Mammography is a special form of X Ray used to detect early forms of Breast Cancer which can not be detected seen or felt. It is used as a diagnostic as well as a screening tool. The goal of mammography is the early detection of breast cancer, typically through detection of characteristic masses and/or micro calcifications. Mammography is believed to reduce mortality from breast cancer.

Mammography for Diagnosis and Treatment

Screening Mammography

Mammography plays a central part in early detection of breast cancers because it can show changes in the breast up to two years before a patient or physician can feel them.

Diagnostic Mammography

Diagnostic mammography is used to evaluate a patient with abnormal clinical findings-such as a breast lump or lumps-that have been found by the woman or her doctor. Diagnostic mammography may also be done after an abnormal screening mammography in order to evaluate the area of concern on the screening exam.

What is the right time to get a Mammo?

In young / pre menopausal women,the right time would be within one week of menses. Afer menopause it can be done at any time.

How frequently you need to get a Mammo?

According to various Health organizations (the American Cancer Society – ACS, the American Medical Association – AMA and the American College of Radiology – ACR)

• Beginning at the age of 40 – Every Yearly
• Those who had Cancer in one of the Breasts and those who have genetic history of Breast cancer – May need to start screening early at the age of 35 yrs.

How is Mammography done?

During mammography, a specially trained technician / Nurse will position your breast in the mammography unit. Your breast will be placed on a special platform and compressed with a paddle (often made of clear Plexiglas or other plastic). The technologist will gradually compress your breast.This might cause you some discomfort. Breast compression is necessary in order to evenly spread out the breast tissue so that all it can be well visualized.

The technologist will stand behind a glass shield during the x-ray exposure. You will be asked to change positions between images. The routine views are a top-to-bottom view and an oblique side view. The process will be repeated for the other breast. You must hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image. The technician will walk behind a wall or into the next room to activate the x-ray machine.

When the examination is complete, you will be asked to wait until the radiologist determines that all the necessary images have been obtained. The examination process would take about 30 minutes.

Results

Normal Results

Breast tissue that shows no signs of a mass or calcification is considered normal.

Abnormal Results

A well-outlined, regular, clear spot is more likely to be a noncancerous condition such as a cyst. A poorly outlined, cloudy area is more likely to suggest breast cancer. However, not all breast cancers are perfectly round, and some cancers may appear well-defined. Sometimes, the doctor will use ultrasound to further examine your breast and determine the next best step. When findings from a mammogram or ultrasound look suspicious, a biopsy is performed to determine if it a cancerous or noncancerous condition.

Benefits

• Imaging of the breast improves a physician’s ability to detect small tumors. When cancers are small, the woman has more treatment options and a cure is more likely.
• The use of screening mammography increases the detection of small abnormal tissue growths confined to the milk ducts in the breast, called ductal carcinoma in situ (DCIS). These early tumors cannot harm patients if they are removed at this stage and mammography is the only proven method to reliably detect these tumors. It is also useful for detecting all types of breast cancer, including invasive ductal and invasive lobular cancer.
• No radiation remains in a patient’s body after an x-ray examination.
• X-rays usually have no side effects in the diagnostic range.

Risks

False positives

The goal of any screening procedure is to examine a large population of patients and find the small number most likely to have a serious condition. These patients are then referred for further, usually more invasive, testing. Thus a screening exam is not intended to be definitive: It is intended to have a high sensitivity so as to not miss any cancers.

The cost of this high sensitivity is a relatively large number of results that would be regarded as suspicious in patients without disease. This is true of mammography. The patients called back for further testing from a screening session (about 7%) are sometimes referred to as “false positives”, implying an error. In fact, it is essential to call back many healthy patients for further testing to capture as many cases of cancer as possible.

Research shows that false-positive mammograms may affect women’s well-being and behavior. Some women who receive false-positive results may be more likely to return for routine screening or perform breast self-examinations more frequently. However, some women who receive false-positive results become anxious, worried and distressed about the possibility of having breast cancer, feelings that can last for many years.

False negatives

At the same time, mammograms also have a rate of missed tumors, or “false negatives.” Accurate data regarding the number of false negatives are very difficult to obtain, simply because mastectomies (Removing the breast surgically) cannot be performed on every woman who has had a mammogram to determine the false negative rate accurately. Estimates of the false negative rate depend on close follow-up of a large number of patients for many years. This is difficult in practice, because many women do not return for regular mammography making it impossible to know if they ever developed a cancer.

Researchers have found that breast tissue is denser among younger women, making it difficult to detect tumors. For this reason, false negatives are twice as likely to occur in premenopausal mammograms.

Regardless of the precise number of false negatives, it is very clear that even if some tumors are missed, lives are saved when they are found. Women need to understand that a negative mammogram is not a perfect guarantee that there is no breast cancer present, but it is the best method we have available.

Other risks

The radiation exposure associated with mammography is a potential risk of screening. The risk of exposure appears to be greater in younger women. The largest study of radiation risk from mammography concluded that for women 40 years of age or older, the risk of radiation-induced breast cancer was minuscule, particularly compared with the potential benefit of mammographic screening, with a benefit-to-risk ratio of 48.5 lives saved for each life lost due to radiation exposure

Limitations of Mammography

Initial mammographic images themselves are not usually enough to determine the existence of a benign or malignant disease with certainty. If a finding or spot seems suspicious, your radiologist may recommend further diagnostic studies.

Interpretations of mammograms can be difficult because a normal breast can appear differently for each woman. Also, the appearance of an image may be compromised if there is powder or salve on the breasts or if you have undergone breast surgery. Because some breast cancers are hard to visualize, a radiologist may want to compare the image to views from previous examinations. Not all cancers of the breast can be seen on mammography.

Breast implants can also impede accurate mammogram readings because both silicone and saline implants are not transparent on x-rays and can block a clear view of the tissues behind them, especially if the implant has been placed in front of, rather than beneath, the chest muscles Experienced technologists and radiologists know how to carefully compress the breasts to improve the view without rupturing the implant.

When making an appointment for a mammogram, women with implants should ask if the facility uses special techniques designed to accommodate them. Before the mammogram is taken, they should make sure the technician is experienced in performing mammography on patients with breast implants.