Grab a Friend, Get a Mammogram: The Squeeze, the Scan, and the Callback

Healthcare guidance, pricing, and availability may change. This episode is for educational purposes only and is not medical advice.

Rebecca: Got my flu shot today

Tristin: Oh, you're gonna feel like crap tomorrow

Rebecca: And she said,

"I've got a plan. I've got

several I need to get, and I'm gonna do one a

week."

Tristin: he's like, "I'm what they call a grinder."

Welcome to Please Health Me. I'm Tristan, and each week I bring real health questions from around the internet to my mom, Rebecca, a board-certified family nurse practitioner with 45 years of experience. Together, we try to make healthcare a little easier to understand so you know more about what's happening, what questions to ask, and what options you might have.

We're here to educate, not diagnose or treat medical conditions. What we discuss should never replace advice from your own healthcare provider.Welcome back to Please Health Me. It's October, which means pink ribbons on everything, so today we're talking mammograms. And I have to start with a story, because I had my first mammogram ever literally yesterday. I thought this topic this month, awareness month, it would probably be great for the pod to go and get it done, and then share my experience.

And I will say, it was fun going with someone you know, who had done it many times before, and actually bragged about that.

I probably could have gone to one of those vans, but Carrie couldn't, so I thought, "That's fine. I'll just do this place that she liked," and also it was recommended by my NP. It was a nice place that did all kinds of imaging.

We both got into the back, which was really nice, and the changing, they kind of have a separate changing area, that we were able to just go into our separate little kind of like bathroom stalls, take off our shirts and bras, replace it with a gown that opened in the front. and then went and sat down, and Carrie went in first.

And it was funny, 'cause I was sitting there waiting for my turn, and I thought, "Oh, I'm gonna just grab my phone from the locker," and just as I was about to, she was already done. So literally between the two of us, it took 10 minutes. tech was super nice, took a quick history.

two things that she did really let me know that were important: First, if for some reason I move or I don't want to go back to their place again, I need to make sure to get both the records and the imaging to take to my next, location so that they can do some comparisons.

I know this is really crucial, 'cause I actually have a friend who had a terrible time trying to get all of her scans when she moved, and she's moved all over the country multiple times. So- Make sure you somehow write, collect, or note this somewhere, and, put it away so that you don't forget to do that when you leave.

It's probably the last thing on your mind when you're in the middle of a move. And then the second was, and she emphasized this, that I could get a call to come back for better imaging, and that it didn't necessarily mean anything and not to freak out, which of course she said is easier said than done.

But it can happen. and then it was like, was bam, two sides, two smashes, and over with. I could not have been faster. It really was not that painful. Like, tug your ear for 10 seconds and that was probably the worst of it. And I get that everyone's different, but, really it was, to me it was nothing.

and then after we came home, I kid you not, an hour later I got a text that said it was normal.

I went into my portal and boom, there it was. I know we were worried about

having the results of this in time for the

podcast, and wow, they were right there. And she had told

me two to three days when I walked out,

so I was really shocked. Mine came in first.

I

think Carrie's

were, like, an hour after that So of course then when I got the results I sent them over to you, Mom. that's my

experience.

What,

do you think about the results?

Rebecca: Well, I'm happy that you both had normal mammograms. Yay. And now you know it was fast and easy. if people listen to our episode on the five cheapest things you can do for preventative health, a mammogram was one of the tests we recommended for women. It's an important test that women can do for their health. bringing a buddy is an excellent way to get your mammogram and something I never even thought about, so that was great. you can get it done and go to have coffee or

lunch and catch up.

Tristin: Угу

Rebecca: And yes, truly, you need to keep your records, especially if you move. I told all my patients to keep all their records, especially now when providers change jobs or suddenly your practice or clinic is closed.

it's sometimes hard to get ahold of those things. They're your records and your property, so you should keep them. And since you'll get many mammograms, it's important to have old studies available to radiologists to compare to a new one. Even if you don't move, your facility will always compare to your previous to make sure there are no changes.

