What is a mammogram?
A mammogram, also known as a mammography, is a screening method that screens the breast tissue for cancer (breast cancer) through the use of a specialised X-ray. These are a vital element in diagnosing breast cancer in the early stages, together with monthly self-examinations of the breast and regular clinical exams.
After skin cancer, breast cancer is the second most common cancer in women. Depending on age and family history, your risk for breast cancer may be higher.
Doctors recommend that women over 40 should undergo a mammogram every second year. If you have a breast cancer history personally or in your family, your doctor may suggest that your screenings be more regular, he or she may also suggest the use of further diagnostic tools.
A mammogram is able to be used to screen or diagnose the breast for cancer. If detected in the early stages, the cancer can be treated and cured. It is important to note that mammograms do not cure cancer or reduce the risk of developing the condition, they are only a detection method.
Why are mammograms conducted?
A screening mammogram is when your doctor orders a mammogram as a routine test in order to detect cancer or monitor any changes in the breast. It is typically used for women who don't have any symptoms of cancer, the idea is to identify the cancer before the noticeable clinical signs.
If you have any sign of breast cancer, such as an abnormal lump felt in the breast, your doctor will order a diagnostic mammogram. The idea here is to investigate any abnormalities found in the screening mammogram as well as other issues such as nipple thickening, breast changes, breast pain, changes in skin appearance, nipple discharge and the development of a new lump in the breast.
Women who have breast implants will also have to have a diagnostic mammogram in order to properly view the breast. Diagnostic mammograms normally require more X-rays so as to view multiple positions of the breast. Your radiologist may also focus on certain concerning areas.
What are the different types of a mammogram?
There are a few different ways that mammograms are captured, these being:
- A standard mammogram which creates images of the breast which are then placed onto film.
- A digital mammogram which puts the images of the breast into the form of an electronic file, this is an easy platform for your doctor to see the different views of the breast without having to take more images.
- A three-dimensional (3D) mammogram which uses digital mammogram and breast tomosynthesis (putting the 3D images of the breast into electronic form). The 3D image of the breast allows your doctor to clearly see the breast tissue.
When to go for mammograms
The age for when to begin going for mammograms is not specified. It is best to speak to a doctor regarding your own personal risks factors and your preferences so that you can both decide on creating a screening schedule that is best suited (occasionally breast ultrasounds will be recommended for younger women).
There are however some general rules or guidelines to follow for when mammograms should begin as a regular occurrence, these include:
- Women who have a moderate risk of developing breast cancer: In this case, women are recommended to start going for mammograms when they are 40 and over. They can normally go for screening once every second year, but from the age of 45, it is recommended for them to get an annual mammogram.
- Women who have a higher risk of developing breast cancer: In this case, women are recommended to begin screening before the age of 40. Risk factors include those with breast cancer in their family history or having a personal history of cancer or where precancerous lesions have been detected. This may also result in your doctor recommending an MRI as a combination procedure with regular mammograms.
How to prepare for a mammogram
To prepare for a mammogram, it is best to follow the subsequent steps in order to ensure the best experience:
- Choose a facility that is certified or one your doctor recommends.
- Try to choose a period when you know your breasts will not be as tender, this is normally the first seven days after your period (menstrual cycle) unless you have already experienced menopause, in this case, you will no longer have your menstrual cycle. Your breasts tend to be more tender during the week prior to your period (menstrual cycle) as well as the week once your period is finished.
- If you are booked to go to a different or new mammogram facility, it is advised that you bring previous screening images with you, you can also request for them to be put onto a CD or flash disc. This helps the radiologist to compare previous screenings to the current ones.
Avoid using deodorant, perfume, creams or oils on your arms and breasts as these may contain metallic particles that can be visible in your scan.
- If you experience mammograms to be uncomfortable and painful, consider getting some medicine like aspirin or ibuprofen prior to the procedure.
