mammogram is a special X-ray image of the breast. Two X-rays are taken for each breast. The X-rays are usually done by a trained woman radiographer. The mammograms are then reported by a radiologist. Recent advances in mammography equipment and techniques have resulted in women now only receiving a small radiation dose, which is about the same as that received every year from normal background radiation. The benefits of being screened for breast cancer far outweigh any potential risks of radiation from a mammogram examination.

Mammography is the most effective, non invasive and the best way to detect early breast cancer especially when it is too small to be felt by the patient or the doctor. For this reason, breast screening is now available to all women aged 40 and above. Mammography complements but cannot replace monthly breast self examination (BSE) and regular physical examination.

Mammography is usually not painful but may be uncomfortable especially in women with smaller breasts. Each breast is gently squeezed and flattened by a special device when the x-ray images are taken. This lasts for a few seconds and will not harm the breast. The entire examination will take approximately half an hour.

The present guidelines for screening of asymptomatic women (women who do not have any symptoms related to the breast) are:  

• At age 35-40: baseline mammogram
• At age 40-49: mammograms at one or two year intervals
• At age 50 and above: annual mammograms

Symptomatic women, that is women who have signs or symptoms related to the breast like a lump, nipple discharge, mastalgia (breast pain), unexplained decrease or increase in breast size or appearance, will require a mammogram to resolve the particular problem.

This may sometimes require additional images where the abnormal area seen on the mammogram is further compressed to give a clearer picture. A palpable lump or an abnormality detected on screening mammogram may also require further examination like breast ultrasound or special mammographic procedures such as stereotactic guided fine needle aspiration cytology (FNAC), core biopsy or wire localisation.

Mammography may be the key to successful treatment and cure of the disease. However, mammography can fail in detection of some cancers since not all breast carcinomas produce a recognisable change in the mammogram and this occurs more often when the woman has dense breast tissue. Palpable cancers are not always visible and visible cancers are not always palpable.

No special preparation is required for a mammogram. However, it is advisable to wear separates (two piece garments) – sarong, skirt or pants with a button-through top. This is helpful for the mammographic positioning and also for an ultrasound examination, if needed. The women are advised not to use deodorant, talcum powder or perfume which may cause artifacts on the X-ray film and which may require a repeat examination.

1. Fine Needle aspiration cytology

This is a method where a small sample of suspicious breast tissue is obtained with a fine needle and sent to a pathologist for further examination. This is done by a radiologist, using ultrasound to guide them or mammogram using special computer targeting system that allows the abnormal area in the breast to be located using a two dimensional approach. This is called stereotactic biopsy.

2. Core Biopsy

This method involves obtaining larger samples of tissue using special needles. This can also be performed using ultrasound or mammography as a guide.

3. Aspiration and Drainage

A breast abscess can be drained by a radiologist using ultrasound as a guide. A fine needle is placed into the cyst or abscess and the fluid or pus sucked out.

4. Wire localisation

In this method, a wire is inserted by a radiologist into the abnormal area in the breast under mammographic stereotactic guidance. This is only performed for small suspicious lumps in the breast that cannot be felt by the doctor as a guide for the surgeon during removal of the lump.

5. Ductography (Galactography)         

Ductography is a contrast X-ray examination of ducts in the breast performed by a radiologist to identify tumours in the ducts. This examination is useful for investigating nipple discharge.

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Last Updated:
Thursday, 21 August, 2003