Alarming fact: Today, only 66%
of U.S. women
age 40 and older
get an annual
mammogram.
That is 3 million
women less than
5 years ago

Benefits of Mammography far outweigh the risk and inconvenience

Step 3: Mammography

Mammography is a test that uses x-rays to generate images of the breast tissue. The test is performed to detect and evaluate abnormalities such as tumors and cysts. It is very important to perform mammograms regularly.

Successful treatment of breast cancer depends on early diagnosis. Mammography plays a major role in early detection of breast cancers. The U.S. Food and Drug Administration reports that mammography can find 85 to 90 percent of breast cancers in women over the age of 50! It is important to understand that the benefits of mammography far outweigh the risks and inconvenience.

There are two types of mammography exams: screening and diagnostic.

  • A screening mammogram is an x-ray examination of the breasts in a woman who has no complaints or symptoms of breast cancer. The goal of screening mammography is to detect cancer when it is still too small to be felt by a woman or her physician. Early detection of small breast cancers by screening mammography greatly improves a woman’s chances for successful treatment. Screening mammography is recommended every one to two years for women once they reach 40 years of age and every year once
    they reach 50 years of age. Also, the current recommendation is to have a base line mammogram at the age of 35.
  • A diagnostic mammogram is an x-ray examination
    of the breast in a woman who either has a breast complaint (for example, a breast lump found
    during self-exam) or has had an abnormality found
    during screening mammography. Diagnostic mammography is more involved and time-consuming than screening mammography. It is used to determine the exact size and location of breast abnormalities and to image the surrounding tissue, sometimes including the lymph nodes. Typically, several additional views of the breast are imaged and interpreted during diagnostic mammography. Women with breast implants or a personal history of breast cancer will usually require the additional views used in diagnostic mammography.

How is Mammography Performed?

During mammography, a woman stands in front of a mammography machine and one of her breasts is placed on a clear plastic plate and gently, but firmly, pressed from another plate above her breast. This compression flattens the breast so that the maximum amount of tissue can be imaged and examined. The pressure lasts a few seconds and does not harm the breast. The same steps are repeated with the other breast. The plates of the machine are then tilted to take a side view of each breast. When done, a woman will have two different views of each breast for a total of four pictures.

At some facilities, mammography technologists may place adhesive markers on the breast skin prior to taking images of the breast. The purpose of the adhesive markers is twofold: first, to identify areas with moles, blemishes or scars so that they are not mistaken for abnormalities, and secondly, to identify areas that may be of concern (e.g. a lump was felt during physical examination). Some centers routinely mark the nipple with a small dot to provide a clear “landmark” for the radiologist on the mammogram images.

A mammogram is like a fingerprint; the appearance of the breast on a mammogram varies tremendously from woman to woman, and no two mammograms are alike. It is extremely helpful for the radiologist to have x-ray pictures (not just the reports) available from prior examinations for comparison purposes. This will help the doctor to recognize small changes that occur gradually over time and detect problems as early as possible.

Dense breast tissue can make mammographic evaluation difficult. Younger women (before menopause) may have denser breast tissues. Because fatty breasts are easier for a mammogram to see through, dense breast tissue can sometimes hide outlines of areas that need closer study. If a particular area needs a better image, an ultrasound is usually the next step.

As of April 28, 1999, a new version of the Mammography Quality Standards Law mandates that all women who have mammograms must be informed of the results in writing. However, if you have not been informed of your results within a week or so of your mammogram, do not assume they are normal. Follow up with your healthcare provider who will provide you with the results.

New Technologies

Research is being done to study new ways of taking images of the breast and detecting cancer early.
They include:

  • MRI: Magnetic Resonance Imaging
  • CAT: Computerized Axial Tomography Scan
  • PET: Positron Emission Tomography Scan

These tests may help make a diagnosis after a woman has had an abnormal mammogram.

How Does Mammography Work?

The breast is made of fat, fibrous tissue and glands. Different tissues in the breast absorb different amounts of x-rays, therefore producing different shades of black, gray, and white on the film:

  • Fatty tissue absorbs a small amount of x-rays and appears black or dark gray.
  • Normal fibrous and glandular tissues (milk glands, lymph nodes) contain watery fluid and absorb a moderate amount of x-rays, and appear light gray.
  • Fibrous and glandular tissues may contain calcium and appear white or nearly white.

The mammogram is interpreted by a radiologist, who compares the new images of a woman’s breast to each other and to previous mammograms a woman may have had. The radiologist will look for shadows and patterns of tissue density to detect any abnormalities.

Will the Mammogram hurt?

Most women say that getting a mammogram is uncomfortable. A few women say that it is painful, although the pain doesn’t last long. What you will experience will depend upon the size of your breasts, how much your breasts need to be pressed, the skill of the technologist, and where you are in your monthly menstrual cycle.

When making the mammogram appointment, make sure you discuss the following:

  • Availability of previous mammograms for comparison: if you are changing mammogram facilities or seeing a new doctor, try to arrange for your previous mammograms to be sent to the facility before your appointment
  • When and how you will learn about your results
  • Make sure to discuss breast implants or any other breast surgery in the past
  • If possible, try to avoid scheduling your mammogram when your breasts are tender or swollen, such as the week before or during your period.

What can affect the Mammogram?

Surgery and major injuries can affect your mammogram. Be sure to tell your health care team if you have had breast reduction, breast reconstruction, or breast implants. Women with certain surgical procedures may need additional x-ray pictures taken during their mammogram.

Tips for Getting a Mammogram

  • On the day of the test, don’t wear deodorant, perfume, or talcum powder. Sometimes ingredients in these products can show up as white spots on a mammogram.
  • You may find it more comfortable to wear a top with a skirt or pants instead of a dress. This way you’ll only have to remove your top during the mammogram
  • Be prepared to describe any breast symptoms, changes, or problems to your health care team.

What if my Mammogram is abnormal?

Do not panic! Mammograms find many conditions that are not cancer. Most women who need further exams or testing do not have cancer. The tests your doctor recommends will depend on what showed up on your mammogram.

  1. Additional Diagnostic Mammograms
  2. Ultrasound
  3. Exams by Specialists
  4. Biopsy: a biopsy involves removal of small samples of breast tissue, which can be done with a needle or through surgery.

What happens if they find breast cancer?

For many women, treatment for breast cancer begins within a few weeks after the diagnosis. Usually, a woman has time to learn about her options and doesn’t have to make an immediate decision. She can discuss her treatment choices with her doctor, get a second opinion, talk to friends, or learn from other women with cancer. Not all breast cancers are treated the same way, and different treatments have different advantages and disadvantages. It is normal to feel some shock and stress, making it hard to process information at first or even ask questions. Some women find it helps to make a list of questions, take notes, or have a family member or friend with them when they talk to the doctor. The most important thing is that a woman feels informed of her options and comfortable with her decision. Keep in mind, millions of breast cancer survivors are fine today and feel stronger than before!

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