the difference between a regular mammogram, a 3D mammogram, and an automated breast ultrasound? My name is Prakash Chandran.

Today, we're going to find out everything you need to know about mammograms and why they're so important.

Here with us to discuss is Cari Henry, lead mammography technologist at Templeton Imaging.

So Cari, it's so good to have you here today. For those of us that don't know, what exactly is a mammogram?

Cari Henry: A mammogram is basically an x-ray of the breast focusing on the breast tissue and what's inside to determine if there's anything going on in there.

Prakash Chandran: Okay. And why is it so important for women to get a mammogram?

Cari Henry: Women especially tend to have things that, you know, with our hormones changing and things going on that come up in the breast. Majority of the things are normal, but some of the things could be cancer. And so it's a wonderful cancer screening to catch things at an early stage before it gets too crazy. And it's very recoverable in these days.

Prakash Chandran: Got it. Yeah. So you mentioned that it's something that they should get done at an early stage. Exactly what age should a woman consider getting her first mammogram?

Cari Henry: We recommend that we go by the American College of Radiology and they say between 35 and 40 to have a baseline mammogram and then after the age of 40 to do it yearly.

Prakash Chandran: Okay. And does that change at all if you have a family history of breast cancer?

Cari Henry: I would say definitely that should be a conversation with that particular person's doctor because some people have gotten cancers early as say 30 or in their upper 20s. So that could change based on having that kind of history or sometimes I see people get genetic testing and find out that they do have a gene for breast cancer, and that may change things as well.

Prakash Chandran: Okay. Understood. So definitely something to communicate with your primary care provider, right?

Cari Henry: Absolutely.

Prakash Chandran: Awesome. So let's just talk about what exactly happens during a mammogram. Maybe talk about the process itself.

Cari Henry: Well, I like to make sure the patient knows what they're getting into. First off, if it's their first mammogram, I explain what we're going to do like we take a total of four pictures usually, two on each breast. I introduce them to the machine, what the compression paddle looks like. Let them know that they're in complete control, that we're not trying to squish them to where they never want to come back. You know, if they say, "Okay, stop. I can't take it anymore," I'll have them stop or I will stop. I'd rather get a mammogram without complete compression, than no mammogram at all, so I don't want to scare anybody away. But it usually takes maybe 7 to 10 minutes including dressing and undressing. And I'd like to address any questions the patient may have or concerns they may have. And then they leave and they get their report and, hopefully, it just becomes a yearly thing.

Prakash Chandran: Okay. And after that first report, is that what is considered a baseline or is that something else?

Cari Henry: When it's their first mammogram, it would be considered a baseline and a baseline being they've never had a mammogram before. So we don't have anything to compare to from previous to now. So if they come in and they've had a mammogram, those images are always compared to their priors.

If a baseline mammogram comes in, they don't have a prior. So we establish what is normal for that particular patient. Everybody's breast issue is almost like a fingerprint. So we don't know what is normal for them. So we establish what is normal for that person and then that image is compared to future mammograms, making sure everything is stable as they move into the future.

Prakash Chandran: Okay. And at a high level, once the mammogram results or pictures are submitted, what exactly are they looking for?

Cari Henry: They are looking at the breast tissue itself, like I was talking about the baseline mammogram. They're looking at what they feel is normal. They're looking at the breast tissue. There's fatty tissue amongst the fibro glandular type tissue, which some people refer to as a dense breast tissue. The more we compress on the breasts, the more we can distribute that breast tissue so we can see through it better. They're looking for maybe areas of just a change in that tissue. It's almost like a fingerprint. So when you compare the current images to the prior images, you're looking for a subtle change. Otherwise, like a lump, you might see something more white on that image. Sometimes you see an actual shape. And with 3D mammography, you can see so much more. You can see all kinds of things that one of our radiologists refers to it as reading tea leaves. You know, it's just kind of looking at everything and they kind of flip back and forth through all these slices that are produced by the 3D image. And it just gives so much information that it's phenomenal compared to what we used to have in the past.

Prakash Chandran: Yeah. So let's unpack that a little bit. You just mentioned 3D mammography. How is that different from a traditional mammogram?

Cari Henry: We do both. We do 2D mammography, you know, what we refer to as digital mammography or traditional mammography and then we have 3D. It's the same machine. It's the same images. The patient themselves probably wouldn't notice any difference between the two. But on the reading end of things, the 3D provides a lot more information, whereas the 2D is still a great exam.

But sometimes things can be overlapped. It's one image. Maybe somebody has a denser area on the upper part of their breasts and a denser area on the bottom. And it kind of compresses making it look like there's something when there's really nothing. Whereas the 3D, it's kind of making an arc over the patient's head so to speak and it's producing multiple images through the breast, providing the doctor much more information to determine what is real, what is dense breast tissue. So it's amazing what they come up with and what they can see compared to the 2D. Although, some people prefer to stay with the 2D. But most insurances are paying for 3D now, so it's not too much of a question anymore. Most people, I'd say 95% of the people get the 3D versus the 2D.

