Q	Is there an age when I start to need a mammogram?
A	For patients with breast symptoms mammography is not normally performed before 35 years of age. The NHS Breast Screening Programme starts aged 50 years and examines patients 3-yearly until 70 years; after that patients may attend 3-yearly but they have to make an appointment rather than be sent one automatically.
Q	What is breast screening?
A	Breast screening (mammography) is an x-ray examination of the breasts. Breast screening can show breast cancers at an early stage, when they are too small for you or your doctor to see or feel.
Q	Does breast screening prevent breast cancer?
A	No, mammography only helps find breast cancer if it is already there. You should be aware of any changes in your breasts because breast cancer can develop at any time. Some women will develop breast cancer before their first screening mammogram or between screening mammograms. There is a simple five-point breast-awareness code that all women should remember. Know what is normal for you Look at and feel your breasts Know what changes to look for (lumps, pain, discharge from the nipple or anything else unusual) Tell your doctor about any changes immediately Go for breast screening regularly every two or three years if you are over 50 There are many reasons for changes in the breast. Most of them are harmless but you should get all of them checked as there is a small chance that they could be the first sign of cancer.
Q	How long does it take?
A	A mammogram takes a few minutes and involves a tiny dose of radiation, so the risk to your health is very small.
Q	Why do I need breast screening?
A	One in nine women will develop breast cancer at some time in her life. Breast cancer is more common in women over 50. Breast screening can help to find small changes in the breast before there are any signs or symptoms. If changes are found at an early stage, there is a good chance of a successful recovery. Breast screening is less effective in preventing deaths from breast cancer in women aged under 50 years. Whatever age you are, if you are worried about any breast problem, please contact your doctor who may refer you for a specialist opinion if necessary.
Q	Where do I go for breast examination?
A	The breast screening centre may be in a hospital or clinic or in a mobile unit (caravan/trailer).
Q	Do I have to avoid eating or drinking before my mammogram?
A	No you don't. Mammograms can be performed whether or not you have had anything to eat or drink.
Q	Do I have to avoid anything before my mammogram?
A	Please do not use talcum powder or spray-on deodorant on the day you go for breast screening as this may affect the mammogram.
Q	What exactly happens during the mammogram?
A	When you arrive, feel free to ask any questions you have about mammograms. When you have undressed to the waist and are ready and comfortable, a radiographer will explain mammography to you and ask you a few questions. The Radiographer will put your breasts, one at a time, between two special plates and take the x-rays. Mammography takes a few minutes and your breasts are only pressed between the two plates for a few seconds each. There is no evidence that this procedure harms the breast.
Q	Why is it necessary to compress my breast?
A	Breast compression is necessary in order to: even out the breast thickness so that all of the tissue can be visualized; spread out the tissue so that small abnormalities won't be obscured by overlying breast tissue; allow the use of a lower x-ray dose since a thinner amount of breast tissue is being imaged; hold the breast still in order to eliminate blurring of the image caused by motion; reduce x-ray scatter to increase sharpness of picture.
Q	I don't have a problem with breast (asymptomatic) why do I need a mammogram?
A	Mammograms are good at finding breast cancer before they give symptoms. Medical studies have shown a 40% reduction in breast cancer deaths.
Q	I have breast symptoms (symptomatic) why do I need a mammogram?
A	Mammograms are good at finding breast cancer but are combined with clinical examination and often ultrasound and needle biopsy as the three tests (clinical examination + imaging-mammography/ultrasound + needle biopsy) combine to give the best sensitivity. This is known as Triple Assessment or the Triple Test.
Q	What are the breast symptoms that suggest I might need a mammogram?
A	A breast specialist doctor may refer a patient for a mammogram (and / or breast ultrasound) for a lump or mass, a focal abnormality, breast deformity, nipple discharge, non-cyclical pain or skin changes.
Q	Why is ultrasound used?
