What is Mammogram?
A mammogram is a detailed X-ray examination to show the tissues of the breast. It can help to diagnose breast disease. It can detect abnormalities even before a lump is felt. Most experts agree that early detection is the key to successful treatment of breast cancer.
How is it done?
The radiographer will position your breasts on a special platform. She will need to apply compression to your breasts. Typically 4 views are taken, two views of each breast. These are the craniocaudal (CC) view and medial-lateral oblique (MLO) view. Occasionally special additional views are taken to assess a particular region of the breast.
What does the doctor look for in the Mammogram?
We look for clues that point to breast disease. The primary concern is for breast cancer.
There are three main things we look for calcifications, suspicious massess or architectural distortion of the breast tissues. Some calcifications or masses are clearly suspicious of cancer, whereas some are benign due to a variety of non-cancerous breast diesease. Similarly, any subtle distortion of the breast tissue architecture may point to early breast cancer, even before a mass is felt or seen. It is the doctor’s role to analyse the mammogram films, look at the pattern of calcifications and mass, and determine whether there is cause for concern.
What if my Mammogram is abnormal?
Bear in mind that a mammogram is basically a two dimensional X-ray image of the breasts which is a three dimensional structure: we are compressing the breasts as flat as possible to take X-ray images of the breasts. While there are clear-cut cases of breast cancers picked up on mammogram; an abnormal mammogram does not automatically equate to cancer. Often it just means we detected some changes due to the normal ageing process of the breasts, common benign harmless breast lesions like cysts, to the dreaded cancer. It is important not to panic if the mammogram shows some findings, and go for further recommended tests for better assessment.
If your mammogram is abnormal, you will need further testing. An ultrasound
of the breasts is typically the next in line to be performed; it is simple & quick to perform, and provides a wealth of information otherwise not easily obtained on a mammogram. Some patients may eventually need a biopsy of the abnormality before we can come to a proper diagnosis of what it is.
What are the limitations of mammography?
A mammogram can be difficult to interpret without prior mammograms for comparison because the pattern of breast tissue is not the same for every woman. If you have had previous mammograms done elsewhere, it is advisable to bring these along; as it would be of great help to the doctor for comparison.
Some occult cancers may be hidden by the very dense breast tissues of
some women. An ultrasound may be performed in these cases, to minimise the risk of missing the cancer.
Women who have had silicone breast injections or breast implants. These cause shadows in the mammogram that make interpretation difficult, and we may potentially miss abnormalities hidden by the shadows.
Are there any alternatives to mammography?
Perhaps the biggest complaint women have regarding mammogram is the
breast discomfort experienced on breast compression which is a necessary part of the examination. This has deterred many otherwise healthy women from participating in a screening mammogram program.
Two of the common imaging alternatives include breast ultrasound or breast
MRI. A breast ultrasound is simple to perform, provides good information of the breasts and does not involve any radiation to the breasts; which makes it an attractive alternative screening tool to the mammogram. However, it does not adequately detect microcalcifications or its pattern of distribution; which is an important feature of an early type of breast cancer (DCIS – ductal carcinoma in-situ).
Breast MRI uses a strong magnet rather than X-rays to create a detailed
image. Compared to mammograms, breast MRI:
– has more “false positive” findings (changes that are not breast cancer)
– is more expensive
– may lead to more unnecessary biopsies in women who are not at high risk
for breast cancer
Although other imaging methods (breast MRI and breast ultrasound) can
detect breast cancer, no imaging method other than mammography has been studied for screening the general population and found to be associated with decreased death from breast cancer. Therefore, mammography, while imperfect, is currently the only recommended screening test for the general population of women.
Routine breast self-examination, regular clinical follow-up & examination, together with screening mammogram is perhaps the best combination for early detection of breast cancer. The aim is to pick up early cancers, which offer the best chance of complete cure. Screening Saves Lives!
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