8/16/2018 Mammography - procedure, test, pain, time, types, risk, cancer, rate

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Mammography
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Definition
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Mammography is the study of the breast using x rays. The actual test is called a mammogram. It is an x ray of the breast which shows the fatty,
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fibrous, and glandular tissues. There are two types of mammograms. A screening mammogram is ordered for women who have no problems with their
breasts. It consists of two x ray views of each breast: a craniocaudal (from above) and a mediolateral oblique (from the sides). A diagnostic
mammogram is for evaluation of abnormalities in either men or women. Additional x rays from other angles, or special coned views of certain areas,
are taken.

Purpose
The purpose of screening mammography is breast cancer detection. A screening test, by definition, is used for patients without any signs or
symptoms, in order to detect disease as early as possible. Many studies have shown that having regular mammograms increases a woman's chances
of finding breast cancer in an early stage, when it is more likely to be curable. It has been estimated that a mammogram may find a cancer as much as
two or three years before it can be felt. The American Cancer Society (ACS) guidelines recommend an annual screening mammogram for every
woman of average risk beginning at age 40. Radiologists look specifically for the presence of microcalcifications and other abnormalities that can be
associated with malignancy. New digital mammography and computer-aided reporting can automatically enhance and magnify the mammograms for
easier finding of these tiny calcifications.
The highest risk factor for developing cancer is age. Some women are at an increased risk for developing breast cancer, such as those with a positive
family history of the disease. Beginning screening mammography at a younger age may be recommended for these women.
Diagnostic mammography is used to evaluate an existing problem, such as a lump, discharge from the nipple, or unusual tenderness in one area. It is
also done to evaluate further abnormalities that have been seen on screening mammograms. The radiologist normally views the films immediately and
may ask for additional views such as a magnification view of one specific area. Additional studies such as an ultrasound of the breast may be
performed as well to determine if the lesion is cystic or solid. Breast-specific positron emission tomography (PET) scans as well as an MRI (
magnetic resonance imaging (../La-Pa/Magnetic-Resonance-Imaging.html) ) may be ordered to further evaluate a tumor, but mammography is still
the first choice in detecting small tumors on a screening basis.

Description
A mammogram may be offered in a variety of settings. Hospitals, outpatient clinics, physician's offices, or other facilities may have mammography
equipment. In the United States only places certified by the Food and Drug Administration (FDA) are legally permitted to perform, interpret, or develop
mammograms. Mammograms are taken with dedicated machines using high frequency generators, low kvp, molybdenum targets and specialized x
ray beam filtration. Sensitive high contrast film and screen combinations along with prolonged developing enable the visualization of minute breast
detail.

In addition to the usual paperwork, a woman will be asked to fill out a questionnaire asking for information on her current medical history. Beyond her
personal and family history of cancer, details about menstruation, previous breast surgeries, child bearing, birth control, and hormone replacement
therapy are recorded. Information about breast self-examination (BSE) and other breast health issues are usually available at no charge.

At some centers, a technologist may perform a physical examination (../Pa-St/Physical-Examination.html) of the breasts before the mammogram.
Whether or not this is done, it is essential for the technologist to record any lumps, nipple discharge, breast pain or other concerns of the patient. All
visible scars, tattoos and nipple alterations must be carefully noted as well.

Clothing from the waist up is removed, along with necklaces and dangling earrings. A hospital gown or similar covering is put on. A small self-adhesive
metal marker may be placed on each nipple by the x ray technologist. This allows the nipple to be viewed as a reference point on the film for concise
tumor location and easier centering for additional views.

Patients are positioned for mammograms differently, depending on the type of mammogram being performed:

Craniocaudal position (CC): The woman stands or sits facing the mammogram machine. One breast is exposed and raised to a level position
while the height of the cassette holder is adjusted to the same level. The breast is placed mid-film with the nipple in profile and the head turned
away from the side being x rayed. The shoulder is relaxed and pulled slightly backward while the breast is pulled as far forward as possible. The
technologist holds the breast in place and slowly lowers the compression with a foot pedal. The breast is compressed between the film holder
and a rectangle of plastic (called a paddle). The breast is compressed until the skin is taut and the breast tissue firm when touched on the lateral
side. The exposure is taken immediately and the compression released. Good compression can be uncomfortable, but it is very necessary.

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Compression reduces the thickness of the breast, creates a uniform density and separates overlying tissues. This allows for a detailed image
with a lower exposure time and decreased radiation dose to the patient. The same view is repeated on the opposite breast.
Mediolateral oblique position (MLO): The woman is positioned with her side towards the mammography unit. The film holder is angled parallel to
the pectoral muscle, anywhere from 30 to 60 degrees depending on the size and height of the patient. The taller and thinner the patient the
higher the angle. The height of the machine is level with the axilla (armpit). The arm is placed at the top of the cassette holder with a corner
touching the armpit. The breast is lifted forward and upward and compression is applied until the breast is held firmly in place by the paddle. The
nipple should be in profile and the opposite breast held away if necessary by the patient. This procedure is repeated for the other breast. A total
of four x rays, two of each breast, are taken for a screening mammogram. Additional x rays, using special paddles, different breast positions, or
other techniques may be taken for a diagnostic mammogram.

The mammogram may be seen and interpreted by a radiologist right away, or it may not be reviewed until later. If there is any questionable area or
abnormality, extra x rays may be recommended. These may be taken during the same appointment. More commonly, especially for screening
mammograms, the woman is called back on another day for these additional films.

A screening mammogram usually takes approximately 15 to 30 minutes. A woman having a diagnostic mammogram can expect to spend up to an
hour for the procedure.
The cost of mammography varies widely. Many mammography facilities accept "self referral." This means women can schedule themselves without a
physician's referral. However, some insurance policies do require a doctor's prescription to ensure payment. Medicare will pay for annual screening
mammograms for all women over age 39.

Preparation
The compression or squeezing of the breast necessary for a mammogram is a concern of many women. Mammograms should be scheduled when a
woman's breasts are least likely to be tender. One to two weeks after the first day of the menstrual period is usually best, as the breasts may be tender
during a menstrual period. Some women with sensitive breasts also find that stopping or decreasing caffeine intake from coffee, tea, colas, and
chocolate for a week or two before the examination decreases any discomfort. Women receiving hormone therapy may also have sensitive breasts.
Over-the-counter pain relievers are recommended an hour before the mammogram appointment when pain is a significant problem.
Women should not put deodorant, powder, or lotion on their upper body on the day the mammogram is performed. Particles from these products can
get on the breast or film holder and may show up as abnormalities on the mammogram. Most facilities will have special wipes available for those
patients who need to wash before the mammogram.

Aftercare
No special aftercare is required.

Risks
The risk of radiation exposure from a mammogram is considered minimal and not significant. Experts are unanimous that any negligible risk is by far
outweighed by the potential benefits of mammography. Patients who have breast implants (../A-Ce/Breast-Implants.html) must be x rayed with
caution and compression is minimally applied so that the sac is not ruptured. Special techniques and positioning skills must be learned before a
technologist can x ray a patient with breast implants.
Some breast cancers do not show up on mammograms, or "hide" in dense breast tissue. A normal (or negative) study is not a guarantee that a woman
is cancer-free. The false-negative rate is estimated to be 15–20%, higher in younger women and women with dense breasts.
False positive readings are also possible. Breast biopsies may be recommended on the basis of a mammogram, and find no cancer. It is estimated
that 75–80% of all breast biopsies resulted in benign (no cancer present) findings. This is considered an acceptable rate, because recommending
fewer biopsies would result in too many missed cancers.

Normal results
A mammography report describes details about the x ray appearance of the breasts. It also rates the mammogram according to standardized
categories, as part of the Breast Imaging Reporting and Data System (BIRADS) created by the American College of Radiology (ACR). A normal
mammogram may be rated as BIRADS 1 or negative, which means no abnormalities were seen. A normal mammogram may also be rated as BIRADS
2 or benign findings. This means there are one or more abnormalities but they are clearly benign (not cancerous), or variations of normal. Some kinds
of calcifications, enlarged lymph nodes or obvious cysts might generate a BIRADS 2 rating.
Many mammograms are considered borderline or indeterminate in their findings. BIRADS 3 means either additional images are needed, or an
abnormality is seen and is probably (but not definitely) benign. A follow-up mammogram within a short interval of six to 12 months is suggested. This
helps to ensure that the abnormality is not changing, or is "stable." Only the affected side will be x rayed at this time. Some women are uncomfortable
or anxious about waiting, and may want to consult with their doctor about having a biopsy. BIRADS 4 means suspicious for cancer. A biopsy is usually
recommended in this case. BIRADS 5 means an abnormality is highly suggestive of cancer. A biopsy or other appropriate action should be taken.

Screening mammograms are not usually recommended for women under age 40 who have no special risk factors and a normal physical breast
examination. A mammogram may be useful if a lump or other problem is discovered in a woman aged 30–40. Below age 30, breasts tend to be
"radiographically dense," which means the breasts contain a large amount of glandular tissue which is difficult to image in fine detail. Mammograms for
this age group are controversial. An ultrasound of the breasts is usually done instead.

Patient education
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The mammography technologist must be empathetic to the patient's modesty and anxiety. He or she must explain that compression is necessary to
improve the quality of the image but does not harm the breasts. Patients may be very anxious when additional films are requested. Explaining that an
extra view gives the radiologist more information will help to ease the patient's tension. One in eight women in North America will develop breast
cancer. Educating the public on monthly breast self-examinations and yearly mammograms will help in achieving an early diagnosis and therefore a
better cure.

Resources

periodicals
Carmen, Ricard, R. T. R. Mammography: Techniques and Difficulties. O.T.R.Q., 1999.
Gagnon, Gilbert. Radioprotection in Mammography. O.T.R.Q., 1999.

Ouimet, Guylaine, R. T. R. Mammography: Quality Control. O.T.R.Q., 1999.

organizations
American Cancer Society (ACS), 1599 Clifton Rd., Atlanta, GA 30329. (800) ACS-2345. http://www.cancer.org (http://www.cancer.org) .
Federal Drug Administration (FDA), 5600 Fishers Ln., Rockville, MD 20857. (800) 532-4440. http://www.fda.gov (http://www.fda.gov) .
National Cancer Institute (NCI) and Cancer Information Service (CIS), Office of Cancer Communications, Bldg. 31, Room 10A16, Bethesda, MD
20892. (800) 4-CANCER (800) 422-6237. Fax: (800) 624-2511 or (301) 402-5874. http://cancermail@cips.nci.nih.gov
(http://cancermail@cips.nci.nih.gov) . http://cancernet.nci.nih.gov (http://cancernet.nci.nih.gov) .

Lorraine K. Ehresman
Lee A. Shratter, M.D.

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Learn more about tumor microenvironments with Nilogen’s 3D screening

2 A Fresh Approach to Immuno - Oncology platforms nilogen.com

Also read article about Mammography (/knowledge/Mammography.html) from Wikipedia

User Contributions:
1
XAVIER Oct 22, 2007 @ 9:09 am
(/La-

i would like to ask you the predisposing factors of getting breast cancer and how to prevent such things.ok thanks

2
XAVIER Oct 22, 2007 @ 9:09 am
(/La-

PL'S KINDLY GIVE ME RESPONSE OF THESE QUESTIONS:WHAT ARE TWO APPROCHES CAN YOU DONE TO GET SUIT
MAMMOGRAPHY MACHINE AND DIFFICULTIES OF MAMMOGRAPHY MACHINE

3
diane Apr 19, 2008 @ 5:17 pm
(/La-

how much of the muscle from the breast to the underarm does the mamogram normally cover?

4
Bonnie Medina Sep 25, 2008 @ 5:05 am
(/La-

I am a mammographer in Honduras.....need all the help I can get to make things better for my patients....work for an organization called
CAMO...Central American Medical Outreach. Do you have anyone that could work with me....that speaks both Englis and Spanish???
Need to share thoughts and ideas with someone....Dr. Richard Hirsh helped start this program also....long ago!
Please write ....ASAP! Bonnie Medina - Santa Rosa de Copan, Honduras

5
Daniel (mailto:denz2810 [at] yahoo [dot] co [dot] uk) Feb 23, 2011 @ 10:22 pm
(/La-

How often the mammography test can be peformed ? Is it ok for a memmography test within two months of the 1st test.???
can u pls. answer this question.

6
Naomi Feb 8, 2012 @ 2:02 am
(/La-

I have heard that doing x-ray frequently can cause cancer . Does this mammography also have any such adverse effect ?

7
flor Apr 18, 2012 @ 12:12 pm
(/La-

Can a mammogram be done during or on the first day of the menstruation?

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8/16/2018 Mammography - procedure, test, pain, time, types, risk, cancer, rate

8
Baby Aug 15, 2013 @ 1:01 am
(/La-

If you dont do the mommogram what will be the effect?

9
Monica Oct 14, 2014 @ 1:01 am
(/La-

I am 26 years old. i feel lumps in my breast. there are no other symptoms of cancer as mentioned in documents i read, like there is no fluid
coming or it doesn't pain. Plz tell me do i have to get mammogram test done. or is it normal to have lumps in breast.

10
arline picclo Jan 7, 2015 @ 3:15 pm
(/La-

The technician lowered the foot pedal for compression too quickly not once, but three times; and, I felt excruciating pain. I developed a hematoma
= Three months later, it has dissolved only slightly. I am still swollen and tender to the touch. Now, the swelling has grown and is very tender.
What should I expect?

11
SAMREENA Oct 19, 2016 @ 10:10 am
(/La-

I am 34 years old unmarried my ultrasound report have mention my both side there are multiple fabriod tissue and lump node the sizes are 19mm
and 3-4mm BIRADS-II one side is painful and lump node is painless doctor recommend wait long time whenever your tissues size will be 5 to
6CM do you recommend me may I take mammogram test but my age is less than 40 years?
I am waiting for your reply

12
Patel Puspaben Jan 10, 2018 @ 7:07 am
(/La-

probably benign changes in from of fibroadenoma in right breast - BIRADS III

This words meaning???

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