And as far as the callbacks go, yes, you may get one. But again, it does not mean there is something wrong. The newer methods actually prevent more callbacks. But if your last mammogram was using the older method, the newer method in comparison may show something we did not see before. And this is because they're way more sensitive.

It can pick up things we couldn't see in the older methods when we compare. So that's one reason you might be called back, and it's only that and no other reason.

Tristin: She really emphasized that, so I actually

appreciate that. and we got a lot of questions

on this one

from, women getting their very first mammogram, like me, to women staring at a report

full of words,

they've never seen. So let's start, let's just start at the very top.

Mom, I always thought that you waited

until 50 for your first one.

Is that still

true?

Rebecca: not anymore. In, 2024, the USPSTF, which stands for the United States Preventative Services Task Force, recommended mammogram screening starts at age 40. the USPSTF is a group made up of recognized experts in preventative medicine, and they meet and discuss recent medical data and decide if changes in preventative care are needed, and that was a big change from the previous age of 50

Tristin: 10 whole years earlier, like that's a big jump. What made them change it?

Rebecca: there were three main reasons. First, although more than

80% of

breast cancer is still diagnosed in women over 50, with a median age about 64, breast cancer rates are rising in

women under 50

Tristin: Yeah, so this is still mostly an older woman thing, but younger women are actually catching up. And I myself have seen this with one of my most favorite hairdressers in Portland, who literally turned 30 and had her second child and was diagnosed with stage four breast cancer right as

we headed into,

COVID.

It was l- it was terrible. She didn't survive. It was really tragic. two little girls, and she

was,

the second super young person I knew that died from a cancer that normally does not impact lower ages. Nick was 37 with colon cancer, and

then in her earliest of 30s, breast cancer. That's not the kind

of, you know, catching up that we want.

what's reason

number two?

Rebecca: there's now less risk in screening thanks to the new advanced technologies

Tristin: Yeah, and we'll get into that tech in a minute. and reason number three

Rebecca: And reason number three was it's an effort to reduce breast cancer deaths in Black women Appallingly,

the breast

cancer death rate in Black

women is 40% higher than in white women. Now, you would take that to mean Black women have a higher rate of

breast cancer, but that's not the case

Tristin: so they're not getting it more often, but they're dying from it more often? Why?

Rebecca: they tend to be diagnosed at

later stages. They have worse access

to care,

and they're more likely to have triple-negative breast cancer, which is an aggressive form of breast cancer

Tristin: Yeah, that's terrible. So starting screening earlier is partly about catching it

before

it gets to

those later stages. Let's back it up and keep it really simple

What is

a mammogram?

Rebecca: Okay, so a

mammogram?

is a type of imaging of the breast tissue. It uses a low-dose X-ray system to examine the breast. It exposes that part of the body to a small dose of radiation to produce pictures of the breast tissues. X-rays are the oldest form of medical imaging. Most everyone has had an X-ray sometime in their life

Tristin: Yeah. So it's basically the same thing as when you break your arm, it's just pointed somewhere, like, a lot

more personal.

Which brings us to the part that everyone talks about. Jess, 38, in Columbus, Ohio writes, "I just had my first mammogram

and I'm still sore hours later. Is it normal

to hurt

this much? And is there anything I can do to make it easier?"

Jess, mine was an ear tug for 10 seconds, but,

you know, I know everyone's

different. Mom, why the squeeze?

Rebecca: Well, it makes sense, right? The flatter the tissue, the more you see. If you spread anything thinner, you can see better. Every woman has different sized breasts, so it stands that someone can have a different experience than others. But the squeezing is for a short time, and then you're done And there are things, you can help a little bit.

we don't know, when she

got her mammogram, but if you make your

appointment in the seven to 14 days after a period, then you're less likely to have more sensitive breasts. when we're closer to our periods, the breasts are more sensitive. And if you have fibrocystic breasts, which is common, meaning more fibrous tissue, or fibroadenomas, which are smooth, benign little breast lumps, these areas may swell right before the period, and they become tender.

