Afraid of getting a mammogram? You’re not alone.

Presented by Providence Imaging Center

As a radiologist with a specialty in breast imaging, Dr. Heather Tauschek looks at as many as 7,000 mammograms every year.

But when she turned 40 and it came time for her own first mammogram, Tauschek admits: She was scared.

That’s right. Even a doctor who reviews anywhere from 60 to 100 mammograms every single day was a little bit afraid to get one herself.

“I have the world’s worst white coat syndrome,” Tauschek said. “My heart races. I get nervous.”

It’s not unusual to be nervous about getting a mammogram. In fact, fear is one of the most common reasons women put off the routine screening.

“It’s very commonly an emotional experience,” said Lauren Jager, the mammography supervisor at Providence Imaging Center. “That’s super normal. It’s kind of nerve wracking. You’re getting checked for cancer.”

But a mammogram doesn’t need to be a scary experience. If you know what to expect, you’ll find it’s a lot less intimidating -- and a lot more pleasant -- than you imagined.

What happens at a mammogram?

A screening mammogram starts out just like any other visit to the doctor, and these days, that means some extra measures to prevent the spread of COVID-19. Providence Imaging Center, where Jager works, is located inside Providence Alaska Medical Center. When you enter the hospital, you’ll have a quick screening with a temperature check and a few questions about your health. At the imaging center, you check in just as you would at your regular doctor’s office, after which you’ll go into an exam room, where you’ll undress completely from the waist up and change into a hospital gown. (You can also ask for a warm robe, Jager added.)

Once you’re ready, an imaging technologist like Jager will come in and go through a fairly detailed health history questionnaire, and then it’s time to capture some images.

The mammography machine is large, and you’ll stand next to it and be asked to position your body so that your breast is in the best possible spot. A pair of large paddles will gently compress your breast, and you’ll be asked to hold your breath and stay very still while the images are being recorded.

This is the part that makes some people nervous. And Jager said she understands; it’s a little weird to think of putting your breast between two pieces of plastic to be squeezed, even if it’s a gentle squeeze.

“We do use compression,” Jager said. “That’s how we get the good pictures.”

But while the screening feels awkward and possibly uncomfortable, it shouldn’t be painful. If it is, Jager said: Speak up. Often there are adjustments that can be made to help.

“The technology has gotten so much better, even since I started doing mammograms about eight years ago,” Jager said. “Patients who haven’t come in in a few years always comment on how much better it is.”

Equipment has been redesigned to compress differently and for shorter periods of time. Many patients are able to take advantage of SmartCurve paddles, new equipment that curves around the breast and makes the experience more comfortable. The position, configuration and equipment that work best will vary from patient to patient.

“We’re making sure that each individual person gets the best exam for them,” Jager said. “One of the things about breasts is that nobody is shaped the same. We’re kind of making sure that each patient, all of their breast tissue has been imaged and imaged well.”

Typically, the imaging technologist will take two images per breast: Top-to-bottom and side-to-side. Sometimes they may need to get additional pictures, especially if your breast tissue is dense (which is common among younger women). If they’re having a hard time getting an image of the area behind your nipple, they may take some “nipple in profile” pictures as well. You’ll repeat the process on the other side, and then, as quickly as it started, your appointment will be over.

“It’s super quick,” Jager said. “You’re pretty much in and out of here within 20 minutes. The radiologist looks at it later that day. Almost everybody leaves saying ‘That wasn’t bad at all.’”

How do you prepare for a mammogram?

There are a few things you should know about your mammogram ahead of time. For one thing, if you menstruate, you may want to book your appointment for the week after your period, when your breasts will be least tender. If you think the compression might leave your breasts feeling sore, you might want to take some aspirin or ibuprofen before your visit. And when getting ready for your appointment, be sure not to apply deodorant or any creams, lotions or perfumes in the area of your armpits or chest. They can show up on your mammogram, which could lead to you being called back in unnecessarily.

When Tauschek went in for her first screening, she recruited two friends to schedule mammograms at the same time so they could offer one another moral support.

