Mammography, also known as a mammogram, is the examination of the breast using X-rays. It is considered the most effective tool for early breast tumor detection.
Most medical experts agree that successful treatment of breast cancer is linked to early diagnosis. 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.
Most imaging centers and hospitals use digital mammography – also known as a full-field digital mammography. Digital mammography allows the radiologist to alter the orientation, magnification, brightness and contrast to produce images of the breast that can be seen on a computer screen.
Computer-aided detection, or CAD, uses a digitized mammographic image to search for abnormal areas of density, mass or calcification that may indicate the presence of cancer. The CAD system highlights these areas on the images, alerting the need for further analysis.
Current guidelines from the U.S. Department of Health and Human Services (HHS), the American Cancer Society (ACS), the American Medical Association (AMA) and the American College of Radiology (ACR) recommend screening mammography every year for women, beginning at age 40.
The National Cancer Institute (NCI) recommends that women who have had breast cancer and those who are at increased risk because of a genetic history of breast cancer should seek expert medical advice about whether they should begin screening before age 40 and how often.
Before scheduling a mammogram, discuss any problems in your breasts with your doctor. In addition, inform your doctor of hormone use, any prior surgeries, and family or personal history of breast cancer. Generally, the best time is one week following your period. Do not schedule your mammogram for the week before your period if your breasts are usually tender during this time. Always inform your X-ray technologist if there is any possibility that you are pregnant.
To image your breast, an X-ray technician will position you near the machine, and your breast will be placed on a platform and compressed with a paddle. Breast compression is necessary to:
- Even out the breast thickness so that all of the tissue can be visualized.
- Spread out the tissue so that small abnormalities won’t be obscured.
- Allow use of a lower X-ray dose.
- Hold the breast still to eliminate blurring of the image caused by motion.
- Reduce X-ray scatter to increase picture sharpness.
The technologist will go behind a glass shield while making the X-ray exposure. You will be asked to change positions slightly between views. The process is repeated for the other breast. Routine views are a top-to-bottom and side view.
The full exam takes about half an hour. The technologist will apply compression on your breast and, as a result, you will feel pressure on the breast. Some women with sensitive breasts may experience some discomfort. Be sure to inform the technologist if pain occurs as compression is increased. If discomfort is significant, less compression will be used.
Up to 40 percent of American women have dense breasts, which simply means that a woman has more fibrous, glandular tissue in her breasts than fatty tissue. Because dense breasts can make it more difficult to identify breast cancer, Arizona law now requires that health care facilities performing mammographies include a woman’s breast density classification in the summary report sent to the patient after her mammogram. Women whose results are negative (no breast cancer found) but have dense breast tissue, must be notified of the condition. Women are encouraged to discuss the issue with their health care provider and consider additional breast cancer screening options. QCBN
By Stephen V. Ward, M.D.
Stephen V. Ward, M.D., is a radiologist at Northern Arizona Radiology.
Please add normal NAR bio