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Diagnostic Mammograms

Diagnostic mammograms are like screening mammograms in some ways and different in others (related: Screening Versus Diagnostic Mammograms: What You Can Expect). A screening mammogram is recommended annually for women over 40 with no risk factors or clinical symptoms and a normal physical exam. The technologist doing a screening mammogram takes standard prescribed views of both breasts.  A diagnostic mammogram is performed for women who have a higher risk for breast cancer, palpable lumps or abnormalities in the physical exam, clinical symptoms, or an abnormal screening mammogram. 

 

Although the same machine is used for screening and diagnostic mammograms, the views obtained in a diagnostic mammogram are tailored to the specific person. For example, a person called back from a screening mammogram to evaluate an area of concern will have views targeted to the area, whereas a person coming in for a diagnostic mammogram with a palpable lump will get standard views like the ones used for screening and additionally targeted views to the area of palpable concern. 

 

Both types of mammograms, screening and diagnostic, help your breast radiologist rule out or help diagnose breast cancer. Breast ultrasound is ordered alongside a screening or a diagnostic mammogram to help radiologists get additional information about the areas of concern and to evaluate dense breast tissue.

 

At Houston Methodist, our board-certified radiologists use advanced 3D technology to detect the smallest lumps and abnormalities with accuracy. Our radiologists will review your diagnostic mammogram and provide same-day results, often while you are still in our Breast Care Center. 

When to Get a Diagnostic Mammogram

Diagnostic mammograms are used to both find and rule out breast cancer.  A diagnostic mammogram may be recommended for two reasons: After a screening mammogram shows an abnormal result, or you if you experience breast cancer symptoms.

 

If you experience any of the symptoms listed below, you should see your primary care doctor or gynecologist right away — he or she will provide you with the necessary doctor's order for a diagnostic mammogram.

Suspicious Mammogram Findings

Some suspicious mammogram findings that can prompt your doctor to order a diagnostic mammogram can include:

 

  • Architectural distortion: This is when no lump or mass is seen, but there is an oval or round pattern of breast tissue on a mammogram. 
  • Calcifications and microcalcifications: These are bright white spots on mammograms that can range in size. Calcifications are often benign, but tight, clustering microcalcifications can indicate breast cancer.
  • Ductal carcinoma in situ (DCIS): This is when abnormal cells are located in the milk ducts but have not spread to other parts of the breast.
  • Masses: A white patch or mass, that can have spiky or fuzzy edges, may indicate breast cancer. 

Breast Cancer Symptoms

Additionally, your doctor may order a diagnostic mammogram if you experience symptoms such as:

 

  • Lumps, hard knots or thickening inside the breast or underarm
  • Breast swelling, warmth, redness or darkening
  • Changes in breast size or shape
  • Skin dimpling or puckering
  • An itchy, scaly nipple sore or rash
  • Nipple or breast inversion or retraction
  • Sudden nipple discharge
  • New pain in one spot that does not go away

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Diagnostic Mammograms — What You Need to Know

  • How to Prepare
  • What to Expect
  • Understanding Your Results
  • How to Prepare

    Preparing for your diagnostic mammogram is simple:

    There are no special instructions you must follow before a diagnostic mammogram. You may want to wear comfortable clothes, including a top with pants, shorts or a skirt. That way, you will only have to remove your top and bra during the appointment. You will want to skip applying deodorant, lotions, powders or creams before your appointment. If you forget, our Breast Care Center care team will provide you with wipes to remove any of these products — they can appear as white spots on the images, which can affect the reading of your mammogram. 

     

    If there is a risk you may be pregnant, please contact your doctor who will likely reschedule your appointment.

  • What to Expect

    What to expect during your diagnostic mammogram:

    A diagnostic mammogram is similar to a screening mammogram, just a little longer. Your breast technologist will walk you through each of these steps:

     

    • Check in and fill out any necessary forms.
    • In the changing room, you will remove your top and bra, wipe off any deodorant or lotions, and put on a robe.
    • You will be taken to exam room, where a mammogram technologist will ask about your breasts and any concerns you may have.
    • The technologist will position one of your breasts on the machine, which will briefly compress your breast while the technologist takes an X-ray image. 
    • This process is then repeated to get the four standard images for each breast. Each compression is very quick.
    • Your technologist will then do spot compression or magnification images of any areas of concern. These may be uncomfortable, but they last just a few seconds.
    • Next you will have your ultrasound (if part of your appointment).
    • Your breast radiologist or technician in most cases will talk with you immediately about your results and any next steps.
    • Finally, you will go back to the changing room to get dressed and continue with your day.
  • Understanding Your Results

    What your diagnostic mammogram results mean:

    A diagnostic mammogram report will include details about breast tissue, including the density of breast tissue, as well as any areas of concern, such as lumps or calcifications (tiny mineral deposits). 

