Mammography is a very crucial diagnostic and imaging method for diagnosing breast cancer in women. Mammography images, called mammograms, are helpful for both diagnosis and screening. It plays a fundamental role in early detection of breast cancer together with regular clinical examinations and monthly self-examinations. Mammograms may also indicate other disorders and abnormalities in the breast. Experts recommend that women aged 40 and older should have regular screening every two years. In case of a personal or family history of breast cancer, it is advised to start screening earlier, have it more frequently, or use additional diagnostic methods.
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Mammography is an imaging method using low-energy X-rays, particularly for imaging breast tissue. It plays a very important role in early detection of breast cancer. When there is no suspicion or symptom of cancer, mammography taken only for a check-up purpose is known as screening mammogram. (1) However, if a mass in the breast is diagnosed, if there are symptoms or breast implants, a diagnostic mammogram is required.
Diagnostic mammograms are more comprehensive than screening mammograms. More X-rays are given to capture images of the breast from multiple angles. Some areas of concern may also be enlarged. (2)
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Digital mammography uses the same x-ray technology as conventional mammograms, however solid state detectors are used instead of film to record x-rays passing through the breast. These detectors convert the x-rays into electronic signals, and then send them to the computer. The computer converts these electronic signals into images that can be viewed on a monitor and stored for use. (3)
Although there is no difference in terms of patient’s experience at the time of screening, digital scanning may be a more proper choice for cancer screening in young or high-density breasted women. Most breast imaging centers have converted from film to digital mammography. (3)
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Experts and health care centers have different views on when women should start regular mammography or how often tests should be repeated. However, the common view is that women aged 40 and older should have a mammography every year or every two years and once a year from the age of 54.
In case of a history of breast cancer in the family, screening should be started before the age of 40, mammography can be taken more frequently and additional diagnostic tools can be used. Women at high risk for breast cancer may be advised to have a breast MRI in addition to annual mammograms.
You can decide which screening plan is best for you after discussing with your doctor about your risk factors, preferences, and the benefits and risks of screening. (2)
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Calcifications can be caused by cell secretions, cell waste, inflammation or trauma. Small, irregular deposits called microcalcification may be related to cancer. Larger, thicker areas of calcification may be caused by aging or benign breast tumor fibroadenoma.
Most breast calcifications are benign, nevertheless if the calcifications seem to be irregular and proliferated, the radiologist may ask additional diagnostic images.
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An abnormal looking mammogram does not always mean cancer. An additional mammogram, test or examination is needed for a definitive diagnosis. Additional tests may include additional mammograms, known as compression or magnification views, as well as a procedure (biopsy) to take a breast tissue sample for ultrasound imaging or laboratory testing.
The patient can be referred to a chest specialist or surgeon. These doctors are experts in diagnosing breast problems. They perform follow-up tests to diagnose breast cancer.
The radiologist interprets the mammogram and sends the written report containing the results to the doctor and the patient within a few weeks. In case of doubt, the report may be given earlier.
Bones appear in white, soft tissue in gray and even black on the X-ray. In mammogram film, low-density tissues such as fat appear translucent (background becomes almost black, darker gray tones), whereas dense tissue areas such as connective and secretory tissue or tumors appear whiter.
Although today mammography is the best screening method for breast cancer, it cannot detect all breast cancers. Some factors may prevent accurate results. For example:
Some cancers detected by physical examination may not be visible on the mammogram. The cancer may be very small or may be found in an area that is difficult to see by mammography, such as the armpit. Mammograms may miss one out of 5 cancers.
In many difficult cases, additional imaging technologies such as ultrasound or magnetic resonance imaging (MRI) can be used to increase the sensitivity of the examination. Recent studies have shown that a nuclear medicine method called molecular breast imaging (MBI) may be an effective and cheaper alternative to MRI for patients with dense breasts.
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General surgeons or obstetricians may request mammography from their patients. However, it is recommended to consult a radiologist experienced in breast radiology for routine screening. It is the responsibility of the radiologist to perform, interpret, and supplement the mammography examination with good quality.
Resources and References:
1- Mammography2- What is mammography?3- Mammograms4- What Is Breast Cancer Screening?SHARE ARTICLE
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