From www.medscape.com/womenshealthhome

Women's Health for Nurse Practitioners Ask The Expert
Can a Lactating Woman Have a Mammogram?
Posted 02/25/2003

from Medscape Nurses

Question
Can a woman who is lactating have a mammogram if she feeds or pumps prior
to the test? If so, is the mammogram able to detect lesions (cancer or
intraductal papilloma) as it would for a woman who is not lactating?

Response
from Pat Camillo, PhD, RNC, WHNP, GNP, 02/25/2003

A mammogram is not the best diagnostic tool for a lactating woman for the
same reasons that it is not generally recommended for most women under
age 35 years. Young women tend to have very dense breasts, making it
difficult to find radiographic lesions. The lactating breast shows an
even greater increase in parenchymal density, with more nodular and
rope-like characteristics, corresponding to ductal distention with milk.

Here is an alternative approach to consider for lactating women with
suspected lesions[1]:

Begin with an ultrasound if there is a palpable abnormality. Ultrasound
can clearly demonstrate a solid vs cystic mass or galactocele. This would
initially eliminate the need for a mammogram.

Fine-needle aspiration can be offered if a mass is determined to be a
cyst or galactocele, usually with no further intervention necessary.

If the palpable mass appears solid on ultrasound, a biopsy is indicated.
Stereotactic guidance for fine-needle aspiration or large-core breast
biopsy can be used successfully in the lactating woman. To minimize
creation of a milk fistula, the affected breast should be pumped just
prior to the procedure.

Biopsy is also indicated if the mass is palpable but the ultrasound is
negative.

If the abnormality is found to be malignant, then a bilateral mammogram
is done, the purpose of which is to explore whether there are other
suspicious lesions.

Fortunately, breast cancers are not common in lactating women. Lactating
adenomas and fibroadenomas are the most common solid palpable masses and
these are always benign.[2] However, when malignancies are found, they
are often in an advanced stage with a poor prognosis. This has less to do
with the physiology of these lesions and more to do with the delay in
identifying them.[3] Although routine mammography screening is not
indicated, a baseline clinical breast examination is an important part of
initial prenatal care. Changes or abnormalities of any kind should be
investigated with the same level of concern regardless of whether a woman
is breast-feeding.

References
Hogge JP, De Paredes ES, Magnant CM, Lage J. Imaging and management of
breast masses during pregnancy and lactation. Breast J. 1999;5:272-283.
Abstract
Sumki JH, Perrone AM, Harris, KM, Nath ME, Amortegni AJ, Weinstein BJ.
Lactating adenoma: US features and literature review. Radiology.
1998;206:271-274. Abstract
DiFronzo LA, O'Connell TX. Breast cancer in pregnancy and lactation. Surg
Clin North Am. 1996;76:267-277. Abstract
Suggested Readings
Scott-Conner CEH. Diagnosing and managing breast disease during pregnancy
and lactation. Medscape Women's Health. 1997; 2:1. Available at:
http://www.medscape.com/viewarticle/408859 Accessed January 30, 2003.

Scott-Conner CE, Schorr SJ. The diagnosis and management of breast
problems during pregnancy and lactation. Am J Surg. 1995;170:401-405.

About the Panel Members
Pat Camillo, PhD, RNC, WHNP, GNP, Associate Professor and Director, The
Women's Health Program, Seton Hall University, College of Nursing, South
Orange, New Jersey.

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