So you'd wanna limit your caffeine a week before because they can cause an increase in tenderness if you have fibrous or fibroadenomatous breasts. And you can take Tylenol or ibuprofen before you go, about an hour before. And then when you're done, wear, just wear a, a nice supportive bra for the day, but not an underwire, something comfortable.

really, it won't last that long if you had it. it's not gonna be something that you're gonna have sore breasts for days.

Tristin: Yeah, that's actually something to ease the pain, like Tylenol or ibuprofen. That's a nice idea.

and then of course supportive bra,

that's a good one too. I also realize now that we also

needed to make sure not to wear deodorant, which in my hot climate is tough.

I just made

sure to shower later and try to keep really cool throughout the day before, since our appointments were in the

afternoon.

so the squeeze has a purpose. Now, you said X-rays are the oldest

kind of imaging. Has anything changed since our mom's

generation? No offense, Mom.

Rebecca: there have been recent advances in breast imaging. full-field digital mammography, or FFDM, and tomosynthesis, which is a three-day-- 3D mammography, are newer ways to look at breast tissue

Tristin: those are a mouthful. Start with the digital one

Rebecca: In, uh, full field digital, the X-ray film is replaced by detectors that convert

the image to

electrical signals, Similar to how a digital camera works. The image can be seen on a computer screen and adjusted to make it

easier to see abnormalities. that can help eliminate

the need to come back for more imaging, which happens with

X-ray mammograms, and you won't notice any difference in how the image is

taken compared to the,

to mammograms you've had in the

past.

Tristin: So same squeeze, better camera. Film to digital, sounds like going from like a disposable camera to like your phone camera. And I actually think you pointed out that I had

this type of

mammogram too.

I think that's great. And then there's the 3D one, Tomosynthesis. Say that five times fast.

Rebecca: No, thanks. Tomosynthesis.

is a newer type of digital X-ray that creates a 3D image of the breast. During the exam, an X-ray arm sweeps over the breast in an

arc,

And it takes multiple pictures. the images are very thin, and that

lets the radiologist look at multiple layers of breast tissue with great detail compared to other studies

Tristin: Like flipping through slices of bread instead of looking at the whole loaf

Rebecca: Well, more like flipping through a book as the layers of the pages, the layers are very thin

Tristin: so instead of looking at one flat picture, the radiologist can look through the tissue page by page. I remember that arm moving during mine, but I had no idea what it was doing. I was, you know, mostly concentrating on where to stand and what to hold onto. And that brings us to something these images can help with: dense breasts. Brittany, 32, in

Sacramento, California. She wrote, "My mom had

breast

cancer at 43."

Ooh, wow. "So I got checked early.

My report says I have dense breasts. What does that

even

mean?"

Rebecca: as we said, dense breast just means more fibrous tissue or fatty tissue. It's not abnormal, it's just the way you are. Tomosynthesis is the study of choice in women with dense breast tissue. dense tissue shows up white on a mammogram, and so do tumors and calcifications, which make these mammograms harder to read.

So you can't-- with that, you won't see, have a tumor hiding behind some dense white, fibrous tissue, so it's really helpful.

Tristin: And funny enough, dense breasts are the whole reason we went where we did

because Carrie

has dense breasts and said

I can't just do the walk-in van.

I have to

get the certain

kind. And I was like, "Well, what difference does

it make to me?

I'll just book at the same place." But it turned

out

that I also

had

Rebecca: dense breasts. I did not know that. doesn't mean that your breasts are big

or that they're, more full. it just means you've got more

fibrous tissue in there,

But, you can see on that on that

scan,

Tristin: Yeah, my first scan that I just had

Rebecca: you yourself can see that you, you see a lot of white in there, right? Kinda scattered all over. and that says

that you're considered dense breast because you have a lot of that.

