The special type of x-ray machine used for the breasts produces lower energy x-rays that do not penetrate tissue as easily as that used for routine chest x-rays or x-rays of the arms or legs, but it does improve the contrast of the image. Modern mammography also results in a significantly lower dose of radiation to the breast compared with the earlier units.

For a mammogram, the breast is squeezed between 2 plastic plates attached to the mammogram machine unit in order to spread the tissue apart. This squeezing or compression ensures that there will be very little movement, that the image is sharper, and that the exam can be done with a lower x-ray dose. Although this compression causes some discomfort, it only lasts for a few seconds and is needed to produce a good mammogram. The entire procedure for a mammogram takes about 20 minutes.

The x-ray machine for mammograms

Mammography produces a black and white image of the breast tissue on a large sheet of film, which is "read" or interpreted by a radiologist. Radiologists are doctors who have special training in diagnosing diseases by looking at images of the inside of the body produced using x-rays, sound waves, magnetic fields, or other methods. Other doctors who treat breast diseases may also look at the mammogram.

Screening Mammograms

Breast cancer takes years to develop. Early in the disease, most breast cancers cause no symptoms. When breast cancer is detected at a localized stage (it hasn’t spread to the lymph nodes), the 5-year survival rate is 98%. If the cancer has spread to nearby lymph nodes (regional disease), the rate drops to 81%. If the cancer has spread (metastasized) to distant organs such as the lungs, bone marrow, liver, or brain, the 5-year survival rate is 26%.

A screening mammogram is an x-ray exam of the breast in a woman who has no symptoms. The goal of a screening mammogram is to find cancer when it is still too small to be felt by a woman or her doctor. Finding small breast cancers early by a screening mammogram greatly improves a woman’s chance for successful treatment.

A screening mammogram usually takes 2 x-ray pictures (views) of each breast. For some patients, more pictures may be needed to include as much breast tissue as possible.

American Cancer Society Recommendations for Early Breast Cancer Detection

Women age 40 and older should have a screening mammogram every year, and should continue to do so for as long as they are in good health.

Women should be told about the benefits, limitations, and potential harms associated with regular screening. While mammograms will detect most breast cancers, a small percentage will be missed. Also, sometimes signs on a mammogram that appear abnormal may require a biopsy that will turn out not be breast cancer. In this instance, a woman has undergone a procedure for an abnormality that wasn’t cancer, and she has been through a period of anxiety about the possibility of having breast cancer. However, mammograms, despite their limitations, remain the most effective and valuable tool for decreasing suffering and death from breast cancer.

There is no fixed age at which women should stop getting mammograms. Mammograms for older women (over age 65) should be based on the woman’s health and whether or not she has other serious illnesses. Age alone should not be the reason to stop having regular mammograms. As long as a woman is in good health and would be a candidate for treatment, she should continue to have mammograms.

Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional preferably every 3 years. After age 40, women should have a breast exam by a health professional every year.

There may be some benefit in having the CBE shortly before the mammogram because if the examiner discovers a mass, then the mammogram can focus on that area of suspicion. The exam should include instruction for the purpose of helping a woman become familiar with her own breasts. Women should also be given information about the benefits and limitations of CBE and BSE (breast self-exam). Breast cancer risk is very low for women in their 20s and gradually increases with age. Women should be told to promptly report any new breast symptoms to a health professional.

BSE is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any breast changes to their health professional right away.

Women who choose to do BSE should have their BSE technique reviewed during their physical exam by a health professional. It is okay for women to choose not to do BSE or not to do it on a regular schedule. However, by doing the exam regularly you get to know how your breasts normally feel and you can more readily detect any signs or symptoms. If a change occurs, such as a lump or swelling, skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness of the nipple or breast skin, a discharge other than breast milk, or a change in the size of one breast, you should see your doctor or nurse as soon as possible for evaluation. Remember that most of the time these breast changes are not cancer.

