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. *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html