Tristin: Yeah, so it's like trying to find a polar bear in

a

snowstorm. Everything's white, which is why the 3D slices help

Rebecca: Exactly.

Tristin: now we've got a question about computers

reading

these things.

I went to a talk at the beginning of the month about this very

thing, and Priya, 50, in Seattle, Washington also asked, "I read that AI can spot

breast cancer better than the doctors who read mammograms.

Is that true? Would I want a computer reading mine?"

Rebecca: actually computer programs to help

screen mammograms have been around

since 1998. But originally, the

studies showed they did not really prove any benefit. But now we have AI. We have improved

readings and detection with AI. they are FDA approved and show real benefit in cancer detection without increasing false positive rates.

studies up to now have proved the value of AI in mammogram screening, but studies have not recommended a replacement of radiologists. AI can quickly read mammograms and flag areas of concern, so then the radiologist can read and confirm what they found. so it's very helpful to, to weed through a lot of mammograms at a time and they can really pick things up

Tristin: Yeah, So it's less robot doctor and more

highlighter,

like the computer points and the radiologist

decides

Rebecca: Yeah, I, it's, a great way to do things. I think we have the best of both worlds Right. now. We have a built-in second opinion

Tristin: Yeah.

So that's how they read the images, but deciding when you need screening also depends on your history. Brittany mentioned that her mom had breast cancer, and the tech asked me also about my family too.

How does that information change the plan?

Rebecca: as we discussed before, the medical societies can differ in their guidelines. they all have their own way, but the majority agree screening should start at 40, and that?

should be every one to two years. But what helps decide is personal history, family history, breast density, and other factors that go into the type and frequency of screening. A woman at 40 who goes for her first mammogram will now have her family history and personal history taken to help make a plan for how often she needs to go.

Tristin: Yeah, so this is not a one-size-fits-all.

They're

building you, like, a personal plan. how do they figure out where you

land?

Rebecca: for women with no history of breast cancer, providers use what they call the Gail Risk Assessment Tool. It uses factors like your age, your age at your first period, your age when your first child was born, how many first-degree relatives that, had breast cancer, like mothers, sisters, daughters, race, how many breast biopsies you've had, whether positive or negative, and any atypical hyperplasia, which is a, an excess of abnormal-looking cells but that are not cancerous

Tristin: Yeah, those were literally the questions she asked me before my mammogram

Rebecca: Well, the answers to those questions give a woman a Gail score,

and

a score over 1.7% moves you from an average risk to an increased risk category. Other increased

risk categories are very dense breasts, prior radiation to the breast. These can change how often you're screened and what type of screening are used

Tristin: Okay, so it's like a credit score but for your boobs. What about the women with the strongest family history?

Rebecca: Yes. Well, the women with a family history of

breast cancer

who've tested positive for genetic markers, the common ones are the BRCA1 and 2, will have more frequent screenings by MRI because they're at the highest risk category

Tristin: Got it. So now I have to ask

because I know

someone listening is probably

thinking this, but I don't have any risk factors, so I'm fine

Rebecca: Well, the number one risk factor is being a woman. So when I hear, "I have no

risk factors,"

from women who don't want to do a mammogram, I always say that

Tristin: Mic drop. Okay, so what else raises your risk?

Rebecca: both alcohol and smoking can cause inflammation and damage DNA,

which can increase

risk. Regular

drinking and

obesity after menopause can cause higher estrogen levels, and too much estrogen will fuel some types

of breast cancer.

Also, diets high in fat and low in fiber and diabetes or high

blood sugar like prediabetes

Tristin: Hmm. Any good news? Like, is there anything that lowers it?

Rebecca: Well, a few. Some protective factors are menopause before 45, which of course you can't

control, and breastfeeding

and regular exercise

Tristin: So the stuff you can control, drink less, don't smoke, move your body. Okay, now let's talk about what happens after the mammogram, the waiting. Dana, 46, in Tucson, Arizona, writes

Every year I get my mammogram and then sit refreshing my patient portal until the

next night. I hear some people are getting results the same day.

