Mammography

Also Known As

Mammogram, mammography exam

Description

Mammography is an X-ray examination of the breasts. It differs from a general X-ray exam in that it uses low energy X-rays to get high resolution and high contrast images of soft tissue.

Mammography is the most effective way to detect breast cancer early. It is capable of discovering breast cancer that is too small to be revealed by palpitation (i.e., felt with the hands). Early detection of breast cancer -- when it is still small -- is the best way to improve patient survival rates, as there are several effective treatment methods to choose from, and prognosis is good.

Mammography can find 85-90% of all breast cancer, making it the most reliable screening test. The remaining 10-15% that doesn't show up on a screening mammography may be discovered by hand. According to recent research, mammography can detect breast cancer up to 2 years earlier than by hand.

Done concurrently -- regular mammograms, monthly breast self-examinations, and breast examinations by your doctor ?these three procedures provide the best protection against this voracious cancer with one of the highest morbidity rates of all diseases.


Advantages of this procedure

* Fast and safe.
* The most sensitive test used to detect breast cancer early.
* Low dose of radiation.


Conditions that benefit from this procedure

* Breast lump
* Thickening of the breast
* Breast pain
* Nipple discharge
* Skin change on the breast
* Women over age 50


Common conditions revealed by this procedure

Screening mammography


1. Can detect breast cancer early, even in the absence of complaints or symptoms.

Diagnostic mammography

1. Used to diagnose breast diseases, usually prompted by a lump, pain, thickening, nipple discharge, or a change in breast size or shape.
2. Used to evaluate abnormalities detected on a screening mammogram.
3. Used as a screening test in the case of breast implants.


Common diseases revealed by this procedure

Benign conditions

1. Cyst
2. Fibroadenoma
3. Fibrocystic breast condition
4. Abscesses
5. Fat necrosis
6. Galactoceles

Breast cancer

1. Ductal carcinoma
2. Invasive ductal carcinoma
3. Medullary carcinoma


How this procedure is performed

After the radiologist places your breast on a specially designed cassette, a transparent plastic paddle is pushed down on your breast. Once the breast is adequately compressed, the technologist flips a switch and exposes it to X-ray beams. X-rays pass through the breast and reach the film inside the cassette to make an image. A series of X-rays will be taken, with the cassette placed next on the outside of the breast, with the paddle compressing it from the inside. Top to bottom and side views of the other breast are taken in the same way.

The breast is compressed to spread the tissue apart, allowing for quality images with lower doses of radiation. The breast compression lasts only a few seconds and may cause minor discomfort, but it does not harm the breast, even with the presence of breast implants. If it feels painful, tell the technologist to stop.

During the diagnostic mammogram, additional views (such as cone views with magnification, localized views of a specific area) will be taken to carefully evaluate any breast abnormality.

Wait for the technologist to tell you whether the X-rays came out okay. If no additional examinations are needed, you can go home. The entire examination usually takes 20 to 30 minutes.

Preparation for this procedure

* Before scheduling a mammogram, you should discuss any new findings or problems in your breasts with your doctor. Also, inform your doctor of any prior surgeries, hormone use, and family or personal history of breast cancer (Recommendations of the American Cancer Society). Women who are pregnant or suspect pregnancy should inform their doctor or X-ray technologist.
* If your breasts are often tender, schedule your mammogram one week following your period. Do not schedule a mammogram for the week before your period.
* Wear a two-piece outfit or loose-fitting clothing with no necklace. You will be asked to remove all jewelry and clothing above the waist and to change into a hospital gown. Do not wear deodorant, talcum powder, lotion, creams, or perfumes on your breasts or under your arms on the day of the exam. These can appear on the mammogram film as calcium spots.
* Describe any breast symptoms or problems you might have to the technologist. If possible, obtain your prior mammogram films (not reports) and make them available to the radiologist for comparison. Ask when you can expect the results of your mammogram.



Results of this procedure

A radiologist (a physician specialist trained to interpret mammography images or other radiology exams, such as X-ray, CAT scans, MRI, etc.) reviews the mammography and reports the results separately to you and to your doctor. You can get the results at the time of your appointment or by mail. Your doctor's office will inform you of your official mammography results.

If abnormalities have been found, appropriate treatment and additional examinations will be given.

If you don't receive mammography results within 30 days after the examination, call your mammography facility or your doctor.

Risks of this procedure

* Mammography uses X-rays to image breast tissue. Radiation exposure received from two mammographic views is equivalent to six months of natural background exposures (i.e., radon gas from buildings, cosmic rays).
* Radiation exposure from a screening mammography is believed to be safe.
* If you are pregnant or suspect pregnancy, let your doctor or technologist know, so that special care will be taken to ensure maximum safety.
* When you have breast implants, particularly those placed in front of the chest muscles, they can hinder accurate imaging of breast tissue. When you make the appointment, inform the doctor's office that you have implants so that special care and techniques can be taken by the technologist to improve images without rupturing your implants.
* Screening mammograms miss about 20 percent of breast cancers, even when the tumors are present at the time of examination. This "false negative" rate is higher in younger women. So, women should have regular clinical breast exams (by a professional health care provider), in addition to a screening mammography.
* Most abnormalities detected on mammography are not breast cancer. Between 5 and 10 percent of screening mammograms are abnormal, but only a few of them prove to be cancer by additional exams, such as a diagnostic mammogram, ultrasound, or aspiration biopsy. This "false positive" rate is also higher in younger women.