Prakash Chandran: Got it. And you've mentioned dense breasts a couple of times, maybe talk a little bit about what that is and how a woman knows if she actually has them.

Cari Henry: Yeah. That could be kind of difficult because sometimes even when I'm doing the mammogram, I feel a breast and I feel like it feels like it's dense. And then we take the image and she's not really that dense at all, dense being more glandular tissue than fatty. So I would say the only real way to tell for sure is that mammogram. But at the same time, women usually when they're young, under 40, tend to be more on the dense side. And, as we get older, we go through menopause, we become less dense, more on the fatty side, easier to see through fatty breast tissue versus dense, but it's kind of only can be determined by that mammogram. As people get older and go into menopause, they'll take hormones and sometimes hormones can throw that off and make the breast dense in a fake way. You know, by just adding that hormone, it makes that breast become more dense.

Prakash Chandran: Yeah. So, you know, we've talked about a couple of different methods here. And one of the things that I'd seen in my notes is the automated breast ultrasound. Can you speak to what that is?

Cari Henry: It's only for dense breasts, so it's not to take the place of the mammogram as well. It's an additional screening tool. We don't want anybody to think that it takes the place of the mammogram. And that's been a big misunderstanding when we first got it. Everybody thought, "Oh, good. I can forget doing the mammogram and I'll just do this automated breast ultrasound." And I don't know if it's correct or not, but I've always kind of referred to the mammogram as the lawnmower and the automated breast ultrasound is kind of like the edger. You know, if you want to kind of get a little bit more detail. But it doesn't do much good for people that have fatty breasts.

And it's an exam that you would come in for and the woman lays on a ultrasound table. It has like a little cutout in the table itself. And there's an ultrasound transducer in there, so the breast is placed on top of that ultrasound transducer. And it goes around in a clockwise motion and kind of sweeps around the breast. So it does one breast at a time. And then it gets read by the radiologist and then again a report is generated in the end of that. But again, it's conversation with that patient's doctor and, you know, trying to determine if that's something that is good for them.

Prakash Chandran: Okay, understood. So this is something that is coupled almost all the time with a normal mammogram. And it's typically if you establish a baseline and you figure out that you have more dense breasts, it's usually good to couple with an automated breast ultrasound. Is that correct?

Cari Henry: Yeah, it's kind of a hard thing because an additional tool would be MRI for people, especially of high risk. But the automated breast ultrasound kind of got thrown into that. And it's a great tool, but it's still not where we want it to be, because it causes confusion because you have a mammogram, then you have this automated breast ultrasound as another additional screening tool only for dense breasts. But then, you add in, say we see something on the mammogram or that automated breast ultrasound, then you have to have a targeted breast ultrasound where they focus on a particular area. So it does get very confusing for the average person. It's confusing for us sometimes. And if anybody has any questions, they can always call and ask one of the technologists to help it make sense to them.

Prakash Chandran: Okay, understood. And you know, one of the things that I have heard is that sometimes a mammogram can be a little painful. And I think this kind of relates to some of the compression that you were talking about earlier in our conversation. But what might you tell a woman who's afraid to get a mammogram?

Cari Henry: I would say majority of the time, I would say 98.7% of the time, a lady will come in really kind of anxious about it. And then we do the first picture and they go, "Oh my gosh. Is that really all it is? Is that all it is? I've been worried about this all this time and it's really nothing." It's amazing what, you know, everybody conjures up in their mind and people have talked about it. It almost becomes like a rite of passage, you know, like, "Oh, you got to get that Mammogram." and then they come in and they're like, "Wow, that was really nothing."

It's come a long way. We used to have these paddles that were always fixed where it wasn't kind of obliging or complying with the breast because the breast isn't a uniform organ. It's kind of thicker against the chest wall and it gets thinner as you come out towards the nipple. But now, we have these flexi paddles that are much more obliging to the breast. So I think people are tolerating a lot more.

And it's also not that long of an exam. It's kind of just pretty quick. I think anybody can tolerate the compression for just, you know, a few seconds.

Prakash Chandran: Yeah, it definitely seems like it. And just to give women more reasons why getting screened early or getting a mammogram early is so important, are you able to share like a success story where breast cancer or a tumor was caught early and at a treatable stage?

Cari Henry: You know, I always go back to this one particular lady and I call her my Rose story. It's just a flower that, but I'll just call her Rose. But she was a lady that had breast implants and she was afraid to get her mammogram for a number of years. She put it off because she was afraid of doing this exam with her implants. And she came in and I just let her know she's in control. We're going to take these images and just do one at a time. And she got through it.

And with implants, we have to do what's called implant displacement, where we move the implant back. And of course, that's kind of worrisome for that patient and she tolerated it quite well. We did the imaging, looked at the images. And I was looking at kind of back and behind, and I saw something back there that looked a little questionable to me.

