Mammograms

A mammogram is a specialized low-dose X-ray that produces an image of the inner structures of the breast.


Purpose
Mammograms may be used for screening or diagnostic purposes. Screening mammograms are intended to detect unsuspected breast cancer at an early stage. Mammograms can also detect small calcium deposits in the breast. Although most deposits are benign (noncancerous), a cluster of tiny specks of calcium (called microcalcifications) may be an early sign of cancer. Diagnostic mammograms are used to evaluate abnormal findings from a screening mammogram or physical breast exam. Diagnostic mammograms are also used in special cases, such as when a woman has breast implants. The only difference between the two types of mammograms is that more pictures are taken during diagnostic mammograms.

Indications
The debate on the timing of mammography continues. Some health care professionals recommend regular mammograms every one to two years beginning at age 40 and annually beginning at age 50. The U.S. Preventive Services Task Force recommends mammograms every one to two years, with or without clinical breast examination, for women age 40 and older. Ultimately, the decision about when to begin mammography is between you and your doctor.
Although all women have some risk for the development of breast cancer, you have an increased risk if you:

are older (Nearly 80 percent of all breast cancer cases occur after age 50.)
have a family history of breast cancer in one first-degree relative (such as a mother, sister or daughter) or two or more close relatives (such as cousins)
have a personal history of breast cancer
have certain genetic changes involving the BRCA1 or BRCA2 genes
have a personal history of gynecologic cancer, particularly uterine or ovarian cancer
had a first biological child after age 30 or never had biological children
received chest irradiation for certain cancers when you were young
have an abnormal breast biopsy of a certain type, such as atypical hyperplasia (the excessive proliferation of cells) or lobular carcinoma in situ
are age 45 or older and had 75 percent or more dense tissue on a prior mammography
If you have risk factors for breast cancer, ask your doctor about the need for earlier or more frequent screenings.

Regardless of when you had your last mammogram, see your doctor for a breast exam if you notice:

a lump in your breast, armpit or upper chest
a newly inverted nipple (the nipple turns in)
nipple discharge, which is often bloody and from only one breast
nipple itching, scaliness or tenderness
thickened or dimpled breast skin ("orange peel" appearance)
change in the size or shape of one breast
any other unusual breast or nipple changes

Patient preparation
On the day of the mammogram, don't use deodorant, talcum powder or lotion under your arms or near your breasts. These products may appear as suspicious marks on the X-ray. Wear a two-piece outfit so you only have to remove your top, and remove any jewelry worn around your neck. p /> To minimize the discomfort, schedule the exam during the first two weeks after your period if you're still menstruating. Your breasts will be the least tender during this time. Some studies also indicate this is the most accurate time for detecting cancer.
It may also be helpful to bring the following items to your appointment:

the name, phone number and address of your doctor
the dates and places of previous mammograms and other breast procedures
previous mammogram films, if possible

Procedure
The X-rays are taken by a radiologic technologist using equipment dedicated to only taking breast X-rays. During the test, which takes about 10 minutes, you'll either sit or stand in front of the X-ray machine. One breast at a time will be placed on the machine and compressed while the pictures are taken. Flattening the breast allows a low X-ray dose to be effective and improves the accuracy of the test. You may be uncomfortable while your breasts are compressed. Be sure to inform the technician if you experience excessive discomfort during the procedure.
Digital mammography is a new method of recording images of the breast. Instead of recording the images on an X-ray film, they are recorded in computer code. The process for the patient remains the same. Digital mammography exposes you to less radiation, the images can be corrected for overexposure or underexposure, and all areas of the breast can be viewed despite differences in breast tissue densities.


Postprocedure care
The X-rays will be analyzed by a radiologist. Make sure you receive either a verbal or written report of the mammogram. If you don't understand it, ask for clarification and find out if there are any recommendations for follow-up care or further testing. Be sure to address any other questions you may have regarding your breast health.

Benefits
Regular mammograms are the most effective way to detect breast cancer, as well as other breast diseases, at an early stage. Mammograms can help detect tumors that are too small to be felt with a physical breast exam. Mammograms have been proven to decrease breast cancer deaths in women age 50 and older.

Risks
Women with breast implants face a small risk of rupture with mammograms. Also, for these women, complete visualization of the breast is unlikely. False-positive results (when the test is positive even though no true disease exists) may lead to unnecessary anxiety and additional diagnostic testing. False-negative readings (when the test is negative but the disease is really there) are possible and may provide a false sense of security.

Considerations
In addition to regular mammograms, it's important to see your doctor for regular clinical breast exams. Some authorities recommend monthly breast self-exams. Other medical authorities consider them optional because they're not as sensitive as clinical exams.
The Mammography Quality Standards Act (MQSA) of 1992 requires that all mammography facilities meet certain quality standards. These standards require the facility to use dedicated mammography equipment, which must be calibrated at least once a year to ensure proper functioning. The person who takes the X-rays must have special training in mammography and be accredited by the American College of Radiological Technologists or licensed by the state. The standards also require the doctor who will interpret the mammogram to be board certified and specially trained in mammography. Before you have a mammogram, be sure your facility meets MQSA standards.

Digital mammography can only be done in facilities certified to offer traditional mammography. As with traditional mammography, strict criteria must be met regarding personnel, equipment, record keeping and reporting. Keep in mind that digital mammography is offered in only a limited number of facilities due to the newness of the procedure. If you'd like to have a digital mammogram, discuss it with your doctor.


Pregnancy-specific information
If an abnormal breast exam occurs during pregnancy, diagnostic tests including a mammogram may be performed. There is little risk to the fetus. However, a false-negative result may occur, meaning the mammogram is negative and breast cancer is present.

Senior-specific information
The risk of developing breast cancer increases with age, so it's important to have a mammogram on a regularly scheduled basis. Again, mammograms have been proven to decrease breast cancer deaths in women age 50 and older.