What to do if the result are abnormal

Most mammographic abnormalities turn out to be benign (non-cancerous) change, such as a cyst, thicker breast tissue, and fibroadenoma. According to a study of 100 women age 50 and older who have a mammographic abnormality, only about 14 actually have invasive breast cancer.

To find out whether the abnormality seen on the mammogram is cancer or not, you may need to take diagnostic mammography, breast ultrasonography, galactogram, magnetic resonance imaging (MRI), biopsy, or aspiration.

Breast biopsy, which can be done surgically, is the final confirmative diagnostic test. Part or all of the lesion may be removed after a skin incision is made. A needle biopsy can be done without surgery. In this procedure, only a part of the suspicious tissue is removed with biopsy needles, and is examined under a microscope. Very thin needles can be used to remove fluid or fragments of tissue (a procedure called "fine needle aspiration biopsy"). Larger needles can be used to remove a cylindrical piece of tissue to examine larger amounts of tissue (a procedure called "core needle biopsy").

If you have breast implants

When you schedule your mammogram, tell the doctor's office that you have implants and make sure they are experienced in X-raying patients with implants.

Breast implants can hide breast tissue when you take mammograms without special care. Four additional films will be taken, as well as the four standard images. These additional X-rays, called "implant displacement (ID) views", will be taken with the breast pulled forward and the implant pushed back. Compression of the breasts during mammography does not cause implant rupture.

If you suspect implant rupture or other problems with implants, magnetic resonance imaging (MRI) is the best alternative.

Getting high-quality mammograms

All mammography facilities except VHA (veterans hospital administration) facilities are required to be FDA certified by federal law (MQSA - Mammography Quality Standards Act). When the equipment at the facility in question, along with the people who work there (i.e., technologists, radiologists, and medical physicists), and the records they keep, all meet federal standards, then that facility is accredited by the FDA and allowed to display an MQSA certificate.

MQSA regulations also require mammography facilities to give patients an easy-to-read report on the results of their mammogram, as well as an official medical report to their personal doctor.

You can get high-quality mammograms in breast clinics, radiology departments of hospitals, private radiology offices, and doctor's offices. Mobile units (often vans) also offer screening mammograms at shopping malls, community centers, and offices.

To find an FDA-certified mammography facility near you, ask your doctor, or call the National Cancer Institute's Cancer Information Service toll free at 1-800-4-CANCER. You can find the information on the FDA's web site at http://www.fda.gov/cdrh/mammography/certified.html.

Risk factors for breast cancer

Age
As you get older, your risk of breast cancer increases.

Personal history of breast cancer
If you have had breast cancer, there is a higher chance of recurrence.

Family history of breast cancer
A woman's chance of developing breast cancer increases if her mother, sister, daughter, or two or more other close relatives, such as cousins, have a history of breast cancer (especially if they were diagnosed before age 50).

Genetic alterations
There is a high chance of developing breast cancer when there are genetic alterations, such as BRCA1 and BRCA2. Ten percent of all breast cancer is related to genetic alterations.

Certain breast changes
There is a high chance of developing breast cancer if there have two or more biopsies from past benign conditions, atypical hyperplasia, or lobular carcinoma in Situ (LCIS.)

Dense breast tissue
When the mammogram shows dense breast tissue, the chances of developing breast cancer are higher.

Radiation therapy
There is a higher risk of developing breast cancer later as a result of radiation exposure at an early age used to treat diseases like Hodgkin's disease.

Reproductive and menstrual history
The later a woman has a baby after 30, the younger a woman was when she started menstruation (before 12), and the later a woman enters menopause (after 55), the higher the chances of developing breast cancer. Also women who have never given birth have a high risk of breast cancer.


When to start this procedure

Consult your doctor to see when you should start receiving screening mammograms and how often you should receive them. Here are some general guidelines women should to follow:

Age 50-69
Get annual screening mammograms. There is good evidence that mammograms decrease deaths from breast cancer in women in this age group.

Age 40-50 without a past or family history of breast cancer
Discuss with your doctor the risks and benefits of getting regular mammograms, and make a personal decision. Receiving routine screening mammograms at this age is still controversial.

Many health and medical organizations (National Cancer Institute, American Medical Association, American Cancer Society, American College of Obstetrics and Gynecology, American College of Surgeons, American College of Radiology) recommend routine mammograms every other year or every year for women in their forties.

But several organizations (American College of Physicians, US Preventive Services Task Force, American Academy of Family Practice, Canadian Task Force on the Periodic Health Exam) are against routine mammography under age 50 because the risks outweigh the potential benefit.

Age 35-40
The American Cancer Society and American College of Surgeons recommend that women in this age group obtain their first baseline mammogram.

Previous breast cancer
All women, at any age, who has had breast cancer should get annual screening mammograms.

Family history of breast cancer If your mother, sister, or daughter has or has had breast cancer, you should start annual screening mammograms at age 40 or 5-10 years earlier than the earliest age that your relative(s) acquired the disease.


Further procedures

Galactogram
To evaluate the cause of nipple discharge, a fine plastic tube is placed onto the nipple through which contrast dye is injected to fill the ducts, and a mammogram is taken.

Breast sonography
The best way to distinguish a cyst from solid mass is to use high frequency sound waves (inaudible sound) to image breast tissue by picking up echoes. This imaging technique is useful to help guide a mass or cyst biopsy when doctors cannot feel any abnormality.

MRI (magnetic resonance imaging)
MRI uses magnetization and radio waves to produce high contrast cross-sectional images. Contrast material (Gadolinium DTPA) can be injected into a vein in the arm to improve diagnostic capability. This is the best imaging method to detect ruptured breast implants.