Mammography 6: Final Questions

This is video 6 of a 6-part series on Mammograms. Join Dr. Denise Reddy in this video series as she answers some additional common questions about mammograms. She will cover questions like;
How to prevent False Positives?
What is a screening vs. a diagnostic mammogram?
Does diagnostic mammograms equal high risk?
Do I need a doctors order to receive a mammogram?
How can I be proactive and take my breast health into my own hands?
Destry: This is the final show in our 6 part series on mammograms. We have gone through every step of the process from making your appointment to actually getting a mammogram to getting your results and understanding more about risk. Again, we are joined by Dr Denise Reddy from Scottsdale Medical Imaging, and today we are looking at a final set of questions that have come from our viewers during the course of this series.
Here is the first question: “I’ve read online that mammograms lead to “over-diagnosis” and “false positives”. What does this mean?”
Dr Reddy: Modern screening mammograms are very good at finding early cancers that can now be successfully treated. However, they can also find cancers that will never cause symptoms or threaten a woman’s life. This is what’s described as "over-diagnosis" of breast cancer. The problem here is that although there have been huge advances in mammography and breast cancer detection in the past decade, at this time even the very best technologies and techniques often cannot distinguish between cancers that are life threatening need treatment from those that are not life threatening and don’t need treatment do not. Sometimes this is described as the difference between the cancers you will die “from” and the cancers you will die “with”. As a result almost all have to be treated. We really have little alternative. Some breast cancers can develop so quickly that waiting to see what the cancer does is usually regarded as not a good option.
Over-diagnosis is different from false-positive results. False positive means a radiologist sees something in your mammogram that appears abnormal and needs you to come back in for additional testing (diagnostic mammograms, ultrasound, perhaps a biopsy) to rule out cancer. False-positive mammograms inevitably create anxiety but when something looks abnormal additional testing is essential.
Destry: Our next viewer is asking about the different types of mammogram. She wrote: “I’m not sure I understand the difference between a screening mammogram and a diagnostic mammogram?”
Dr Reddy: Screening mammograms, like the one you had, Destry in program 2, are performed in “asymptomatic” patients; that is women who have no signs or symptoms of breast cancer. Two views of each breast are obtained during the exam. These are interpreted by the radiologist.
A diagnostic mammogram is still an x-ray of your breasts, but more pictures are taken during a diagnostic mammogram and it’s done for a different reason. For example we perform diagnostic mammograms for follow-up on a screening mammogram that looks abnormal. We’ll also do a diagnostic mammogram with women who have a past history of breast cancer or with women who are “symptomatic” meaning a breast exam has shown things such as a lump that can be felt, nipple discharge, abnormal skin changes.
Destry: This next question goes along with that. The question asks: “I was called back for a diagnostic mammogram last time. Everything turned out fine but does this mean I’m now at higher risk for breast cancer?” This is a good question.
Dr Reddy: It is a good question and no, it does not mean you are at higher risk for breast cancer. About 10% of women will be called back for additional imaging and for the majority of women once we have additional images we will find there is no abnormality there and they can just return to routine screening without any worries.
Destry: This is really good news from somebody watching our segments and she wrote, “After watching Destry get her mammogram she’s convinced me to get my first mammogram. Do I need a doctor’s order?”
Dr Reddy: At SMIL we do ask you to first get an order from your physician. There is always a chance that your mammogram will show something that needs urgent follow up care and we want to be sure you have a clinician in place first, just in case. If for some reason you can’t do that then there are some facilities that allow self-referral; call ahead to make sure your facility accepts them...