During the mammogram
Your doctor will ask you to take off your clothes from your waist up, as well as remove any necklaces you may have on. You will be given a gown that ties in the front. You may be asked to stand or sit during the procedure, depending on the facility.
You will then be sitting or standing in the front of the specialised X-ray (mammogram) machine. The radiologist will place each of the breasts onto a platform while adjusting the machine to your height accordingly. The radiologist will then assist you in placing your arms and head in the right places so as to allow for a clear image of the breasts.
Your breasts will then be pressed onto the platform through using a plastic and clear plate. This applies pressure for a couple of seconds in order to spread the tissue of the breast out. This pressure may be uncomfortable or painful, but it is not harmful. Also, remind yourself that a few seconds of pain once a year is worth it in the greater scheme of things because early detection of breast cancer can save your life.
You may be asked to hold your breath during the X-ray. This applied pressure enables your breast to be spread evenly, allowing the X-ray to pass through the breast tissue. It also holds your breasts in place for a clear scan.
After the mammogram
Once the images have been produced of both the breasts, the radiologist will check them to ensure they are of good quality. If they are blurred or inadequate, you may be asked to repeat some tests aspects. When clear images have been produced, you will be able to put your clothes back on. The procedure normally takes about 30 minutes.
In the case of a digital mammogram, the electronic images will be made available immediately. In other cases, the radiologist may give your results to your doctor before 30 days.
The results of a mammogram
Mammograms are the white and black images produced through mammography. They are normally digital images which are sent to your the computer screen of your radiologist to interpret and then give your doctor a report on.
The radiologist will look for possible findings that could indicate cancer as well as noncancerous abnormalities (benign tumours for example), such findings may require an additional follow-up appointment or treatment.
Findings can include:
- Lumps or masses – either cancerous or benign (noncancerous)
- Calcifications (calcium deposits) in tissues and ducts– these can be due to cell debris, cell secretions, as well as inflammation. Coarser and larger parts of calcification can also be caused due to a benign (noncancerous) condition such fibroadenoma, which is a commonly known tumour that is noncancerous.
- Specific dense areas– these denote to tissue seen to be more glandular as opposed to fatty. If the area is distorted, it may suggest that the tumour has invaded the neighbouring tissues.
- Development of a new dense area since the last mammogram.
If your doctor reports that there are parts that denote concern on the mammogram, he may suggest additional mammograms. Other additional procedures may also be conducted, these can include an ultrasound or even a biopsy. A biopsy will remove a breast tissue sample to be sent to the lab for testing.
The risks of a mammogram
Mammograms emit radiation: However, the dose of radiation is low and often the benefits of the procedure outweigh your risk of exposure to radiation.
Other factors to consider
While exceptionally helpful in breast examination and the early detection of breast cancer and other possible issues, mammograms do have some limitations:
- Mammograms can be inaccurate: The accuracy is dependent on the exact technique used and the radiologist skills. Factors for example breast density and age may also result in a false-positive or false-negative mammogram. Younger women are known to have more ligaments and glands in their breasts, this results in breast tissue being dense, which can disguise the cancer signs. As women age their breast tissue becomes more fatty with fewer glands, allowing mammograms to be interpreted easier.
- Additional testing may be recommended after a mammogram: Only about 10% of women need additional testing due to abnormal findings. If the mammogram is seen to be abnormal, the radiologist will often look at previous mammograms in comparison to see if the change is serious.
- Not all cancers can be detected through a screening mammography: In some cases, cancers that have been detected through a physical examination, such as a lump, are unable to be seen in a mammogram. This is normally due to the cancer being in a place that is hard to be viewed by the mammography, like under the arm. Mammograms are able to miss one in five cancers.
- Some tumours discovered by mammography cannot be cured: Aggressive types of cancer that spread more rapidly are able to spread to other different of the body.
Depending on your results, your doctor will explain your report to you and recommend the next steps if any abnormalities were detected.