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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
- Can detect breast cancer early, even in the absence of complaints or
symptoms.
Diagnostic mammography
- Used to diagnose breast diseases, usually prompted by a lump, pain,
thickening, nipple discharge, or a change in breast size or shape.
- Used to evaluate abnormalities detected on a screening mammogram.
- Used as a screening test in the case of breast implants.
Common diseases revealed by this procedure
Benign conditions
- Cyst
- Fibroadenoma
- Fibrocystic breast condition
- Abscesses
- Fat necrosis
- Galactoceles
Breast cancer
- Ductal carcinoma
- Invasive ductal carcinoma
- 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.
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