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Mammography
 What
is a mammogram?
A mammogram is an x-ray examination of the breast. It is used to
detect and diagnose breast disease in women who either have breast
problems such as a lump, pain, or nipple discharge, as well as
women who have no breast complaints.
What are the different
types of mammograms?
A screening mammogram is an x-ray of the breast used to detect breast
changes in women who have no signs of breast cancer. It usually
involves two x-rays of each breast. Using a mammogram, it is possible
to detect a tumor that cannot be felt.
A diagnostic mammogram is an x-ray of the breast used to diagnose
unusual breast changes, such as a lump, pain, nipple thickening
or discharge, or a change in breast size or shape.
A diagnostic mammogram is also used to evaluate abnormalities detected
on a screening mammogram. It is a basic medical tool and is appropriate
in the work-up of breast changes, regardless of a woman's age.
Mammography has been used for about 30 years, and in the past 15
years technical advancements have greatly improved both the technique
and results. Today, specialized equipment, used only for breast
x-rays, produce studies that are high in quality but low in radiation
dose. Radiation risks are considered to be negligible.
How is a mammogram
performed?
 Usually,
a mammogram is done on an outpatient basis, although it can be part
of inpatient care. There is no specific preparation for the examination.
However, a woman should not wear deodorant, powders or lotions under
the arms on the day of the examination, as these substances can
interfere with the images.
Although each facility may have specific protocols
in place, generally, a mammogram procedure follows this process:
1. The patient should describe
any symptoms or problems to the technologist prior to the examination
(if any).
2. The patient undresses from the waist up and
is given a gown to wear.
3. The patient is positioned at the mammography
unit, seated, standing, or lying down.
4. The breast is positioned between two plates
of the mammography unit, and pressure applied to compress the
tissue. (This may produce temporary discomfort.) Breast compression
is necessary in order to obtain the best image with the least
amount of radiation possible.
5. The patient is asked to hold her breath for
a few seconds while the x-rays are taken.
6. The technologist steps behind a protective
window and the image is taken.
7. Each breast may be x-rayed at least two times
from above and from the side positions to produce the films for
the physician to review.
8. After the x-rays are made, the patient is
asked to wait for a short time until the technologist/ radiologist
can review the films to determine if additional x-rays are necessary.
What conditions does a mammogram show?
- Calcifications - Tiny mineral deposits within
the breast tissue. There are two categories of calcifications:
- Macrocalcifications - Coarse calcium
deposits that usually indicate degenerative changes in the
breasts, such as the following:
- aging of the breast arteries
- old injuries
- inflammations
- Microcalcifications
- Tiny (less than 1/50 of an inch) specks of calcium. When many
microcalcifications are seen in one area, they are referred
to as a cluster.
- Masses - May occur with or without associated
calcifications, and may be due to different causes, including
the following:
- Cyst - A non-cancerous collection
of fluid in the breast. Cysts cannot be diagnosed by physical
examination alone nor by mammography alone. Either breast
ultrasound or aspiration with a needle is required. If a mass
is not a cyst, then further imaging may be necessary.
- Benign breast conditions - masses
can be monitored with periodic mammography, but others may
require immediate or delayed biopsy.
- Breast cancer
Mammography guidelines:
In the United States, breast cancer is the most common form of cancer
among women. Almost 185,000 new cases of breast cancer are diagnosed
each year. Only lung cancer causes more cancer deaths among women
than breast cancer.
Consider the following additional breast
cancer facts:
- Forty-five thousand women
die of breast cancer in the United States each year.
- One in eight women in the United States may
develop breast cancer.
- Breast cancer risk increases with age. The greatest
incidence of breast cancer occurs in women over the age of 50.
- Mammography can detect over 90 percent of breast
cancers before they become large enough to feel or cause symptoms.
What are the risk factors
for breast cancer?
Any woman may develop breast cancer. However, the following risk
factors may increase the likelihood of developing the disease.
1. Risk factors that cannot be changed:
- Gender
Breast cancer occurs nearly 100 times more often in women than
in men.
- Aging
A majority of cases of breast cancer occur after age 50.
- Personal history of breast cancer
- Previous breast irradiation
- Family history and genetic factors
- Having a close relative, such as a mother or
sister, with breast cancer increases the risk.
- Benign breast disease
- Previous breast biopsy in which the tissue showed
atypical hyperplasia
- Menstrual periods that began early in life
- Menopause began later in life
2. The most frequently cited lifestyle-related
risk factors:
- Smoking
- Not having children
- Not breastfeeding
- Oral contraceptives
- Obesity and a high-fat
diet
- Physical inactivity
- Alcohol
- Estrogen replacement
therapy
- Induced abortion
3. Environmental risk factors:
Exposure to pesticides, or other chemicals, is
currently being examined as a possible risk factor for breast cancer.
It has been found that 70 percent of the women diagnosed with breast
cancer had no significant risk factors. This means that monthly
self-examination of the breasts, regular screening mammograms, and
clinical breast examinations are extremely important in the early
detection of breast cancer.
National Cancer Institute Guideline
for Screening Mammography:
Women in their 40s and older should have a screening mammogram on
a regular basis, every one to two years.
American Cancer Society
Guideline for Screening Mammography:
Women 40 years of age and older should have a screening mammogram
every year.
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