Women’s Health

Your mam­mo­gram, ex­plained

Prevention (USA) - - CONTENTS - BY LAU­REN STREICHER, M.D.

Even when you hear that your an­nual mam­mo­gram is nor­mal, it can be dis­con­cert­ing to get your hands on the ac­tual re­port, filled with mys­te­ri­ous, scary ter­mi­nol­ogy. Yes, th­ese re­ports are meant for com­mu­ni­ca­tion be­tween doc­tors, but most of us, if we don’t know what a word means or it sounds bad, think it must be bad…re­ally bad.

The word “neg­a­tive” is a good ex­am­ple. In life, neg­a­tive things are bad. In medicine, “neg­a­tive” means noth­ing bad was found. (But even af­ter you’ve got­ten a neg­a­tive re­port, if you feel some­thing in your breast that wasn’t there be­fore, get it checked out.)

In­ter­pret­ing your mam­mo­gram should be left up to the ra­di­ol­o­gist, but it’s still help­ful to know what com­mon phrases mean. Keep in mind that th­ese terms are de­scrip­tive, not di­ag­nos­tic: A biopsy is the only way to di­ag­nose breast can­cer.

SEVEN TERMS AND WHAT THEY MEAN

DEN­SITY: The amount of fi­brous and glan­du­lar tis­sue, as op­posed to fatty tis­sue, in your breasts. The less fat there is, the higher the den­sity. Hav­ing dense breast tis­sue is com­mon and not ab­nor­mal, but this can make it harder to eval­u­ate mam­mo­gram re­sults and may be as­so­ci­ated with in­creased risk of breast can­cer. Women with dense breasts may also need an ul­tra­sound or an MRI.

PARENCHYMA­L ASYMMETRY:

This find­ing may be due to im­per­fect po­si­tion­ing dur­ing the scan, or maybe your breasts, like most women’s, don’t match. When a woman is “in­vited” back for more views, it’s of­ten be­cause an area on one breast didn’t look the same as the cor­re­spond­ing area on the other.

AR­CHI­TEC­TURAL DISTORTION:

No mass was seen, but the ap­pear­ance of the breast tis­sue is not nor­mal. The ra­di­ol­o­gist’s level of con­cern will de­pend on what is con­tribut­ing to the distortion.

CALCIFICAT­IONS:

Cal­cium de­posits ap­pear as bright white spots on a scan. Most calcificat­ions are not wor­ri­some and do not in­di­cate can­cer.

MICROCALCI­FICATIONS:

Small clus­ters of cal­cium de­posits are con­cern­ing, but while they of­ten in­di­cate that a biopsy is needed (in­tra­duc­tal calcificat­ions gen­er­ally re­quire a biopsy), they’re not di­ag­nos­tic of breast can­cer.

MASS/LESION TUMOR:

Th­ese words, while ter­ri­fy­ing, are also not a di­ag­no­sis of can­cer. A mass is a growth—pe­riod. (A bunion is a mass, but not toe can­cer.) A fi­broade­noma is an ex­am­ple of a com­mon be­nign (non­cancer­ous) fi­brous tumor. A cal­ci­fied mass is al­most al­ways be­nign. But of course, some masses are of greater con­cern than oth­ers.

SPICULATED FO­CAL MASS:

Up to 80% (but not 100%) of th­ese masses are can­cer­ous. A biopsy of th­ese is es­sen­tial. If you see this on a re­port, you have rea­son to be con­cerned, but be glad you had the mam­mo­gram, since most of th­ese masses can’t be felt dur­ing a breast exam. If a biopsy does de­tect can­cer, early de­tec­tion and re­moval is the surest way to a cure.

Based on all th­ese find­ings, the ra­di­ol­o­gist will use the stan­dard­ized Breast Imag­ing Re­port­ing and Data Sys­tem to com­mu­ni­cate an over­all im­pres­sion to your doc­tor, in­di­cat­ing a level of con­cern and sug­gested next steps, if any.

Dr. Streicher is a clin­i­cal pro­fes­sor of ob­stet­rics and gy­ne­col­ogy at North­west­ern Univer­sity’s Fein­berg School of Medicine.

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