The Questions You Should Ask Your Doctor About Your Mammogram

A mammogram is the X-ray picture of the breast. Doctors use mammogram to check for early signs of breast cancer. Regular mammogram can detect breast cancer early, sometimes long before it can be felt. Most women should have a mammogram every year no later than age 50 for women at average risk for breast cancer.

Asymmetry in Breast Tissue

Breast asymmetry occurs when one breast has a different size, volume, position, or form, form the other. Asymmetry is an area of increased density in one breast compared to the corresponding area in the opposite breast.

Asymmetry can indicate breast cancer. An asymmetric area may indicate a developing mass or an underlying cancer.

There are different kinds of asymmetry, from difference in size and tissue density. On a mammogram, an asymmetry typically means there’s more tissue, or white stuff on the mammogram in one area other than the opposite side. Breast cancer can present as an area of focal asymmetry. You may simply have more tissue in one breast than another (global asymmetry) or in one spot (focal nodular symmetry).

Asymmetries require further evaluation, such as a diagnostic mammography, sonography, breast MRI or biopsy. Additional tests may uncover a mass such as a breast cyst. Benign, non-cancerous masses can appear as a focal asymmetry.

You should ask your doctor:

• What is asymmetry on a mammogram?
• Was there a difference in size?
• Was there a difference in tissue density?
• Was there more tissue in one breast?
• Was the asymmetry present on other studies?
• Has the assmmetry always been there?
• What is making that area look different?
• Was this global asymmetry?
• Was this focal asymmetry?
• Did you determine the cause of the asymmetry?

Enlarged Axillary Lymph Nodes

Lymph nodes are part of the immune system. Although they’re found throughout the body, they cluster in the neck, axilla (armpit), abdomen and groin. Their function is to clear lymphatic fluid from the body, which increases during infection or inflammation.

Swollen lymph nodes are a sign that the body is fighting off infection. Lymph nodes can also enlarge when cancer spreads through the body beyond where it originated.

When swollen lymph nodes show up on a screening mammogram, it calls for further testing. When you see enlarged or prominent lymph nodes on screening mammogram within the axilla, the patient is called back for additional evaluation, which can include ultrasound of the breast and axilla.

If patients have enlarged lymph nodes on screening mammography, serial ultrasound evaluation allows your doctor to monitor the lymph nodes more frequently, and ascertain that the enlargement is due to infection/inflammation and not malignancy.

Abnormality of only one node in the axillary chain favors malignancy since metastatic disease tends to affect one node at a time. Pathological lymph nodes are characterized by increased attenuation, high density, a round or irregular shape, and lack of fat in the hilus. Abnormality of multiple nodes in the chain favors a reactive process because inflammation tends to simultaneously affect all nodes in a given chain.

Axillary lymph nodes that demonstrate at least 2 abnormal mammographic features and are either palpable or have shown substantial interval enlargement warrant further ultrasound evaluation. In some cases, the nodes are biopsied to confirm that they are not cancer. New lymph nodes without a clear, underlying cause should be considered for a biopsy.

Ultrasound guided core needle biopsy can be performed for lymph nodes that are in an accessible and safe location (to avoid damage to the axillary vessels or nerves). Ultrasound can differentiate between reactive and malignant diseases.

You should ask your doctor these questions:

• Was the lymph node a normal shape?
• Is there an abnormal lymph node?
• What is the shape of the lymph node?
• Did the lymph node increase in size compared to the previous study?
• Did the lymph node increase in opacity compared to the previous study?
• Is this a new finding?
• Did you consider a biopsy of the lymph nodes?
• Was there a change in the size of the lymph nodes compared to the previous mammogram?
• What is the cause of the enlarged lymph node?
• What is your differential diagnosis for the enlarged lymph nodes?
• Is cancer on your differential diagnosis?

Calcifications in the Breast Tissue

When abnormal cells grow inside the duct, the cells may get so crowded that some of them die and they body can’t clear them away. If this happens, those cells can harden (or petrify) and areas of calcium form. Calcifications typically don’t show up on ultrasound and they never show up on breast MRI.

Calcifications can’t develop into breast cancer. Rather, they are a marker for some underlying process that is occurring in the breast tissue. Sometimes, calcifications can be a marker of underlying cancer development.

Microcalcifications that very in size and shape are more of a concern and they may be clustered in a specific area of the breast. They may be referred to as pleomorphic calcifications. If calcifications are clustered together or concentrated in one segment of the breast, they tend to be viewed with more concern.

Calcifications are more likely to be associated with a cancerous process if they: (1) are smaller than 0.5 mm each; (2) vary in size and shape; and (3) are clustered in one area of the breast. If calcifications are suspicious, further tests are needed. Microcalcifications are smaller flecks (less than 0.5 mm) that resemble small grains of salt. Larger calcifications are less suspicious.

You should ask your doctor these questions:

• Did the calcifications change in number or size?
• How would you describe the shape of the calcifications?
• How many calcifications were there?
• Do the calcifications vary in size and shape?
• Are the calcifications clustered in one area of the breast?