A	As all medical tests have their strengths and weaknesses. Ultrasound can show changes in the breast that are difficult to see on a mammogram or can provide additional information about shadows seen on mammograms. However it does not demonstrate calcium well and is not a successful breast screening method. It is good for guiding needles to drain cysts or take samples of areas in the breast.
Q	When do I get my results?
A	In breast screening the radiographer will tell you when you can expect to receive your result, usually within 2 weeks of the time of examination. For symptomatic patients the report is sent to the doctor in the clinic. This depends upon the clinic set up and when the films are reported, sometimes this will happen immediately.
Q	Can mammography be used to target areas for biopsy?
A	A special type of mammography unit is used to stereotactically target areas for biopsy for cytology or histology.
Q	How reliable is breast screening?
A	Mammography is the most reliable way of detecting small breast cancers early but like other tests, it is not perfect. For example: some cancers are very difficult to see on the x-ray; some cancers, even though they are there, cannot be seen on the x-ray at all; and the person reading the x-ray may miss the cancer (this will happen occasionally, no matter how experienced the reader is). All staff are specially trained and continue training to maintain their expertise
Q	I have nipple rings and I am worried. Will the nipple rings affect the test?
A	No. The pictures are just as good whether you have nipple rings or not and you don't need to remove them unless you want to.
Q	I have breast implants. Is there a danger of bursting the implants and is there any point in doing the x-rays?
A	There is almost no chance of bursting implants and there are no recorded cases where this has happened. If the implant is ruptured already, it is very unlikely that mammography would be harmful. Pictures with implants are much more difficult to interpret because the implant lies over most of the breast tissue. Sometimes, a special method is used where the radiographer will hold the front part of your breast and persuade the implant backwards, so that we can see more of the breast tissue, but I am afraid that x-ray pictures are never quite as good if you have implants, compared to if you do not.
Q	Do I still need x-rays if I have implants?
A	Mammograms are very good at showing calcium in breasts, which can show the earliest change that we can detect towards cancer. No other tests can show us this and so it is still worth while having x-rays with implants.
Q	I am worried that the radiographer might not stop when my breasts are too uncomfortable and might keep compressing. What can I do about this?
A	Tell us what you are worried about before we start the examination. We are specially trained to be careful about compression and will do our very best to get the best pictures, but you are the most important person in the room and, if it is hurting, tell us and we can release the paddle quickly and easily.
Q	I don't have any symptoms (asymptomatic / screening) and I'd rather have an ultrasound because of the x-ray dose. Isn't it just as good?
A	No, I'm afraid not. Ultrasound is used with x-rays but it cannot show us calcium well and will miss pulling in (distortion), as well as asymmetry and small lumps. No screening trial using only ultrasound has ever worked well. The x-ray dose is very small and only given if we are sure that it is more likely to benefit you than harm you.
Q	Can I have a summary of the facts regarding breast screening?
A	To help you decide whether or not to come for breast screening, the main benefits and difficulties of screening for breast cancer are explained below: Most breast cancers are found at an early stage when there is a good chance of successful recover Around half the cancers that are found at screening are still small enough to be removed from the breast. This means that the whole breast does not have to be removed Breast screening saves an estimated 1,250 lives each year in this country. Breast screening reduces the risk of death from breast cancer for women who attend Some women may require more investigations e.g. ultrasound if we are not sure about their mammogram. After more tests, we will find that many of these women will not have cancer Screening may miss some breast cancers Not all breast cancers that are found at screening can be cured Many women find mammography uncomfortable or painful, but normally just for a brief period of time
BREAST ULTRASOUND
Q	I have breast symptoms (symptomatic) why do I need an ultrasound?
A	Mammograms are good at finding breast cancer but are combined with clinical examination and often ultrasound and needle biopsy as the three tests (clinical examinations + imaging-mammography/ultrasound + needle biopsy) combine to give the best sensitivity. This is known as Triple Assessment or the Triple Test.
