Mammography
(Breast X-ray, Mammogram)
Definition
Mammography is the use of low-dose x-rays (radiation) to make a picture of the tissue inside the breast. The resulting picture is called a mammogram.
Reasons for Procedure
Mammography is used to screen for and diagnose breast cancer by detecting tumors or other changes in breast tissue.
Specifically, mammography:
- Aids in early detection of cancer, which improves chances of successful treatment
- Can identify abnormalities before a lump can be felt
- Provides the only reliable method of locating abnormal growths in the milk ducts
- Identifies a lump's location prior to a biopsy or surgery
Mammogram Showing the Progression of a Breast Mass © 2008 Nucleus Medical Art, Inc.
The US Preventive Services Task Force recommends screening mammography, with or without clinical breast examination, every one to two years for women aged 40 and older. High risk women for breast cancer (eg, positive family history of breast cancer in a mother or sister, a previous breast biopsy revealing atypical hyperplasia (abnormal cells), or first childbirth after age 30) are more likely to benefit from regular mammography than women at lower risk.
Nearly all North American organizations support mammography screening, although groups vary in the recommended age to begin screening, the interval for screening, and the role of CBE. The American Medical Association (AMA), the American College of Radiology (ACR), and the American Cancer Society (ACS) all support screening with mammography and CBE beginning at age 40.
The appropriate interval for mammography is debatable between the different organizations:
- Annual mammography is recommended by AMA, ACR, and AC.
- Mammography every one to two years is recommended by AAFP, ACPM, and the Canadian Task Force on Preventive Health Care CTFPHC.
- The American College of Obstetricians and Gynecologists (ACOG) recommends mammography every one to two years for women aged 40 to 49 and annually for women aged 50 and older.
The American Cancer Society has recently released more specific screening guidelines that emphasize educating women about other screening methods, increasing breast cancer awareness, and providing more individualized guidance.
The effectiveness of mammography, for women aged 50 years and older, has been shown in in randomised controlled trials, but is less clear in younger women. A recent study, for example, involving 160,921 women recruited at age 39 to 41 showed that annual screening mammograms up to age 48 did decrease breast cancer mortality over an average of 10.7 years. This reduction, however, was not statistically significant, meaning it could have been due to chance. According to these findings, about 2,500 women would need to be screened to prevent one breast cancer death during this time period. *
Risk Factors for Complications During the Procedure
There are no complications associated with this procedure.
What to Expect
Prior to Procedure
No diagnostic tests are necessary before a mammogram, although monthly self-exams and yearly breast exams by your regular practitioner are recommended.
There are certain considerations need to be considered prior to scheduling your mammogram:
- Schedule a mammogram when breast tissue is least tender, typically a week after your period.
- Some women report less discomfort if they avoid caffeinated beverages and take 400 IU of vitamin E per day for several weeks before the exam.
-
Inform the technician if you are pregnant, have breast implants, or you are breastfeeding.
- If you have breast implants, ask if the facility uses special techniques to accommodate implants, before making an appointment. Implants make it more difficult to see all the breast tissue.
The Day of Your Mammogram
- Do not apply deodorant, talcum power, lotion, or perfume near your breasts or under your arms.
- Some women experience less discomfort during breast compression if they take two ibuprofen tablets about an hour before the test.
- Wear a two-piece outfit; you will need to remove all of your clothing and jewelry from the waist up and change into a gown that opens in the front.
- Bring copies of previous mammograms and reports with you.
- Inform the technician if you are pregnant or have breast implants.
- Describe any breast problems to the technician before x-rays are taken.
During Procedure
You stand in front of a special x-ray machine.
Anesthesia
There is no anesthesia necessary for this procedure.
Description of the Procedure
You stand in front of a special x-ray machine, which has a platform to place your breast. The technician adjusts the height of the platform, then lifts and positions one breast between a special cassette that holds the film and a clear plastic plate. The plate is brought close to the platform and compresses the breast to hold it in place and allow for a clearer image. Tell the technician if the plate compresses so tightly that it feels painful.
Two pictures of each breast are taken during a screening mammogram. During one, you face toward the platform and the image is taken looking down at the breast. For the second, you stand beside the machine, to allow for a side view. The x-rays are repeated on the other breast. Extra images, from different angles, may be necessary if you have breast implants. Magnification mammography allows the technician to ‘zoom in’ on specific areas of interest; for example, on an abnormal mass, or tiny pieces of calcium.
Digital Mammography
Digital mammography is a newer technology that takes the x-ray image and stores it electronically on a computer, unlike the traditional film mammography that transfers the image to film. Digital mammography allows images to be stored, altered, and transmitted more efficiently. Digital mammography also uses less radiation than film mammography. Studies have found that digital mammography is especially beneficial for women under age 50, and also women of any age who have dense breast tissue. The positioning and compression of the breast are the same for both film and digital mammograms, so getting a digital mammogram feels the same as getting a traditional film mammogram.
After Procedure
You'll be asked to wait at the facility until the x-rays are developed, in case more images are needed. Often you simply go home after the screening study, and the radiologist will call you to come back in the near future for further films, if needed.
How Long Will It Take?
The mammography last about 30 to 45 minutes.
Will It Hurt?
Most women do feel discomfort, and some feel pain. Tell the technician about any pain so the plastic plate can be adjusted.
Possible Complications
There are no associated complications.
Average Hospital Stay
This is an outpatient event and does not require a hospital stay.
Postoperative Care
Continue monthly breast self-exams. If you are not familiar with self-exam techniques, ask your doctor to show you, or check the American Cancer Society website (see below).
Outcome
The radiologist analyzes the images and may speak with you at the end of the appointment. Usually though, you'll receive your results by mail within 30 days. If you do not hear from the mammography center, call and ask for the results.
If you were referred by a doctor, that doctor will receive a report describing anything out of the ordinary and suggesting a possible diagnosis. Depending on the results, additional views or tests may be ordered.
RESOURCES:
American Cancer Society
http://www.cancer.org
American College of Radiology
http://www.acr.org
National Cancer Institute
http://www.cancer.gov
RadiolgyInfo
Radiological Society of North America
http://www.radiologyinfo.org
CANADIAN RESOURCES:
Breast Cancer Society of Canada
http://www.bcsc.ca/
Cancer Care Ontario
http://www.cancercare.on.ca/
Radiology for Patients
http://www.radiologyinfo.ca
References:
Agency for Healthcare Policy and Research website. Available at: http://www.ahrq.gov/ .
American College of Radiology website. Available at: http://www.acr.org .
Radiological Society of North America website. Available at: http://www.radiologyinfo.org .
US Preventive Services Task Force. Guide to Clinical Preventive Services, Third Edition. Available online at www.ahrq.gov/clinic/uspstfix.htm.
* Updated Reasons for Procedure section on 12/21/2006 according to the following study, as cited by DynaMed's Systematic Literature Surveillance : Moss SM, Cuckle H, Evans A, Johns L, Waller M, Bobrow L; Trial Management Group. Effect of mammographic screening from age 40 years on breast cancer mortality at 10 years' follow-up: a randomised controlled trial. Lancet . 2006 Dec 9;368(9552):2053-60.
Last reviewed November 2007 by Mohei Abouzied, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.
