Where To Get Your Mammogram
A doctor explains that it's best to have one in a comprehensive breast center with a staff fully trained for appropriate follow-up.
Over the past few decades, screening mammography has become the standard of care for the detection of earlystage, non-palpable breast cancer, and the pink ribbon has come to symbolize the fight against the disease in Western countries. But although having a mammogram is a crucial first step in detecting breast cancer, Linda Sanders, M.D., medical director of the Breast Center at the Ambulatory Care Center, emphasizes that where you get your mammogram makes a difference.
A growing number of physicians are performing mammography in their offices. The images, often digitally acquired, are sent to an off-site company for radiologists to interpret. This may seem like a nice convenience, but that convenience is offset by a number of problems, as Dr. Sanders explains.
“Tele-mammographers, who read your studies at a remote location, are anonymous,” she says. “They may not have dedicated their professional lives to breast imaging but could be general radiologists.” They could be newly trained or inexperienced in the art and science of mammographic interpretation, says Dr. Sanders. A general radiologist, or even a newly trained mammographer, may miss what a breast specialist will find. “Also, an offsite radiologist cannot develop any relationship with a patient,” she adds. “They aren’t available to answer questions or address any issues.”
Another major problem is that if the screening mammogram done in the office does show something worrisome, the patient must be referred to a full-service breast center for further evaluation anyway. Also, does the off-site radiologist have all of the woman’s prior mammograms for comparison? Often, the offices request only one prior year of mammograms for comparison, which limits the ability to detect slow-growing cancers that may not have changed in just one year and may be difficult to spot without much older studies.
Indeed, continuity of care between a patient and her provider is a critical component of both effective care and patient satisfaction. “The National Institutes of Health reports that both quality medical care and patient satisfaction are much greater when there is continuity of care,” says the doctor. “And the costs of medical care inevitably rise, both for the patient and for the entire health care system, if the patient is seen at different facilities.”
Need another reason? “Half of all women have dense breast tissue and should consider having a supplemental screening breast ultrasound,” says Dr. Sanders. “This is a service often not provided in doctors’ private offices.
“For all these reasons, a patient should have her annual mammogram at the same facility where diagnosis with core biopsy, if necessary, is available,” the doctor continues. “At our center, our specialty trained mammographers are on-site. The radiologists who perform the interventional procedures are all fellowshiptrained and we are reachable for consultation. Our patients may talk to us in person about their findings and their reports.”
Perhaps the most appreciated service the Breast Center offers is rapid results. For many women, waiting for results is often hard, sometimes excruciating. The Breast Center helps alleviate the anxiety with communication through PenConnect, an email system that gets results to patients automatically after the mammogram is read. “Sometimes that means getting the result before the patient gets back home. Some patients who need additional testing come back that same day or the next morning.”
For women who find even that too long a delay, the center offers a “Screen with Wait” option. “A patient who is really anxious can remain in the department while we evaluate the mammogram,” says Dr. Sanders. “This is particularly wonderful for those so nervous they must know immediately.” It is also helpful to the elderly or disabled, who may have trouble with transportation, or those who come from far away, who appreciate the assurance that they won’t have to return on another day for additional testing. These appointments are available daily and allow additional on-the-spot imaging. “This helps reduce and mitigate the anxiety,” says the doctor. The Breast Center also recently began offering evening appointments for diagnostic mammograms, especially for working women.
Finally, if mammography reveals a concern, the Breast Center has nurse navigators to help the patient through the next steps of treatment. “If something suspicious is discovered and sampling is required, we are able to offer same-day biopsy, and a follow-up appointment with a breast surgeon in the office next to ours,” she says.
If breast cancer is identified, the Cancer Center at Saint Barnabas Medical Center works closely with The Breast Center to provide continuity of care for the patient and family. In addition, patients have access to an extensive offering of clinical trials, as Saint Barnabas Medical Center has a clinical research partnership with the Rutgers Cancer Institute of New Jersey.
Tele-mammography with remote reading can be a great thing, Dr. Sanders concedes, “for patients who live in a rural area without access to a breast center. But here in New Jersey, there are plenty of options for on-site care. The convenience of mammography in your doctor’s office is far outweighed by the benefits of a full-service breast center such as ours.”
To make a mammogram appointment at the breast center, call 973.322.7800.