Mammography Health Article

Definition

Mammography is the study of the breast using x ray. The actual test is called a mammogram. 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 diagnostic mammogram is for evaluation of new abnormalities or of patients with a past abnormality requiring follow-up (i.e. a woman with breast cancer treated with lumpectomy). Additional x rays from other angles or special 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 years before it can be felt. The American Cancer Society, American College of Radiology, American College of Surgeons and American Medical Association recommend annual mammograms for every woman beginning at age 40.

Screening mammograms are not usually recommended for women under age 40 who have no special risk factors and a normal physical breast examination. Below age 40, breasts tend to be "radiographically dense, " which means it is difficult to see many details. But some differences of opinion exist about the usefulness of screening women between the ages of 40-50. While screening mammograms at 40 can detect cancers in an early stage, some health care providers worry about the increased negative (benign) biopsy rate in this age group.

Some women are at increased risk for developing breast cancer, such as those with multiple relatives who have the disease. Beginning screening mammography at a younger age—generally 10 years younger than the youngest affected relative, but not less than 35 years of 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. The cause of the problem may be definitively diagnosed from this study, but further investigation using other methods may be necessary. This test is also used to evaluate findings from screening mammography tests.

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, since October 1, 1994, only places certified by the Food and Drug Administration (FDA) are legally permitted to perform, interpret, or develop mammograms.

In addition to the usual paperwork, a woman will be asked to fill out a form seeking information relevant to her risk of breast cancer and special mammography needs. The woman is asked about personal and family history of cancer, details about menstruation, child bearing, birth control, breast implants, other breast surgery, age, and hormone replacement therapy. 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 of the breasts before the mammogram. Whether or not this is done, it is essential for the patient to tell the technologist about any lumps, nipple discharge, breast pain, or other concerns.

Clothing from the waist up is removed and a hospital gown or similar covering is put on. The woman stands facing the mammography machine. The technologist exposes one breast and places it on a plastic or metal film holder about the size of a placemat. The breast is compressed as flat as possible between the film holder and a rectangle of plastic (called a paddle), which presses down onto the breast from above. The compression should only last a few seconds, just enough to take the x ray. Good compression can be uncomfortable, but it is necessary to ensure the clearest view of all breast tissues.

Next, the woman is positioned with her side toward the mammography unit. The film holder is tilted so the outside of the breast rests against it, and a corner touches the armpit. The paddle again holds the breast firmly as the x ray is taken. 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 are usually 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 are any questionable areas or an 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 at the mammography facility.

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 with Medicare who are age 40 or older and a baseline mammogram for those age 35 to 39.

A digital mammogram is performed in the same way as a traditional exam, but in addition to the image being recorded on film, it is viewed on a computer monitor and stored as a digital file.