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.
 

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.
 

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.

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.
 

Copyright © 2001-2011 College of Radiology, Academy of Medicine of Malaysia
All Rights Reserved

Terms of Use

Last Updated:
Tuesday, 06 September 2011