Women at increased risk (due to family history, past breast cancer, etc.) should talk with their doctor about the benefits and limitations of starting mammograms when they are younger, having additional tests (such as ultrasound or MRI), or having more frequent exams. Women should discuss with their doctor what approaches are best for them

The American Cancer Society believes the use of regular mammograms, clinical breast exams, and women’s awareness about changes in their breasts are important parts of every woman’s breast health plan, and are the best approach to detecting breast cancer early, when treatment is most successful and when the range of treatment options is greatest. This combined approach is clearly better than any one test. Without question, breast physical exam without mammograms would miss many breast cancers that are too small for a woman or her doctor to feel but can be seen on mammograms. Although a mammogram is the most sensitive screening method, a small percentage of breast cancers do not show up on mammograms but can be felt by a woman or her doctors.

Diagnostic Mammograms

A diagnostic mammogram is an x-ray exam of the breast in a woman who either has a breast complaint (for example, a breast mass, nipple discharge, etc.) or has had an abnormality found during a screening mammogram. During a diagnostic mammogram, more pictures are taken to carefully study the breast condition. In most cases, special images involve magnification to make a small area of suspicious breast tissue easier to evaluate. Many other types of x-ray pictures can be obtained, depending on the type of problem and its location in the breast. These x-rays are tailored to the patient's needs.

For example, a diagnostic mammogram may show that what appeared to be an abnormality actually was quite normal on closer exam, and the woman can then return to routine yearly screening.

It also could show that an area of abnormal tissue has a high likelihood of not being cancer (being benign). For this, it is common to ask the woman to return to be rechecked, usually in 4 to 6 months.

Finally, the diagnostic work-up may suggest that a biopsy is needed to tell whether or not the abnormal area is cancer. If your doctor recommends that you have a biopsy, it does not mean that cancer is present. About 80% of all breast changes that are biopsied are found to be benign when looked at under the microscope. If a biopsy is needed, you should discuss the different types of biopsy (see below) with your doctor to decide which method of biopsy is best for you.

Tips for Having a Mammogram

The following are useful suggestions for ensuring that you will receive a good quality mammogram:

§ Use a facility that either specializes in mammography or does many mammograms a day.
§ If you are satisfied that the facility is of high quality, continue to go there on a regular basis so that your mammograms can be compared from year to year.
§ If you are going to a facility for the first time, bring a list of the places, dates of mammograms, biopsies, or other breast treatments you have had before.
§ If you have had mammograms at another facility, you should make every attempt to get those mammograms to bring with you to the new facility (or have them sent there) so that they can be compared to the new ones.
§ On the day of the exam, don’t wear deodorant or antiperspirant; some of these contain substances that can interfere with the reading of the mammogram by appearing on the x-ray film as white spots.
§ You may find it more convenient to wear a skirt or pants, so that you’ll only need to remove your blouse for the exam.
§ Schedule your mammogram when your breasts are not tender or swollen to help reduce discomfort and to assure a good picture. Try to avoid the week just before your period.
§ Always describe any breast symptoms or problems that you are having to the technologist who is doing the mammogram. Be prepared to describe any pertinent medical history such as prior surgeries, hormone use, family or personal history of breast cancer. Also discuss any new findings or problems in your breasts with your doctor or nurse before having a mammogram.
§ If you do not hear from your doctor within 10 days, do not assume that your mammogram was normal -- call your doctor or the facility.

What to Expect When You Get a Mammogram

§ Having a mammogram requires that you undress above the waist. A wrap will be provided by the facility for you to wear.
§ A technologist will be present to position your breasts for the mammogram. Most technologists are women. You and the technologist are the only ones present during the mammogram.
§ The whole procedure takes about 20 minutes. The actual breast compression only lasts a few seconds.
§ You will feel some discomfort when your breasts are compressed, and for some women compression can be painful. Try not to schedule a mammogram when your breasts are likely to be tender, as they may be just before or during your period.
§ All mammogram facilities are now required to send your results to you within 30 days. Generally, you will be contacted within 5 working days if there is a problem with the mammogram.
§ Only 2 to 4 mammograms of every 1,000 lead to a diagnosis of cancer. About 10% of women who have a mammogram will require more tests, and the majority only need an additional mammogram. Don't panic if this happens to you. Only 8% to 10% of those women will need a biopsy, and most (80%) of those biopsies will not be cancer.

ORMC’s Mammography Department recently was renovated thanks to a contribution from SHINE, the employee giving arm of Oconee Regional Healthcare Foundation.

Source: American Cancer Society