Mammography is a two-dimensional X-ray technique used to detect breast cancer at an early stage. A mammography examination is called a mammogram. Do not always rely on clinical breast examination as a screening tool for the detection of breast cancer. According to the National Cancer Institute, breast cancer is the second most common cancer for women in the United States. WHO reports that breast cancer will be the most common cancer (new cases of cancer) worldwide in 2020.

What Are the Indications of a Mammogram?

Women with a high risk of breast cancer.
Screening of asymptomatic women.
Investigation of the breast lump.
Pain and swelling in the breast.
Axillary lymph node enlargement.
Follow up patients after mastectomy (complete removal of the breast) of the same or opposite breast.
Investigation of patients with nipple discharge and breast skin thickening.
Male breast evaluation.

What Are the Factors to Be Considered Before Taking a Mammogram?

Medical history of the patient.
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Medications that patients take.
Any problems in your breast.
Pregnancy.
Family history of breast or ovarian cancer.
Breast implants.
Have perfume, lotion, and deodorant on the breast on the day of screening.

How Does Mammogram Work?

During mammograms, the patient is asked to stand in front of the X-ray machine, undressed above the waist, and remove the accessories worn on the neck. After that, the technician will give an apron to the patient to tie in the front. The patient's breasts are compressed with a plate to flatten the breast tissue. Once the plate is positioned, the patient may be asked to hold their breath, and the technician will take the X-ray quickly. X-rays are taken from both the front and the side view of both the breasts. This may be quite uncomfortable, but it will improve the picture and reduce the radiation dosage.

After the procedure is done, the patient may be asked to wait until the doctor reviews the image. If the images are not clear or may need additional views, the patient has to repeat the procedure. Usually, a mammogram procedure takes about 30 minutes. It may sometimes vary with waiting time, undressing time, positioning the breast, and repeating the procedure.

What Are the Types of Mammography?

Based on its purpose, mammography is classified as:

Screening mammography
Diagnostic mammography

1) Screening Mammography:

Screening mammography is done for women who do not have signs and symptoms of breast cancer. Screening mammography is a preventive tool that helps to reduce the number of deaths from breast cancer. Early detection of breast cancer helps in starting the treatment at an initial stage.

Screening mammograms may also have some risks. Taking mammograms without the symptoms of cancer may sometimes expose them to radiation and also cause anxiety in patients. You have to talk with your health provider about the benefits and drawbacks before the screening procedure.

2) Diagnostic Mammography:

Diagnostic mammography is done in a specific area of the breast for people who are having signs and symptoms of breast cancer or have any mass in the breasts. It can also be used for doubtful areas in screening mammograms or to reevaluate the area which has been treated for cancer.

What Happens With Abnormal Mammograms?

Abnormal mammograms do not always mean that you have cancer. According to the American Cancer Society, less than 1 in 10 women with abnormal mammograms have cancer. With abnormal mammography, patients may be asked to take additional tests and other imaging.

Reevaluate the suspected area with ultrasound and/or MRI (magnetic resonance imaging).
Surgical biopsy - surgically removing the small tissue from the suspected area, which will be examined under the microscope.
Core-needle biopsy - removing a small piece of tissue through a needle which will be examined under the microscope.

What Is the Right Time for Your Mammogram?

The menstrual cycle of women is considered before scheduling an appointment for a mammogram. The week after your period is the best time to get a mammogram. During this period, the breast tissue is less dense, which improves the accuracy of the mammogram. The week before periods and during periods, your breast is more fibrous and dense, which results in more cloudiness in mammograms which makes it difficult to detect the abnormalities. Also, the breast will be more sensitive and tender during this period.

Who Are All Recommended for Screening Mammography?

People with a family history of breast cancer are suggested for screening mammograms.

According to the American College of Physicians (ACP), women aged between 40 to 49 may discuss this with their health provider. Women aged between 50 and 74 should have biennial mammography. Women aged 75 and above or when life expectancy is ten years or less can discontinue screening.

According to the American Cancer Society (ACS), women with an average risk of breast cancer should have regular screening mammography starting at the age of 45 years. Women aged between 45 to 54 should be screened annually. Women aged 55 or above might have biennial or annual screenings.

What Are the Drawbacks of Mammography?

Mammography may create anxious feelings in the patients. It is quite painful and not comfortable for the patient. A major drawback of this imaging technique is that they are not perfect. Normally, breast tissue is fatty and dense, which may hide breast cancer or other abnormalities resulting in false-negative results.

What Are the Recent Advances in Mammography?

Digital mammography
Computer-aided detection
Breast tomosynthesis

1. Digital Mammography:

Digital mammography is also called full-field digital mammography (FFDM), in which conventional x-ray film is replaced by electronics. In this technique, images of the breast are transferred to the computer from which the radiologist can review and can be stored for a long time.

2. Computer-Aided Detection:

Computer-aided detection is a recent advance in breast imaging in which radiologists can detect even the smallest breast cancer at its early stage. It is software that applies to digital mammography, which was already reviewed. As it is a sensitive technique, it is useful for final interpretation.

3. Breast Tomosynthesis (3D Mammography):

Breast tomosynthesis is a newer type of mammography that creates a three-dimensional image of the breast. A 3D mammography is used to detect early breast cancer without signs and symptoms. This technique can detect breast abnormalities in individuals having dense breast tissue. It can detect a slightly greater number of cases when compared to a standard mammogram. Standard mammography combined with a 3D mammography reduces the need for additional imaging on follow-up. It requires less compression than standard mammography.

Conclusion:

Mammography is a life-saving imaging technique for patients diagnosed with early breast cancer. Breast cancer can be effectively treated with a 90 percent survival rate when identified at an early stage. In mammography, patients are exposed to low radiation when compared to standard chest x-rays. Breast cancer mortality has now decreased with the utilization of early detection tools.