How long

should it actually take?" So Dana, I feel this. They told me two to three days, and mine showed up by text in an

hour. Mom, is that normal?

Rebecca: the timeframe for results has definitely shortened, but it also depends on your facility. Not all facilities have all the latest equipment, may be busier than others. It used to take weeks to get results. if they do see something, it'll take a little longer also 'cause they wanna compare to old mammograms.

Tristin: I

can't imagine waiting that long, and sometimes

the results aren't all clear.

Brittany in Sacramento, her

report also said she needs more

imaging, another mammogram on one side plus an

ultrasound. So she's kinda

freaking out, and this is exactly what my tech warned me about, a

callback for,

quote, better imaging,

could happen.

Should Brittany be

worried?

Rebecca: again, we don't know what our facility has. As I said, digital AI and tomosynthesis really has cut down on callbacks. That was the positive thing. But if something is seen and they do need to further examine an area, they will call you back for that. Also, I did say that if your prior mammogram was more old school, not the 3D new techniques, it will show more, and those things weren't there before, so they can't compare.

They feel like, "Okay, this is new." It may not be. It might have been there all along. doesn't mean it's worrying, but may need a closer look since they didn't see it before. Try not to worry when you get a callback. I have had mammograms for a very long time, and every time there's a new technology, they see something that wasn't there before.

So, I had to go

back, and of course I thought the

same

thing, "Oh, g- this is just what I need

right now," But it was fine, and that's j- usually the way.

Tristin: Yeah. I think we get nervous for having to go back for literally any medical thing at

any point,

Rebecca: This doesn't bode well for me 'cause I'm getting my, my next month in at Mayo,

different place, different equipment. Yeah, so I'll probably get a call

Tristin: you probably just put on a bra and they're like, "You're done, and then you can go away. Would you like some

food?"

Rebecca: No, they're gonna have,

they're probably gonna put an IV in and

Tristin: I'm sorry, You need to go out for this

do an EKG, draw some blood, and then they go "Okay." Oh my God, that's funny

Okay. Then we had a question from Lauren, 37,

in Raleigh, North Carolina. She asked, "I had a

sore lump in

my armpit for a few months. My doctor ordered an ultrasound but not a mammogram.

Would an ultrasound

catch cancer or should I push for both?"

Rebecca: I'm assuming she did not have one. I mean, she's 37. She may never have had a mammogram. if she has and it's been a year or more, yes,

you also need a

mammogram.

But I would say yes, you need a mammogram.

as well. Now, the

ultrasound can show what type of a lump, like lymph node or a solid tumor, but either way, you'll need a mammogram follow-up

Tristin: Yeah, that makes sense. And then there's the scariest word in this whole

episode.

Amanda, 37, in Nashville, Tennessee writes, "Breast cancer runs in my family. I found a lump,

and the radiologist thinks it's probably harmless, but

because of my history she wants a biopsy. My report says suspicious, and I'm gutted.

What

does that word

actually

mean?"

Rebecca: I guess I wonder, since she has it in her family, has she been genetically tested? She should be if she hasn't, and that, that tells you a lot. So do that if you haven't. suspicious gives you a designation of a BI-RADS Category 4. This means the finding does not look like classic cancer, but it is concerning enough that the biopsy is recommended.

It's not a cancer diagnosis. The majority of Category 4 lesions turn out to be benign. The protocol for four and five is a biopsy, so that is why they're doing it, not because they think it's cancer. BI-RADS, by the way, stands for Breast Imaging-Reporting and Data System, and that is a system created by the American College of Radiologists so they can classify all these things and make a protocol for each category.

