Amanda Wilde (Host): Mammograms are our best screening tool to find breast cancer early before symptoms show and when it is most easily treatable. Diagnostic radiologist, Dr. Patrick Jennings, is here to walk us through what to expect at your first mammogram. This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences.

I'm Amanda Wilde. Dr. Jennings, welcome to the podcast. Thank you for being here.

Dr. Patrick Jennings: It is my pleasure.

Host: Well, a first mammogram is a milestone, but it can be unnerving to think about. So, what should I expect during my first mammogram?

Dr. Patrick Jennings: Certainly. So, to begin, you'll be arriving at one of our facilities. We screen here at the UAMS Breast Center on the third floor by the Winthrop P. Rockefeller Cancer Institute. Parking is conveniently located in the adjacent Parking 3 garage. We do validate parking and valet parking is also offered to provide the best experience we can for our patients. We also screen at the Women's Center at the Midtown location.

Here at the breast center, a receptionist will greet you, confirm your arrival at our center. And then, a technologist will bring you to a private dressing room and give you a gown to change into. The technologist will then bring you to a mammography suite and work with you to provide the highest quality and most comfortable exam possible. We do hear a lot about compression. It may cause a sensation of pressure or discomfort. That is when we're placing the breast into compression with a specialized paddle to provide the best imaging, but it's usually not painful. Compression spreads the tissue out to achieve higher image quality, to detect more easily obscured tiny little abnormalities. It also reduces the radiation that's required for imaging. And it prevents motion blurring that can obscure the small calcifications that matter in breast imaging. Each compression only lasts for a few seconds. So, we try to get it done as soon as we can.

After your mammogram at the UAMS Breast Center, you're given the option to wait for your results, which is unusual in breast imaging. Most of the time, you come have the exam performed and then you're sort of dismissed. We get a call later or a letter in the mail. But here, after image interpretation, a radiologist will personally discuss with you your results. We're able to quickly calm fears with a good report. However, if we do need additional evaluation, we can do a same-day diagnostic workup rather than having the patient schedule for an additional visit. This is not only convenient for our patients, but it reduces travel expenses for our dedicated patients that travel some distance to come see us. With the point to that, these additional images, it's not uncommon to be called back for additional imaging after your first mammogram. Most callbacks do not indicate breast cancer. They just mean that more information is needed.

Host: So, it is normal to be called back. But wow, what a relief that you can stay for your results and right away see what they mean.

Dr. Patrick Jennings: Yes, yes, it is a wonderful service that we're able to offer. You're able to stay in your private dressing room, while one of us comes to talk with you or in a communal area in the breast center as well if you would be more comfortable in a more open environment.

Host: Well, it sounds like you do everything to make patients comfortable. Is there anything special I should do to prepare for my appointment? Are there things I should avoid before the mammogram?

Dr. Patrick Jennings: Yes. First, let's sort of talk about who needs a mammogram. The recommendations are all women 40 years and older have an annual breast exam, a mammogram. You should talk with your doctor before the age of 25 really to have a risk assessment performed. The Tyrer-Cuzick, that's T-Y-R-E-R C-U-Z-I-C-K, is a wonderful risk assessment model that looks at multiple factors in your history. You'll see if you may be high risk. High risk is considered greater than 20% lifetime risk of breast cancer. If you are high risk, you may need supplemental screening, even earlier screening, beginning as early as age 25 or 30.

Also, these mutations that you hear a lot about, the BRCA gene mutation, may require earlier screening, additional evaluation than just the mammogram. Also, women that are 30 years and older with a breast problem, like a lump or an isolated pain in the breast, we will start the evaluation with mammogram. And that does require a doctor's order, which is a little different than a screening exam. No doctor orders required for that.

For preparing, it's important to choose a facility that is convenient for you. We would love to see you here at UAMS, but consistently going to one facility allows for easier comparison of the images over time. You may want to schedule your appointment the week after your period if you're still having monthly cycles. Oftentimes, the breasts are less tender since we'll be using some compression. And it's important to wear comfortable clothing, a two-piece outfit, you'll be asked to remove your top and bra for imaging. Wear comfortable shoes. You are going to be standing during the examination.

Bring with you your medical history. If you have a personal or family history of breast cancer or ovarian cancer; if you've had genetic testing, family members had genetic testing. All that plays into these risk assessment models that we use. If you've had prior breast procedures, lifts, implants, biopsies, all that's going to show up on the imaging, and we need to know about that to interpret the films correctly. Hormone use can be a driver for breast cancer. It needs to be taken into part of these risk assessment models.

And if you've had any prior imaging, one of the most important tools we have for looking at a mammogram is last year's mammogram. So if you've had a mammogram before, if you've had ultrasound before, an MRI, all that is important for us to know so we can give you the best interpretation.

Host: How often should we get a mammogram after the first one?

Dr. Patrick Jennings: There are multiple societies out there that all have guidelines for mammography. We follow the Society of Breast Imaging, the American College of Radiologist, and the Breast Surgical Society. They all recommend beginning mammograms at age 40 for a normal risk person. And then, they recommend to continue them annually every year after your first mammogram.

Host: And are there any possible side effects? You mentioned there can be some discomfort during a mammogram.

Dr. Patrick Jennings: Yes. The compression is the biggest complaint that we hear of mammography. Like I said earlier, it is very important for the images that we have good compression to be able to see through that tissue. But the compression is certainly not comfortable. We try to do our best to alleviate any pain. Certainly, let your technologist know if the pain is severe. They want to work with you to achieve the best imaging possible. We have a curved paddle here and a MammoPad. They can all help with discomfort. Certainly work with the tech and they're there to give you the best exam that we can do. Some women may have some soreness for a few hours to even a day after examination. If you're in that boat, you can just take Tylenol, ibuprofen, whatever that you would normally take to help with pain.

Also, talking about side effects, some people have the question of radiation exposure. Mammography does use a small amount of ionizing radiation. But it is the only breast cancer screening tool that has been proven clinically to save lives. It has shown about a 40% mortality reduction. Ultrasound breast, CT breast MRI have not ever been clinically proven the way mammography has. The dose the mammogram uses is small. It's about as much as a cross country flight. And so, the proven benefits of early cancer detection far outweigh any theoretical risk.

Host: And you mentioned, if you are feeling discomfort, to talk to the technician at the time. Are there any other questions I should ask the technician during the appointment?

Dr. Patrick Jennings: Well, the technologist is a highly trained individual that has not only gone to standard radiology technology training, but they've done a special requirement for mammography. So, they're a wealth of information. Certainly, ask them anything that's on your mind.

For your first time, just let them know, "It's my first time." Ask them, "What should I expect today? Is there anything that I can do to help with positioning or anything I can do to help make the exam more comfortable?" Like, the curved paddle and the MammoPad. You could ask, you know, "If I am feeling discomfort, what's the best way I can let you know?" And they'll help guide you through that process. Ask them who's going to interpret your mammogram. How will they let me know if I don't hear the results in a certain time period? Who should I call? What should I do? They're there to work with you on the day of your study.

Host: So, you can ask your technician anything, it sounds like.

Dr. Patrick Jennings: Absolutely.

Host: Well, that's reassuring. And thank you for walking us through this process, Dr. Jennings.

Dr. Patrick Jennings: Oh, you are most welcome.

Host: Dr. Patrick Jennings is a diagnostic radiologist at UAMS. To make an appointment at the UAMS Breast Center, call 501-526-6100. If you found this podcast helpful, please tell others about it and share on your social media. You may want to check out our entire podcast library for other topics of interest. This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences.