Mammogram

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Despite the best advice of cancer researchers and physicians, about 86,000 Washington women age 50 and older have never had a mammogram. This year approximately 830 of the nearly 6,000 women diagnosed with breast or cervical cancer will die from these cancers. Early detection is the best way to combat breast and cervical cancer

Mammograms along with self breast exams, are the best defense women have against breast cancer. The three primary risk factors for breast cancer are being a women, getting older, or having a mother or sister who has had the disease. These are factors that women can't do much to change. However, just because you have one or more of these risk factors does not mean you will get breast cancer. It does mean that you need to take more responsibility for your health. One way of doing this is to get a mammogram.  Treatment is more effective and survival is high when cancer is found early. It is generally agreed that mammograms decrease deaths from breast cancer in women ages 50 and over. There is less agreement about their value for younger women. However, since mammography can show breast changes like lumps long before they can be felt, it is a good idea to have a base-line mammography sometime before age 50. Follow the advice of your health care provider in setting an appropriate schedule for you.  Mammograms are now covered by most, if not all, private insurance plans. Medicare also helps with the cost of mammograms for Medicare recipients. In addition, there is the Breast and Cervical Cancer Control Project which provides mammograms for women who meet the eligibility guidelines. Contact you county health department for more information about BCCCP.  Mammograms are not prefect. However, done in combination with self-breast exams and periodic exams by your health care provider, they are effective in detecting most breast cancer early. Let's face it, mammograms may not be any fun. However, the alternative, a late stage diagnosis of breast cancer, is a lot worse.

A mammography is a procedure for detecting breast cancer by means of X-rays. The American Cancer Society has established guidelines for women to follow concerning mammography.  At age thirty-five to thirty-nine, women should have a baseline mammogram to establish what is normal, which will be used for comparison in later years.  Between the ages of forty and forty-nine, women should have a mammogram every one to two years, depending on their physician's recommendations.  Women aged fifty and over should have a mammogram annually.  Quality mammograms are important because they show irregularities in the breast long before they can be felt by you or your doctor. Tiny micro-calcifications can be seen even before they have time to form into a lump. How the mammogram is performed and how well the film is read may affect the results, so ask questions about certification and standards of the center you use.

Imaging Bilateral (both sides) mammography: These x-rays of the breast are especially useful in detecting breast cancers that cannot be felt. Even if one breast has an obvious lump and the other feels normal, doctors must take x-rays of both breasts to make sure no other tumors are present. Technicians use a special x-ray machine to take a mammogram. The breast is placed on the machine’s lower plate, which is made of metal and has a drawer to hold the x-ray film. The upper plate, made of clear plastic, is lowered to compress the breast for a few seconds as the technician goes to the control panel and takes the picture. Screening mammography, with its top-down and side views, is used for the early detection of breast cancer in women without any breast symptoms. Diagnostic mammography, with multiple views, helps characterize breast masses or determine the cause of other breast symptoms

Why are Mammograms Done?  Mammograms are done to prevent breast cancer or to catch it early. All women are at risk for breast cancer. It causes more deaths among women than any other cancer except lung cancer. However, many breast cancers can be cured if they are caught early. To ensure this, every woman should perform regular breast self-examinations and have mammograms.  The American Cancer Society advises women to have their first mammogram by the age of 40. This is called a baseline screening. Your doctor will be able to compare this x-ray with future exams. After the age of 40 a mammogram should be scheduled every one or two years. It is recommended that women over age 50 have an annual mammogram.  Mammography can typically spot lesions one-fifth the size of those that can be felt by hand during self-examination or clinical breast examination by a healthcare professional. For example, an experienced examiner can feel a lump the size of a small pea. Mammography can find a lump the size of a grain of rice. Overall, mammography can pick up about 40% of cancers that are too small to detect by touch on clinical examination.  Mammography can miss some breast changes, most often in younger premenopausal women with dense breast tissue. The overall "false negative" rate for screening mammography is about 10% -- in other words, 1 in 10 lesions may not show up on a mammogram. Mammography also has "false positive" findings. These may lead to biopsies that turn out to be negative or benign, and therefore, in hindsight, unnecessary. However, these biopsy procedures prove that a suspicious lesion is not cancerous. The accuracy of mammography depends a lot on the skill of the radiologic technologist who positions the breast, and on the interpreting physician who examines the x-rays. It is therefore very important to choose a facility with equipment approved by the U.S. Food and Drug Administration (FDA) and staff who meet American College of Radiology skill requirements

What Should I Do to Prepare for My Mammogram?  Women of childbearing age should not schedule a mammogram during the week before menstruation is due, because the breasts may be sore and tender at this time. Drinks that contain caffeine should not be taken for 24 hours before the mammogram; Talcum powder, deodorants and antiperspirants should not be used on the day of the mammogram. These products sometimes contain aluminum, which shows in x-ray films and makes the x-rays hard to see clearly. You will be asked to undress to the waist and put on a small gown. Sometimes earrings and other jewelry must also be removed.

What is it Like to Have a Mammogram?  An x-ray technologist places your breast between two plastic plates that compress (squeeze) it. This is not dangerous, and it needs to be done to get a good picture of the breast. It may cause discomfort in some women, but it does not damage the breast in any way, nor does it produce any lasting discomfort. Two x-rays are taken of each breast during the mammogram--one from above and one from the side. A specially trained doctor, a radiologist, reads the mammogram to see if the breast is healthy.

Is There Any Danger in Having a Mammogram?  Modern mammogram equipment and techniques expose women to only minimal amounts of radiation. Discomfort from compressing the breast is temporary.

What to expect on your first mammogram: The mammogram machine, which you notice, is the compressor. This is a paddle-like device that compresses or squeezes your breast into something that resembles a pancake or a flat object. At maximal compression, this is when the technologist activates the xray tube and takes the mammogram picture, and then after this, she releases compression. Usually 2 views are taken of each breast.

Reading a Mammogram The mammogram can show tiny microcalcifications, which indicate early breast cancer. We see many benign types of calcifications also, so the radiologist should be well trained and a skilled interpreter to avoid sending all the benign calcifications to the surgeon for a biopsy. In the event the mammogram shows a suspicious finding, the patient may be recalled for additional views with magnification, or for a breast ultrasound.  See example of breast ultrasound below.  If the suspicious finding can be seen on the ultrasound machine, then ultrasound percutaneous needle biopsy can be done right there on the spot. This is very quick, causes only minor momentary discomfort, and the patient goes home right away. The biopsy usually gives the answer whether the suspicious finding is benign or malignant. If it is malignant, the patient then will proceed to a more complete excisional biopsy of the breast lesion by a breast surgeon usually with preoperative needle localization done by the radiologist. If the suspicious finding on the mammogram can not be visualized with the ultrasound machine, then the patient may proceed to Stereotactic Biopsy which is done in a special mammogram machine by the radiologist. The mammogram is first checked by the technologist and then read by a diagnostic radiologist, a healthcare providers who specializes in interpreting x-rays. The radiologist looks for unusual shadows, masses, distortions, special patterns of tissue density, and differences between the two breasts. The shape of a mass can be important, too. A growth that is benign (noncancerous) such as a cyst, looks smooth and round and has a clearly defined edge. Breast cancer, in contrast, often has an irregular outline with finger-like extensions. Many mammograms show nontransparent white specks. These are calcium deposits known as calcifications.   Macrocalcifications  Macrocalcifications are coarse calcium deposits. They are often seen in both breasts. Macrocalcifications are most likely due to aging, old injuries, or inflammations. They usually are not signs of cancer. Macrocalcifications are usually associated with benign breast conditions. However, many clusters of macrocalcifications one area may be an early sign of breast cancer. Microcalcifications  Microcalcifications are tiny flecks of calcium found in an area of rapidly dividing cells. Clusters of numerous microcalcifications in one area can be a sign of ductal carcinomain situ. About half of the cancers found by mammography are detected as clusters of microcalcifications. Reporting the Results The radiologist will report the findings from your mammogram directly to you or to your healthcare providers, who will contact you with the results. If you need further tests or exams, your healthcare providers will let you know. If you don't get a report, you should call and ask for the results. Don't simply assume that the mammogram is normal if you do not receive the results. Your mammograms are an important part of your health history. Being able to compare earlier mammograms with new ones helps your healthcare providers evaluate areas that look suspicious. If you move, ask your radiologist for your films and hand-carry them to your new physician, so they can be kept with your file. Always make sure that the radiologist who reads your mammogram has the old films to use for comparison.

8 Tips for a Good Mammogram   Ask to see the FDA certificate that is issued to all facilities that meet high professional standards of safety and quality.  Use a facility that either specializes in mammography or performs many mammograms a day.  If you are satisfied that the facility is of high quality, continue to go there on a regular basis so that your mammograms can be compared from year to year.  If you change facilities, ask for your old mammograms to bring with you to the new facility so that they can be compared to the new ones.  If you have sensitive breasts, try having your mammogram at a time of the month when your breasts will be least tender. Try to avoid the week right before your period. This will help to lessen discomfort.  Don't wear deodorant powder or cream under your arms - it may interfere with the quality of the mammogram.  Bring a list of the places, dates of mammograms, biopsies, or other breast treatments you have had before.  If you do not hear from your physician within ten days, do not assume that your mammogram was normal, confirm this by calling your physician or the facility.  Printed with permission from the American Cancer Society.

National Alliance of Breast Cancer Organizations Breast.Cancer.Com BreastCancer.net

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