Q	What are the breast symptoms that suggest I might need a mammogram?
A	A breast specialist doctor may refer a patient for a mammogram (and / or breast ultrasound) for a lump or mass, a focal abnormality, breast deformity, nipple discharge, non-cyclical pain or skin changes.
Q	Is there an age when I can have an ultrasound?
A	Unlike mammography ultrasound does not use x-ray so for patients with breast symptoms mammography is not normally performed before 35 years of age
Q	Why is ultrasound used?
A	As all medical tests have their strengths and weaknesses. Ultrasound can show changes in the breast that are difficult to see on a mammogram or can provide additional information about shadows seen on mammograms. However it does not demonstrate calcium well and is not a successful breast screening method. It is good for guiding needles to drain cysts or take samples of areas in the breast.
Q	I don't have any symptoms (asymptomatic / screening) and I'd rather have an ultrasound because of the x-ray dose. Isn't it just as good?
A	No, I'm afraid not. Ultrasound is used with x-rays but it cannot show us calcium well and will miss pulling in (distortion), as well as asymmetry and small lumps. No screening trial using only ultrasound has ever worked well. The x-ray dose is very small and only given if we are sure that it is more likely to benefit you than harm you.
Q	What is Ultrasound-Guided Breast Biopsy?
A	Ultrasound is an excellent way to evaluate breast abnormalities detected by mammography, the patient or her doctor, but in some cases it is not possible to tell from the imaging studies alone whether a growth is benign or cancerous. Ultrasound-guided breast biopsy is a highly accurate way to evaluate suspicious masses within the breast that are visible on ultrasound, whether or not they can be felt on breast self-examination or clinical examination. The procedure prevents the need to remove tissue surgically e.g. it reduces the number of unnecessary operations for non-cancerous (benign) breast lumps, and also eliminates the radiation exposure that comes from using x-rays to locate a mass. After placing au ultrasound probe over the site of the breast lump and using local anaesthesia, the radiologist guides a biopsy needle directly into the mass. Tissue specimens are then taken using either a fine needle (FNA) for cytology, an automatic spring-loaded or vacuum assisted device (VAD) for histology.
Q	What are the benefits of ultrasound-guided breast biopsy?
A	Ultrasound-guided breast biopsy reliably provides tissue samples that can show whether a breast lump is benign or malignant Ultrasound-guided core biopsy, using either the core method or the VAD, takes much less time than surgical biopsy, causes less tissue damage, and is far less costly. Compared to x-ray-guided breast biopsy, the ultrasound method is faster and avoids the need for ionizing radiation exposure. With ultrasound, it is possible to follow the motion of the biopsy needle as it takes place. Ultrasound-guided breast biopsy is able to evaluate lumps under the arm or near the chest wall, which are sometimes hard to assess by the x-ray-guided method.
Q	What are the risks of ultrasound-guided breast biopsy?
A	There is a risk of bleeding and formation of a haematoma, a collection of blood at the biopsy site. The risk, however, appears to be less than one percent of patients. An occasional patient has significant discomfort, which can be readily controlled by simple pain killers. Infection can occur whenever the skin is penetrated, but the chance of infection requiring antibiotic therapy is less than one in one thousand. Doing a biopsy of tissue deep in the breast carries a slight risk that the needle will pass through the chest wall, allowing air around the lung that could collapse a lung. This is a rare occurrence.
Q	What are the limitations of Ultrasound-Guided Breast Biopsy?
A	Like x-ray-guided breast biopsy, ultrasound-guided biopsy occasionally will miss a lesion or underestimate the extent of disease. If the diagnosis remains uncertain after a technically successful procedure, surgical biopsy will be necessary. The ultrasound-guided method cannot be used unless the mass can be seen on an ultrasound exam. Calcifications within a cancerous nodule are not shown as clearly by this approach as when x-rays are used. Small lesions may be difficult to target accurately by ultrasound-guided core biopsy.

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