Mammography

mammography scan

What is mammography?

Mammography is a breast imaging test that uses low dose x-rays to examine the female breast in order to detect breast cancer and other breast diseases. In the language of a layman, mammography is an x-ray of the breast. It was invented in the late 1950s by Robert Egan.

What are the indications of mammography?

Mammography can be used as a screening as well as a diagnostic technique.
A screening test is carried out in patients who do not have any signs or symptoms of a disease. According to the American Cancer Society (ACS), mammography is recommended as a screening test in-

– Women with a family history of breast cancer.

Women between the age group of 40-44 (optional but advisable to go for annual screening).

– Women in the age group of 45-54 years (annual screening is advised).

– Women ≥55 years (a biennial screening can suffice)

Women should continue to go for screening mammography if their health is optimum and their life expectancy ≥10 years.

– Mammography is used as a diagnostic test in females presenting with-

– Abnormal discharge from the nipple.

– A lump or thickening/puckering of skin of the breast.

– Any change in size/shape of the breast.
Persistent pain in the breast.

– An abnormal screening mammogram.

What does a mammography test detect?

A mammogram can detect-

 – Breast cancer
– Benign tumors
 – Fibroadenoma
– Benign cysts

Are there any contraindications for mammography?

There is no absolute contraindication for undergoing mammography. However, it is not safe to undergo mammography during pregnancy due to the risk of exposing the fetus to the ionizing radiations used.

How do I need to prepare for a mammography test?

No special preparation is needed before undergoing mammography. You just need to make sure that you do not use moisturizing lotions, deodorants or talcum powders on the area of your breasts and your armpits. These tend to appear as artifacts (calcium deposits) on the images.

Also, discuss with your physician your medical history and if you are taking any medication. Inform him if you have any drug allergies. It is advisable to remove any precious jewelry including wristwatches before you go to the hospital or a diagnostic center for mammography.

Do I need to fast before a mammography test?

There is no need to fast before undergoing mammography. A light meal is advised on the morning of the exam.

Can I undergo mammography if I am pregnant?

As discussed above, it is not advisable to undergo mammography as a screening test if you are pregnant. You can postpone the test until after the baby is delivered.

How is a mammography test performed?

A mammography test is performed on an outpatient basis. No sedation or anesthesia is required as it is a non-invasive procedure.

You will be led to the room housing the mammography unit which is a rectangular box-like structure containing the x-ray emitting tubes. It has attached to it, contraptions that hold your breast in place during the procedure.

A technician will place your breasts in the mammography unit. A special platform or table is used to place your breasts. The technician will compress your breasts and hold them in the desired position with plates.

You will be asked to change positions during the procedure and to stay very still when x-rays are aimed at your breasts. You may be asked to stop breathing for a few seconds to eliminate any movement-related artifacts.

In conventional mammography, the views required are sideways and top-to-bottom.

The technician performing the procedure will be in an adjoining room or stationed behind a lead curtain while mammography is being done.

The entire procedure takes about 30 minutes.

Why is breast compression necessary?

It serves the following 3 purposes-

– It holds the breast in place, reducing any movement, thus preventing blurring of the images.

– It evens out the thickness of the breast and spreads out the tissue. This helps in visualizing the whole of the breast tissue and to detect small abnormalities that may be hidden by superimposing tissue.

– As a thinner amount of breast tissue is being visualized, a lower dose of x-ray can be used. More-over, scattering of the x-ray is reduced, leading to the generation of sharper images.

Are there any risks involved?

Mammography is a noninvasive, relatively safe procedure employing a low dose of ionizing radiation. However-

– You may feel some pressure on your breasts during breast compression. This may be more pronounced if you are undergoing periods as the breasts tend to be tender during this stage. It is advisable, therefore, to plan a mammography 7-10 days after your periods start.

– Though the dose of ionizing radiation used during a mammography is very low, there is always a chance of the hazards of radiation to affect your body. The risk-benefit analysis though is in the favor of mammography as a lifesaver.

What are the benefits of mammography?

Screening for breast cancer goes a long way in preventing deaths due to this dreadful disease.

– All types of breast carcinomas can be detected.

– Even small abnormal growths can be detected. For example-ductal carcinoma in situ.

– The dose of radiation used is very low. No radiation remains in your body at the end of the procedure.

What are the limitations of mammography?

– False negatives are common. Mammography is the best screening test available for early detection of breast cancer. Still, it fails to detect lesions at times.

Ionizing radiation is used in mammography in the form of x-rays. Though the dose used is very small, there is always a risk of cancer associated with exposure to radiation.

– Mammography tests tend to give False Positive results.

– In cases where the breast tissue is dense, mammography fails to provide an accurate diagnosis.

– In cases of breast implants, the test fails to give accurate results. Both silicone and saline implants hamper with the imaging process.

What is the cost of undergoing a mammography scan in India?

A conventional mammogram costs around Rs 2000 in India while the cost of digital varieties can go up to Rs 10,000.

What is digital mammography?

Digital mammography refers to the procedure where the conventional x-ray film is replaced by solid-state detectors that convert the x-rays passing through the breast tissues into electronic signals. These electronic signals are conveyed to a computer and digital files created. This procedure is also known as full-field digital mammography (FFDM).

Digital mammography provides images with a better clarity.Images stored in a digital format which can be shared with other radiologists easily in case a second opinion is required.It reduces the need for retakes, thereby reducing the radiation exposure to the patient.

What is 3D mammography?

This procedure is also known as tomosynthesis. As the name implies, it uses the technique of tomography to generate thin slices of the breast tissue which are then stacked to produce 3D images of the breast tissue. As it is often combined with 2D mammography in order to yield better results, the dose of radiation employed tends to add up. The benefits thus tend to be marginally high than the risks involved.

Is mammography performed in males also?

Males may also need to undergo mammography if they experience a breast mass, pain, puckering of the nipple or thickening of the breast tissue. The procedure remains the same including breast compression. The incidence of breast cancer is very rare in men (1 in 1000 males will ever develop breast cancer).

What is the burden of breast cancer in India?

Breast cancer is the leading cause of death in Indian women, surpassing cervical cancer both in incidence and mortality. Breast cancer projections for India paint a gloomy picture. As per the latest statistics, the rate of breast cancer in India is 25.8 cases per 100,000 women with a mortality rate of 12.7 out of 100,000 cases.

However, better health awareness and access to early screening can significantly reduce morbidity and mortality associated with this killer disease.

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