Tristin: okay. that's, that's

helpful. So a lot of this is about really not

panicking at the first scary word on the report, but just to be more, like,

proactive. which brings us to

signs you shouldn't ignore

Rebecca: Yes, there are signs you shouldn't ignore

remember, breast cancer rates are rising in women under 50. So some of those symptoms are a new lump or mass, which can be in the breast or the armpit, nipple changes in appearance, discharge that isn't breast milk, skin changes on the breast. This can be redness, swelling, thickening, or something we call orange peel, where the skin resembles the surface of an orange.

So if any of these things are occurring, you need to see a provider, be examined, and then have the proper imaging.

Tristin: Wow, okay. Orange peel is interesting. So lump, nipple

changes,

skin that looks like an orange, if you notice any of those, you don't wait for your

next birthday.

so Linda, 55, in Denver, Colorado,

asked kind of a

big picture

question, I keep seeing people online argue that mammograms do more harm than good.

Should I

still

get

mine?"

Rebecca: I'm not sure what they mean by that. if you have family history or symptoms, I would hope you would be screened and not listen to the experts on TikTok. If you have never had one. or get them every 10 to 15 years, like a lot of my patients, I urge you to get one. If you will only go every five years, then do that.

It's better than never going. remember, the biggest risk factor is being female. I'm assuming they are afraid of radiation. maybe a, a combined 2D and 3D mammogram screening has a radiation dose of roughly one to two months of natural background radiation. We are exposed to radiation in our daily lives all the time.

We are exposed to low levels of RF radiation from our cell phones, and we sure use those a lot. So much less than a mammogram, but we use those daily and frequently. so yes. the five-year survival rate for women with breast cancer depends on the stage at diagnosis. So for s- stage one, it's 99%.

The rates decrease with each stage, down to 32% in stage four. So obviously, this shows the importance of early

detection.

Tristin: I mean 99%

versus

32%,

that's wh- that's the whole episode in like two numbers, right?

so Linda, I'm hearing that's a yes

Rebecca: Yeah, we have much better techniques for early detection and treatment now. You should never be afraid to be screened for

breast cancer.

Many women live out their lives after treatment with regular follow-up. The key is to get screened and get it early

Tristin: Yeah, so if you've been putting it off, consider this your sign. book it. I, I did and I'm really glad that I did, and I'll be signing up for the next appointment. So okay, here's my

discharge

summary. Screening now starts at 40, not 50.

And I'm 44 so I was even a little

late to the party.

The squeeze is annoying, but it's worth it.

Digital and 3D mammograms are better at

finding things, especially in dense breasts. and then your risk really depends on your history, but as Mom mentioned, being a woman is risk factor

number

one. And a callback or a scary word in a report doesn't automatically

mean

cancer

Rebecca: And the one thing I want everyone to take away is you should never be afraid. to be screened. The key is to get screened. I had patients that were clearly afraid. They didn't want to know. that's really not the way to approach it. You wanna get things done early, and then it isn't a big deal

Tristin: Right? Get screened. You heard her. Make a party of it, like I did, and it was fun actually. It made it much more enjoyable. thank you to Jess, Dana, Brittany, Lauren, Priya, Linda, and Amanda for your questions. If you have a health question you'd love us to dig into, please send it our way at pleasehealthme.com or @pleasehealthmepod on Instagram.

And also remember to follow us on your favorite podcasting platform, and recommend us to anyone you think

who would find it

helpful. You could actually save their life in some of

these cases. Thanks for

listening to Please Health

Me.

Rebecca: Bye

Thanks for listening to Please Health Me. If you found this episode helpful, pass it along to someone else who might too. And if there's a health question you want us to talk about, send it our way at pleasehealthme.com. We'd love to hear what you're wondering about, because chances are, other people are wondering about it too.

And as always, this podcast is for education only. It is not medical advice, and it shouldn't replace the care from your own healthcare provider. If you enjoyed today's conversation, be sure to follow Please Health Me so you don't miss future episodes. You can also visit our website for all our episodes, show notes, and additional resources.