So I asked her, "Let's just try to get one more picture so I can get further back." I got further back and sent her off. And she was like, "Oh my gosh, that was so much better than I thought. Thank you for talking me through it and all that." and then got the images read, and there was some questions. She ended up having to have a biopsy and it was a cancer. And it was an amazing experience because of her journey through that breast cancer, that she was having trouble with their marriage, trouble with her children, got this breast cancer, had to deal with that. When she came back to me the next year, she came back crying, hugging me, thanking me for getting her through this and that it improved her life, that she couldn't believe that something like cancer, treatable as it was, because we caught it so early, that she had a better relationship with her husband, she had a better relationship with her child. And now she's an advocate for doing mammograms and getting it caught early because she just couldn't believe the minimal amount of things that she had to do to take care of this breast cancer.

And she went kind of for the gusto because she ended up having a mastectomy and her implant removed. And she had something called a TRAM flap procedure where they actually make a breast out of your abdominal tissue. It turned out amazingly well, and she speaks very highly of the mammogram today. And I think she's a wonderful example of that kind of thing.

Prakash Chandran: Wow. Yeah. You know, thank you so much for sharing that. And, you know, sometimes these relationships with your loved ones get forged by fire. And, you know, by her being proactive and catching things early, it sounded like everyone was able to band together and get really close to help her through this. And just a year later, she was better in a strong advocate for early mammogram and early screening detection, right?

Cari Henry: Yes. I thought it was wonderful. It's amazing what good things can come up with such a bad thing.

Prakash Chandran: Yeah. Just speaking of being proactive, you know, we're talking about getting mammograms as early as you can. But even before that, and maybe even in conjunction with it, you should also be examining yourself and feeling for lumps on your breast. So maybe let's just talk about that process. How do you go about examining yourself? And how do you know when something is of concern that you should surface when you go in to see a medical professional?

Cari Henry: Yeah. You know, I used to work for a gynecologist and he was kind of funny and he would actually show his being a man, showing his women patients how to lean forward and actually not just feel the breast, but visually look at them. Looking for some sort of change in their shape, dimpling, nipple inversion, little things that are visually seen rather than feeling the breast at first. And I'd watch him lean forward and kind of he goes, "Have your breasts fall forward." It was kind of funny to see a man do that.

But then, as far as feeling the breasts, he wanted to develop a certain pattern, and every woman will come up with what's comfortable for them. But, you know, doing it in a clockwise motion, moving outward to inward or up and down across the breast, coming from the inside to out or outside to in. But basically becoming one with their breast, making sure that what is normal for them. Same thing like with a normal mammogram. Finding out what's normal for them. And then as the months go on, they know what's different when they feel their breasts. They'll feel a change. And it could be a hard lump where all of a sudden like, "Oh gosh, I didn't feel that before" and it's kind of on the hard side. Some of them could be softer. And when these things are brought to their attention, they should definitely contact their gynecologist or their doctor and have that doctor examine them and then determine should they get an ultrasound, should they get a mammogram, or is it something to be concerned about.

Prakash Chandran: And do you have any tips or best practices around when a woman should start self-examination and how often they should do it?

Cari Henry: I would say monthly is a good idea. And just to establish, like, after they get done with their period, because when they have their cycle, there's all kinds of hormones going on, especially the younger, the more that cycle is more effective on the breast. As we get older, cycles change, everybody starts getting changes, which could bring feeling something worrisome because there's so many changes going on as we go through menopause. But I would establish a normal monthly, so many days after the period, then it kind of changes when you don't have a period anymore.

Prakash Chandran: Okay. That's helpful. So, you know, we've covered being proactive with self-examination. We've talked about the age in which you should start getting a mammogram and you mentioned that's the age of 35, unless you have a family history, in which case you should talk to a primary care physician. But if a woman is listening to this and she wants to make an appointment for her first mammogram, how can she go about doing that?

Cari Henry: Just as simple as giving us a call, our phone number is (805) 434-1491 and they can make an appointment. And if they have any concerns, they can always ask to talk to a technologist and we may not be able to talk to them right away, but we can get their number and call them right back if they have any questions or concerns beforehand.

Prakash Chandran: Okay. Well, Cari, I really appreciate your time today. Any closing thoughts that you want to leave our audience with?

Cari Henry: All I can say is don't be afraid, that it actually could be kind of fun. We like to giggle and laugh at things in there and kind of try to make it fun, make it a yearly thing and establish a relationship and find out, you know, as years change and what changes in each other's lives. I get kind of close and I run into people on the outside and we catch up on the outside sometimes. So it's kind of fun to develop that relationship.

Prakash Chandran: Well, Cari, that is amazing to hear. So thank you so much for everything that you do and for educating us today.

Cari Henry: Well, thank you.

Prakash Chandran: That was Cari Henry, lead mammography technologist at Templeton Imaging. Thanks for checking out this episode of Healthy Conversations. If you'd like to make an appointment to get a mammogram, you can call (805) 434-1491.

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