Mammogram

Mammography is designed to take images of the patient’s breasts in order to detect any tumors or other tissue abnormalities. It is a very useful procedure in detecting breast cancers.

• Screening Mammography – This is used to examine changes in the breast of a woman who do not have any signs or symptoms of breast cancer. The focus is to diagnose a cancerous growth before the clinical signs or symptoms start (early diagnosis).
• Diagnostic Mammography – This is done to identify any skeptical changes occurring in the breast e.g. breast pain, lumps, unusual skin color, discharge from the nipples, the unusual shape of the breast, nipple thickening, etc. Diagnostic mammogram comprises of some extra mammogram images.

Guidelines to get a Screening Mammography done:

• The average risk of breast cancer – Woman usually start getting mammograms done at the age of 40 and then keep getting it done every 1 or 2 years. The American Cancer Society also recommends similar guidelines. However, the U.S. Preventive Task Force recommends the women to start the mammography at the age of 50 years and continue thereafter periodically.
• High risk of breast cancer – The women with a suspected risk of breast cancer can get the screening done before the age of 40. This will help in the early diagnosis of breast cancer. In addition, the woman might be at risk of developing breast cancer if she has a family history. The doctor, in such cases, might suggest having an MRI (Magnetic Resonance Imaging) also done for a confirmed and clear analysis.

There are a few limitations and risks involved with mammography:

• Not accurate – The accuracy of the mammography depends on the multiple conditions including skill of the radiologist performing it and, on the technique used. Mammography may sometimes give false-positive or false-negative results, which may happen due to the factors like age and density of the breast.
• Exposure to radiations – Although, the dose of the radiation is low, some of the women might be at a greater risk of exposure to radiation based hazards.
• Age related issues – Typically, more ligaments and glands are present in the breast of younger women as compared to those in older aged women. Resultantly, it is difficult to detect cancerous growth in the breast of younger women because of presence of dense tissue as compared to older women with fewer glands and fatty breast tissues.
• Additional Testing required – Approximately, 10% of the women, undergoing mammography, might require to go for an additional test. These additional procedures may include biopsy (taking a sample of the breast) ,ultrasound or MRI. Also, most of the interpretations observed in a mammogram may not be cancer. Sometimes, the abnormal mammogram findings may need to be compared with a previous mammogram in order to detect the problem clearly.
• Not all cancers detected – In mammography screening, not all the cancers can be detected and a physical examination might be required by the physician to make a clear diagnosis. This can happen in the cases where the cancerous growth is too small or in an area which is difficult to see through a mammogram e.g. armpits.
• Pregnant woman – If the mammogram is needed to be carried out on a pregnant woman, then the woman is asked to wear a lead apron.

The doctor will explain the procedure to the woman in detail before the test.

Preparations (before the test) may include some of the following pointers:

• Get the mammogram done from a certified unit.
• Inform the doctor about the pregnancy beforehand.
• Avoid using any deodorant, body powders, body lotions, perfumes, creams especially on the breast and armpits.
• Avoid going for the mammogram test when the breast seems to be tender. This is the time before and during the menstrual cycle. The best time to get the test done is after the completion of the menstrual period.
• The woman can eat and drink normally before the test is performed.
• If the woman is taking any medicine, the same needs to be informed to the doctor and in case of no risk, the medication can be continued normally.
• Get the previous mammogram reports if there are any.
• Remove all the jewelry before the test.
• The upper half of the clothes needs to be removed or a hospital gown needs to be worn before the test.
• If the woman feels any discomfort or pain before the test, then the doctor may advise to take a painkiller like aspirin or ibuprofen.

During the Procedure:

The woman is asked to stand in front of the mammography X-ray machine. The technician places one of the breasts on a platform. The technician then lowers or raises the platform according to the height of the woman. The arms, head and torso are placed in a position, so that no hindrance is created. The breast is compressed against a clear plastic plate and a pressure is applied for a few seconds to compress and spread out the breast tissues. The pressure applied is not harmful but might cause some pain and discomfort in some women. In case the pain is not bearable, the technician must be informed immediately.

The breast is compressed to even out the thickness and make it easy for the X-rays to penetrate the breast. The pressure applied on the breast is to hold it firmly and prevent it from any movement. This allows less amount of radiation dose and prevents blurring. During the radiation exposure, the woman is asked to stay still and hold breath for a few seconds. The images of the breast will be taken from different angles and will be captured on the monitor.

After the Procedure:

The woman might be asked to wait till the clarity of the images are checked by the technician. In few cases, the technician might ask to repeat the procedure for unclear images. The whole procedure usually takes less than 30 minutes to complete. After the procedure, the woman might feel some discomfort and discoloration in the breast due to the compression during the procedure. After the report is prepared, it is sent to the doctor for further interpretation and discussion with the patient. The woman can go back home and start with the normal routine activities after the test.

The doctor will discuss the results of the mammography test with the patient in detail. Some of the findings of the test are as mentioned.

• Lumps or masses in the breast
• Calcium depositions in the ducts or other tissues (calcification) – This may be caused due to cell debris, secretions from the cells, some trauma, and inflammations. Irregular, tiny deposits present may also be associated with cancer, also known as microcalcifications. If large calcium deposits are seen then this might be due to aging or benign conditions like fibroadenoma (non-cancerous tumor growth found in the breast).
• Tissue distortions – This occurs when the tumors present in the breast invade or start spreading into the nearby tissues.
• New dense portion detected in the breast since the previous mammogram test. These dense areas in the breast specify the presence of a greater number of glandular tissues as compared to fatty ones. As a result, it becomes difficult for the doctor to study such a mammogram. This makes the calcium depositions difficult to locate. These dense areas may also indicate cancer.
• Dense areas may be seen devolving in one of the breasts or in a specific part of the breast.
• Cysts
• Cancerous growth
• Malignant or benign tumors

If the doctor is not certain about the results then some additional tests may be advised e.g. breast biopsy , ultrasound. Also, in a few cases, the doctor might ask to get some more magnified tests done for a clear and better understanding of the problem e.g. MRI. Breast MRI is required in a scenario where ultrasound and mammogram show negative results and if the abnormality or breast changes are unclear.

Q1. Can mammography be done, in case there are implants present in the breast?

A1. The doctor must be informed about the breast implantation at the time when mammography is advised. Although, the implants make it difficult to interpret mammography, still the patient must get the procedure done in a certified healthcare unit where the doctors are experts in performing mammography with breast implants for best results.

Q2. Even after the mammogram, is self-examination of the breast important?

A2. All the cancers or tumors cannot be detected through a mammogram. Especially at a younger age, it is difficult to identify any cancerous growth as there are fewer fat tissues present in comparison to glandular tissues. Hence, it is important to continuously monitor the breasts at home and get the same examined by the doctor once in every three years from the age of 20 years and once every year at the age of 40 years.