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What is Mammography?

A 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.
 

Is Mammography Safe for Me?
Recent advances in mammography equipment and techniques have resulted in women now only receiving a small radiation dose. The benefits of being screened for breast cancer far outweigh any potential risks of radiation from a mammogram examination. The risk of a mammogram is equivalent to smoking 1/8 of a cigarette.
 
How Effective is Mammography?

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 you or your doctor. For this reason, breast screening is now available to all women aged 40 and above. Mammography complements but cannot replace monthly self breast examination and regular physical examination by your doctor even when you have reached 40 years and above.
 

Why is There So Much Controversy over the Effectiveness of Mammography Screening?

There are several issues in this controversy:

  1. What is the “cost effective” age to begin screening? Countries with government funded or insurance funded population based screening (detecting cancer before it can be felt or the person has symptoms) need to look at the economies of looking for a disease that must be common, yet, effectively treated for the benefit of reducing deaths from breast cancer. They have to balance the death reduction rate and justify the expenditure.
     
  2. What is the effective screening interval? What is the best interval between screening mammograms, a year, 2 or 3? There have been many statistical simulations and papers published with regard the best interval and at which age group. In addition, the density (how much glandular and fibrous tissue a breast is made up off) is by itself an independent risk factor for breast cancer. Dense breasts should be screened more often but the ability of the mammogram to pick up smaller/earlier cancers in dense breasts are more difficult. This is where in some countries, MRI of the breast has been recommended for a very small group of women who are at very high risk of breast cancer and have dense breasts.
     
  3. Issue of Overtreatment and Overdiagnosis? This means discovering early cancers which might not progress to the invasive type that will kill a person eventually. When evaluated statistically, it becomes an issue but when a person’s life is evaluated individually, the considerations are different. Who would want to wait and see if the cancer they had detected would or would not progress? Therefore, the disadvantage of screening for breast cancer leads then, to discoveries of some small percentage of cancers which might be treated but would not have caused any problems for the individual. This leads to additional cost (time, financial, unnecessary surgery) to the patient and to the country.
Is Mammography Painful?
Mammography is usually described as painful by many women but if you ask them further, you will realize it is just a temporary discomfort. Almost all of them will say it is definitely tolerable. Each breast is gently squeezed (compressed) 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 from preparing for the examination, taking the mammogram views itself and dressing up again.
 
When Should I Go For a Mammogram?

The recommendation for mammogram will depend on various factors:

  • Risk profile (for example strong family history, dense breasts, previous history of breast cancer, hormone replacement therapy post menopause)
  • The individual’s concept and understanding and preferences
  • Presence of symptoms or signs or suspicions of presence of cancer, no matter the age group

Regular mammograms can be done from 40 years and above in the absence of signs or symptoms. The baseline can be done slightly earlier should the risk profile require it. As for the interval, every one 1 to 2 years depending on the findings of the mammograms. Before embarking on mammograms, you should discuss the pros and cons of mammograms and understand the procedure’s capabilities and drawbacks (in other words, properly counselled to understand what you will be testing for and how it will be done). This is best done with a radiologist who is familiar with breast imaging and regularly practises this modality of imaging.

Therefore, the intervals for countries such as Malaysia will be individualised. It is common after the age of 50 years, in the absence of suspicious findings or probably benign findings to have mammograms at 2 year intervals. Closer follow up with or without complementary tests such as ultrasound may be needed depending on what your mammogram with/without additional tests find.
 

Can I have a mammogram if I am younger than 35 years old?
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. There is no age limit for a mammogram should your doctor suspect you may have a suspicious “abnormality” in your breast.
 
How many Mammogram views of the breast will be taken?
Normally 2 views of each breast are taken. If there is some finding in your mammogram or in relation to your breast symptom and sign, sometimes additional images will be required where the abnormal area seen on the mammogram is further compressed to give a clearer picture or a supplementary view in a slightly different position is done.
 
What if I have a breast implant, can I still have a mammogram done?
It is vital that you inform the radiographer if you have a breast implant. Special views may be necessary for the assessment to allow as much of the breast to be viewed on the mammograms. Special care is also taken with regards to compression. However, you must remember that once you have an implant, it will obscure (block) visualization of parts of your breast, sometimes, with only a small portion of your breast tissue being available for imaging. This will depend on the size of the implant and the position of the implant. Therefore, the ability of the mammogram to pick up abnormalities of the breast is much lower than in a “normal” breast, free from implants.
 
What happens if there is some abnormality on my mammogram?
A palpable lump or an abnormality detected on screening mammogram may require additional mammogram views or further examination like breast ultrasound or special mammographic procedures such as stereotactic guided fine needle aspiration cytology (FNAC), core biopsy or wire localisation.
 
Is Mammography Perfect?
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 cancers produce a recognizable 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. In the best of hands, mammograms therefore can miss 10% of cancers.
 
How Do I Prepare for a Mammogram?
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. You may wish to schedule a mammogram after your period (menses) is over if you have premenstrual breast engorgement and pain.


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Last Updated:
Tuesday, 06 September 2011