    The results of both diagnostic and screening mammograms are coded by a standard coding system, the Breast Imaging Reporting and Data System (BI-RADS) system. The results use a BI-RADS numbers 0 through 6: 

    • BI-RADS 0: Your study is not yet complete and more information is needed. If this is included in the report, additional testing may be needed, such as magnetic resource imaging (MRI), ultrasound, molecular breast imaging (MBI) or contrast enhanced mammography (CEM). 
    • BI-RADS 1 or 2: Your study may be normal, but this category also includes other benign findings, such as cysts. 
    • BI-RADS 3: This means your study is probably benign (not cancer) but there is a finding that needs follow-up, usually done with a short-term interval mammogram and ultrasound in six months. The chance of cancer in this category is low but not zero.
    • BI-RADS 4: This means the findings in your study are suspicious for cancer and a breast biopsy is indicated. You should talk to your doctor who will likely order the biopsy.
    • BI-RADS 5: This means the findings are highly suspicious for cancer. You should talk to your doctor who will order the biopsy. 
    • BI-RADS 6: This means you have been diagnosed with cancer and you should discuss your treatment and imaging plan with your physician. 
Diagnostic Mammogram Benefits

Diagnostic Mammogram Benefits

 

Diagnostic mammograms offer many of the same benefits as screening mammograms, including:

 

  • Early detection: Catching breast cancer at an early stage, potentially before symptoms appear, can increase the likelihood of successful treatment and better outcomes.
  • Monitoring changes: Regular mammograms allow doctors to monitor changes in breast tissue over time, which helps in identifying any new or suspicious developments early.
  • Guiding treatment: If cancer is diagnosed, a diagnostic mammogram will be an important step in building a breast cancer treatment plan that is unique to you and your situation.

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FAQs About Diagnostic Mammograms

How is a diagnostic mammogram different from a screening mammogram?

A diagnostic mammogram looks to answer a specific clinical question — either a screening mammogram showed areas of concern, or someone is experiencing symptoms — and further investigation is needed. During a diagnostic mammogram, additional special imaging views are captured to target areas of concern that may be calcifications or masses. Other diagnostic methods, including ultrasound, may be used during a diagnostic mammogram appointment.

Are diagnostic mammograms painful?

Pain is a very individual experience. If you know your breasts are sensitive during menstruation, consider scheduling your mammogram around your period. And if you’re concerned about pain during your appointment, talk with the breast technologist performing your mammogram. Breast technologists want to get the best images possible for the radiologist to detect any potential cancer — not cause you pain.

Are diagnostic mammograms safe?

Yes. The amount of radiation exposure with a diagnostic mammogram is very low thanks to the newest technology we have to perform the test. We encounter radiation from natural sources all the time in our everyday lives — including the sun — and while we are never entirely free of risk, it is generally quite low. Finding breast cancer early when it is most treatable outweighs the very small risk of radiation exposure.

How often should I get a diagnostic mammogram?

Your referring physician will work with you to determine if you need a diagnostic mammogram or a screening mammogram, based on your clinical symptoms, personal and family history and prior mammograms reports. Your mammogram schedule is based on your individual needs. Women who receive benign diagnostic mammogram results may be able to return to a yearly screening mammogram schedule. For those who have breast cancer risk factors or have a medical history of previous breast surgeries, you may need to have ongoing diagnostic mammograms at a cadence suggested by your doctor.

How long does a diagnostic mammogram take?

Diagnostic mammograms can take anywhere from 30 to 45 minutes, including the time you may need to check in, fill out paperwork, change, etc. If your appointment also includes an ultrasound, that may take anywhere from 15 to 20 minutes in addition to your mammogram. 

Does insurance cover the cost of a diagnostic mammogram?

Insurance may cover a portion of the costs of a diagnostic mammogram, but you may be responsible for a copay or coinsurance amount. Review your insurance plan or contact your insurance provider directly to understand your specific coverage.
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