Understanding Mammography

What is Mammography?

Mammography is the screening of the breast for early detection of cancer in women. It uses a low-dose x-ray machine to photograph the breast tissue and aid in the timely discovery of breast cancer. Mammography is a non-invasive medical investigation and involves the application of ionizing radiation to produce images of the inside of the body. A radiologist may examine a mammogram for detecting breast diseases like abnormal tissue growth, calcifications, cysts, benign tumors and malignant tumors.

Types of Mammography

There are basically three types of mammogram procedures that may be carried out - digital mammography, computer-aided detection and breast tomosynthesis.

• Digital Mammography: It is also referred to as full-field digital mammography and works like a digital camera storing the images as a computer file. The x-ray film is replaced by solid-state detectors which convert the x-rays into electrical signals. This type of breast cancer screening is especially useful in women with dense breast tissues. Since the pictures are stored as images, they can be magnified for further evaluation and shared electronically with others. It allows a closer examination of normal and abnormal tissues and more importantly, it saves the patient from exposure to radiation.
• Computer-Aided Mammography: It is the use of a computer to examine a film or digital mammogram. The software is used to highlight areas of abnormalities on the images which may indicate cancer of the breast. This helps the radiologist to further and thoroughly analyze the doubtful spots.
• Breast Tomosynthesis: It is digital mammography procedure in which an x-ray machine moves over the breast, taking images in a series of thin slices. This provides enhanced detection of breast cancer.

Who must undergo Mammography?

Mammography is a process recommended by doctors from the age of 40 in order to bring down the rate of cancer-related deaths. Women with a lump in the breast or other signs of breast cancer or those who have no breast cancer symptoms are advised to go for mammogram screening. Women who are at a high risk for breast cancer are also advised to under mammography routinely. A mammogram may often show up a breast cyst even before it can be felt.

How is Mammography performed?

Mammography is the process in which low energy x-rays of around 30 kVp is used to examine the human breast. The woman to be screened is made to stand in front of a mammography machine and her breasts placed between two plastic plates by the radiographer. The breast is pressed flat between the two plates for a few moments and a picture taken. Though it is an uncomfortable process because the breast is pressed, the pain will last for a few minutes only. Images are taken of each breast from two directions – for a top-to-bottom view and angled side view. The purpose is to detect the presence if any, of characteristic masses and/or microcalcifications.

Screening and Diagnostic Mammography

• Screening Mammography: It is usually done as a routine procedure to detect the presence of cancer even before it can physically be felt by a doctor.
• Diagnostic Mammogram: It is the procedure conducted to address areas of concern. This happens if during a self-exam, a woman finds something abnormal in her breast, if her physician has some doubts, or during a screening mammography some changes are found, then she is sent for diagnostic mammogram wherein the radiologist will focus on the doubtful areas and check them out.

Mammogram Assessment Levels

A mammogram test report is referred to as BIRADS, or Breast Imaging-Reporting and Data System. Mammogram findings are categorized as such:

• BIRAD 0: Incomplete; additional imaging needed
• BIRAD 1: Negative; continue regular screening
• BIRAD 2: Benign finding; continue regular screening
• BIRAD 3: Probably benign; require six-month follow-up mammogram
• BIRAD 4: Suspicious abnormality; may require biopsy
• BIRAD 5: High possibility of malignancy; action should be taken
• BIRAD 6: Known biopsy-proven malignancy

What is the age for Mammography Screening?

There are two opinions on what is the right age to get a mammogram. While the standard age for a mammography has always been after 40, a more recent school of thought says that the ideal age for the breast screening should be from 50 to 74. After the age of 74, you may want to continue having it done if you wish.

The guidelines issued by the US Preventive Service Task Force say average-risk women should go for routine screening at the age of 50 instead of 40 and should stop at 74 instead of 69. They also advise that mammograms should be done once in two years and not every year. However, the American Cancer Society and some other organizations recommend that women should go for mammograms after the age of 40 and it should be carried out every year. The 50-74 age band recommendation is for average-risk women but those at high risk may need to consult their doctor about whether they should start at 40 or even earlier. And, if at any age a lump is found then, without doubt, a mammogram becomes essential.

What are the disadvantages of a Mammogram?

Mammography can bring down the death rate due to breast cancer because early detection means more chances of a cure. But there are certain drawbacks to this procedure.

• Not all breast cancer lumps can be seen on a mammogram. It is said that during screening a mammogram may miss out on about 20% of breast cancer lumps that are present then. A mammogram cannot distinguish between a non-cancerous breast lump and a cancerous breast lump.
• The body is exposed to radiation during a mammogram. This increases the chance, though marginally, of breast cancer from excessive exposure to radiation.
• Then there is a 5 to 15% chance of a false-positive result which may cause a repeat mammogram to be carried out if there is the slightest doubt during the first one. Most of the repeats, however, turn out to be normal. Sometimes, a false-positive result could require an unnecessary biopsy.
• Apart from all of the above, the anxiety, tension and psychological distress that the person goes through because of all this, plus the costs and time spent... all these factors cannot be ignored.

It is always advisable to talk to your doctor about when and how often should you go for a mammography. She or he will also counsel you on the benefits and drawbacks of such an exam.

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