Mammography

NATIONAL CANCER INSTITUTE IN THE STATES PROVIDES GUIDELINES AND ANSWERS OF SOME FREQUENTELY ASKED QUESTIONS:

What is a mammogram? 
A mammogram is an x-ray picture of the breast. 
Mammograms can be used to check for breast cancer in women who have no signs or symptoms of the disease. 
Many small tumors can be seen on a mammogram before they can be felt by a woman or her doctor. 
Cancer is most easily treated and cured when it is discovered in an early stage. Mammograms do not prevent breast cancer or reduce a woman's risk of developing cancer. But regular mammograms can reduce a woman's risk of dying from breast cancer by detecting a cancer when it is more easily treated.
Your doctor may recommend testing at a younger age if you have risk factors for breast cancer. 

A mammogram is done to:
• Screen for breast cancer in women without symptoms.
• Diagnose breast cancer in women with symptoms. 
Symptoms of breast cancer may include a lump or thickening in the breast, nipple discharge, or dimpling of the skin on one area of the breast.

How are screening and diagnostic mammograms different? 
Diagnostic mammography takes longer than screening mammography because more x-rays are needed to obtain views of the breast from several angles. The technician may magnify a suspicious area to produce a detailed picture that can help the doctor make an accurate diagnosis.

How To Prepare?
If you have previously had a mammogram done at another clinic, have the results sent or bring them with you to your examination.
Tell your doctor if you:
• Are or might be pregnant. A mammogram is an X-ray test with exposure to low-dose radiation and is not done for routine screening during pregnancy.
• Are breast-feeding. A mammogram may not provide clear results in breasts that contain milk.
• Have breast implants. Breast implants require a modified mammogram method.
• Have previously had a breast biopsy. Knowing the location of scar tissue will help the radiologist read your mammogram accurately.

On the day of the mammogram, do not use any deodorant, perfume, powders, or ointments on your breasts or axillary area. The residue left on your skin by these substances may interfere with the X-rays.
You will need to remove any jewelry that might interfere with the X-ray picture. You will need to take off your clothes above the waist, and you will be given a cloth or paper gown to use during the test.

If you are still having menstrual periods, you may want to have your mammogram done.
within 10 days of your menstrual period. The procedure will be more comfortable, because your breasts become tender before your period starts.

What are the benefits of screening mammograms?

Early detection of breast cancer with screening mammography means that treatment can be started earlier in the course of the disease, possibly before it has spread.

What are NCI´s recommendations for screening mammograms? 
a. Women age 40 and older should have mammograms every 1 to 2 years.
b. Women who are at higher risk of breast cancer (for example, because of a family history of the disease) should have their mammograms10 years before the age of the diagnosed family member.

What is the best method of detecting breast cancer as early as possible? 
Getting a high-quality screening mammogram and having a clinical breast exam (an exam done by your doctor) on a regular basis are the most effective ways to detect breast cancer early.

How It Is Done?
A mammogram is done by a radiology technologist or mammogram technologist. The X-ray pictures (mammograms) are interpreted by a doctor who specializes in evaluating radiographic studies (radiologist).

If you are concerned about a specific area of your breast, show the technologist so that this area can be noted.
You usually stand during a mammogram. 
One at a time, your breasts will be placed on a flat plate that contains the X-ray film. Another plate is then pressed firmly against your breast to help flatten out the breast tissue. Very firm compression is needed to obtain high-quality pictures. You may be asked to lift your arm. For a few seconds while the X-ray picture is being taken, you will need to hold your breath. 
Usually at least two pictures are taken of each breast: one from the top and one from the side.
You may be in the mammogram clinic for up to an hour. The mammogram itself takes about 15 to 20 minutes. You will be asked to wait (usually about 15 minutes) until the X-rays are developed or the X-ray films or can be viewed immediately on a computer screen (digitally).

Mammography Machine

B/L Mammogram Craniocaudal Projection

B/L Mammogram MLO Views

How It Feels?
A mammogram is often uncomfortable but rarely extremely painful. If you have sensitive or fragile skin, or a skin condition, let the technician know before you have your exam. 
The X-ray plate will feel cold when you place your breast on it. Having your breasts flattened and squeezed is usually uncomfortable. But it is necessary to flatten out the breast tissue to obtain the best pictures.

What is the Breast Imaging Reporting and Database System BI-RADS)?

The American College of Radiology (ACR) has established a uniform way for radiologists to describe mammogram findings. 
The system, called BI-RADS, includes seven standardized categories, or levels. 
Each BI-RADS category has a follow-up plan associated with it to help radiologists and other physicians appropriately manage a patient’s care.

What is digital mammography? How is it different from conventional (film) mammography?
Digital and conventional mammography both use x-rays to produce an image of the breast; however, in conventional mammography, the image is stored directly on film, whereas, in digital mammography, an electronic image of the breast is stored as a computer file. This digital information can be enhanced, magnified, or manipulated for further evaluation more easily than information stored on film, because digital mammography allows a radiologist to adjust, store, and retrieve digital images electronically.

What is 3D mammography?
Three-dimensional (3D) mammography, also known as breast tomosynthesis, is a type of digital mammography in which x-ray machines are used to take pictures of thin slices of the breast from different angles and computer software is used to reconstruct an image. This process is similar to how a computed tomography (CT) scanner produces images of structures inside of the body.
3D mammography uses low dose x-rays, but, it is considered slightly higher than that of standard mammography.

What other technologies are being developed for breast cancer screening?
NCI is supporting the development of several new technologies to detect breast tumors. Efforts to improve conventional mammography include digital mammography, magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning.

What Affects the Test?
Reasons you may not be able to have the test or why the results may not be helpful include:
• Deodorant, perfume, powders, or ointments applied to the breasts or under the arms before the test. They may interfere with the X-ray pictures.
• Breast implants or scar tissue from previous breast surgery. This may make a mammogram harder to interpret.

WHAT YOU HAVE TO KNOW?
1. Most abnormalities found during a mammogram are not breast cancer. But in many women who have regular screening mammograms the abnormalities will be detected early and they may need more tests to investigate any abnormalities found during a mammogram. If an area of your breast tissue appears to be a concern during a mammogram, other tests such as an ultrasound, MRI or biopsy may be done.
2. Mammogram results are sometimes harder to interpret in women before menopause because breast tissue in younger women is denser than in older women.
3. A digital mammogram allows your doctor to view different parts of the breast without taking more images. Digital mammograms have the same overall accuracy as standard mammograms. The procedure in which a digital mammogram is done is the same as a standard mammogram-each procedure takes about the same amount of time, and breast compression is needed for both. Images from a digital mammogram can be magnified and stored electronically.