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When do you have a mammography exam, an ultrasound exam, a biopsy or a bone density test?

Madeline Crivello, M.D., a radiologist at Mount Auburn Hospital in Cambridge, a teaching hospital of Harvard Medical School, says, “Sometimes women tend to put their families and even their jobs before themselves and, as a result, they neglect important health care screenings and fail to take preventive steps to insure their own well-being.” She continues, “Women need to be proactive about their own health and keep in mind that they should take care of themselves so they can be there for their families and others who depend on them.”

Dr. Crivello also points out that by taking care of your own health, you are also being a good role model for your children, particularly your daughters. When your children see that you have yearly health screenings, such as mammograms, pap smears, and blood pressure screenings, they see this as an important part of being a responsible adult.

Screening mammograms are routine x-rays of the breasts that are performed when there is no clinical abnormality. Every woman should have an annual mammogram exam after the age of 40, or earlier if she has a family history of breast cancer. Diagnostic mammograms are performed when a woman has pain or a lump in her breast or some other issue that indicates a possible abnormality. Women experience minimal but very brief discomfort from the breast compression during a mammogram exam. Radiologists, such as Dr. Crivello, read the x-rays and determine if there are any areas that appear abnormal.

If there is an abnormality suggested on the mammogram, another imaging test commonly performed to obtain additional information is an ultrasound exam. (Many women are familiar with ultrasounds of their developing babies to look for appropriate growth and development.) If an abnormality is confirmed, the next step is usually a biopsy.

Biopsies are typically performed in one of three ways. One approach is with ultrasound, a procedure that uses high frequency sound waves to produce a picture of internal organs. Tissue is sampled with a needle using the ultrasound image as a guide to the affected area. This is the easiest and quickest method for the patient, because she can rest on her back and her breast is not compressed when the tissue sample is taken. The second approach is a stereotactic biopsy, which involves the use of x-rays. During this procedure, the mammography equipment is hooked up to a computer, which helps guide a needle to take a sample of the suspicious tissue. A surgical biopsy is a third approach, although it is usually the least desirable since it is an invasive procedure. Surgical biopsies are performed in instances where the other two approaches are not technically feasible.

A bone density exam is another common screening exam that many women have regularly. This exam helps physicians determine if their patients are losing calcium from their bones and thus, are at risk for developing osteoporosis. Bone loss can be very dangerous for people as they age since fractures are more likely. Women, in particular, are more prone to osteoporosis and often their physicians will prescribe bone density tests to see what is happening to their bones. These exams use very low x-ray energy to produce images of the spine and hip, which are then used to measure bone density. A comparison is made between the patient’s bone density and the average bone mass for someone of the same age.

Dr. Crivello advises every woman to have a baseline bone density test after the menopausal period since the loss of estrogen during menopause makes a woman more vulnerable to bone loss. There are medications that can slow the process of bone loss if it is detected. It’s very important to catch osteoporosis early to prevent fractures. Hip fractures, in particular, can be very serious in elderly patients, frequently leading to death.

Primary care physicians can make referrals for all these imaging tests although you do not need a doctor’s referral for a screening mammogram.

“It is important for women to have regular medical screenings that can help detect cancer or other diseases early. At the Mount Auburn Hospital Hoffman Breast Center, we offer a range of imaging services, including screening and diagnostic mammogram exams that can detect the very earliest stages of breast cancer”, says Dr. Crivello.

For a free breast self-exam shower card, please call us at 617-499-5094.