“There is an element of fear,” Tauschek said. “You don’t know what to expect. We live in Alaska, it’s cold, you have to disrobe. It’s just awkward.”

One other important thing to know about your first mammogram: It is not uncommon to be asked to come back for additional images.

Mammography is regulated by the Food and Drug Administration, so imaging clinics are required to track their statistics and ensure the safety and accuracy of their tests. Generally, Tauschek said, no more than 10 percent of patients should be called back for a diagnostic mammogram or ultrasound. Of every 10 patients who are called back, eight or nine will turn out to have nothing to worry about.

“A lot of people freak out when they get called back, but the majority of people who do get called back don’t have anything wrong at all,” Tauschek said.

It’s very common for first-time mammograms to require some follow-up because there aren’t any existing images to examine for comparison. Once you’ve had a few mammograms, there’s a record of what “normal” looks like for your breasts.

“Sometimes breast cancers can be very subtle in imaging,” Tauschek said. “Having a comparative exam is really what tips you off that there’s been a change. Some things are easy to look at, but some can be really, really subtle.”

And what exactly is Tauschek looking for when she reviews those 6,000 to 7,000 mammograms every year?

“One thing we look for is calcification,” Tauschek said. “It’s kind of like grains of sand or calcium like you would have in the shell of an egg. There are lots of benign causes of calcification, but there are other types of calcifications that are cancerous.”

Tauschek also looks for “architectural distortion,” or a place where tissue starts to pull together in sort of a star shape, as well as subtle changes in breast tissue density.

“They are looking for anything that looks like a mass,” Jager said. “They are looking for anything that looks asymmetric. There’s just a lot of different things -- (the radiologists) have the eagle eyes.”

When should you start getting mammograms?

Over the past decade or so, there has been some debate about when and how often women should have screening mammograms. The American Cancer Society recommends women have the option to receive annual mammograms starting at age 40 and strongly recommends annual screenings from 45 to 54, with biannual mammograms starting at age 55. The American College of Radiology and the Society of Breast Imaging recommend annual mammograms beginning at age 40, and Tauschek concurs.

“Screening mammograms, in countless studies over very large populations, have been shown to decrease breast cancer deaths and morbidity,” Tauschek said.

According to the American Cancer Society, breast cancer death rates decreased by 39 percent between 1989 and 2015. The change is attributed both to improved treatment and to the advent of mammography, which came into widespread usage in the mid-1980s. And spotting cancer earlier can often mean less intensive treatment and better outcomes. Patients whose breast cancer is detected in the “localized” stage, before it has spread to any other areas of the body, have a 98.9 percent five-year survival rate, according to the National Cancer Institute. That drops to 85.7 percent among patients whose cancer has spread to their lymph nodes, and 28.1 percent among patients whose cancer has metastasized, or spread to other systems of the body.

“By finding things earlier and when they’re smaller, you decrease the number of women that die from breast cancer,” Tauschek said.

Don’t let financial concerns stand in your way, either. The Affordable Care Act requires that most health insurance plans cover annual or biannual mammograms with no copay starting at age 40, and the State of Alaska sponsors a program called Ladies First that helps provide no-cost mammography and other preventive services based on income.

Most importantly, Jager said, don’t let fear keep you from scheduling a screening mammogram, whether it’s fear of COVID, fear of the procedure, or fear of what you might learn. Hospitals and clinics have strong disease prevention controls in place, and when it comes to breast cancer, research indicates that early detection saves lives.

“Breast cancer is not going to go away,” Jager said. “Mammography is still really important. I just really hope that people aren’t putting off this particular exam and seeing it as something that’s elective.”

Providence Imaging Center is a full-service diagnostic imaging clinic located in Anchorage and Eagle River. Learn more about mammography and the importance of breast health screening at ProvImaging.com.

This story was produced by the sponsored content department of the Anchorage Daily News in collaboration with Providence Imaging Center. The ADN newsroom was not involved in its production.