Mammography

Mammography

What is mammography?

Mammography is essentially an X-ray examination of the breast. The term "mamma" derives from Latin, meaning breast, and mammography utilizes a form of breast X-ray that involves minimal radiation exposure. Its primary objective is to detect breast cancer at its early stages.

What are the benefits of mammography?

Due to its capability to detect breast cancer in its early stages, mammography identifies smaller tumors, which are more likely to be non-invasive compared to those detected through self-examination. Additionally, such tumors are less prone to spreading to the lymph glands under the arm.

Who undergoes mammography?

Upon reaching the age of 50, women are typically invited to participate in a breast screening program. In the UK, this involves undergoing a mammogram every three years until the age of 70. While not every woman receives an invitation immediately upon turning 50 due to the rolling nature of the screening program, the first invitation is received before one's 53rd birthday.

The objective of mammography screening is to detect cancer while it remains localized before it has the opportunity to metastasize.

For women aged 70 and above, they have the option to request screening every three years. This can be arranged by contacting the local breast screening unit or visiting a screening van in the area.

There are several reasons why women below the age of 50 typically do not undergo screening:

- Breast cancer is less prevalent in younger women.
- Mammography is less effective in detecting breast cancer in younger women due to denser breast tissue.
- The cost-effectiveness of breast screening below the age of 50 is not supported by evidence.

However, young women at a high risk of developing breast cancer due to familial history or biopsy findings indicating abnormalities may undergo screening at an earlier age, often via mammography and at more frequent intervals. Research is ongoing regarding the effectiveness of alternative imaging modalities, such as magnetic resonance imaging (MRI), in high-risk young women.

What should I know before the examination?

On the day of the examination, patients should refrain from using talcum powder or cream around the breast or armpit area.

What occurs during the examination?

During the examination, patients are asked to undress from the waist up and stand in front of the X-ray machine. Each breast is then positioned between two Perspex plates and compressed to obtain images. Typically, two images per breast are captured during the initial visit and one or two images during subsequent visits.

While some women may find the experience uncomfortable or mildly painful, for the majority, it entails only minor discomfort and is quickly completed.

What follows after the examination?

Following the examination, the X-ray films are evaluated, and patients are informed of the results by the screening center within approximately 10 days. A small percentage of women may be asked to return for a second mammogram due to findings necessitating further investigation or technical issues with the initial X-ray. Importantly, being recalled does not indicate a diagnosis of breast cancer.

Of every 10,000 women who undergo mammography, approximately 500 are recalled for assessment, of which 80 may require surgery, and around 60 are diagnosed with cancer. Thus, slightly over 1 in 10 women recalled for further investigation following the initial mammogram are found to have cancer.

How accurate is mammography?

Mammographic screening exhibits high sensitivity, making it uncommon for a tumor in women over the age of 50 to go undetected.

Is mammography safe?

Modern mammography equipment emits minimal radiation, with an extremely low risk of inducing cancer. The benefits of mammography, in terms of cancer detection, significantly outweigh the small associated risks.

Despite some negative publicity surrounding screening, numerous studies have consistently demonstrated a 40% reduction in breast cancer-related deaths among women aged 50 to 64 who undergo regular breast screening.

Can mammography differentiate between benign and malignant tumors?

While mammograms effectively identify breast abnormalities, they may not always distinguish between benign and malignant lesions. Further investigations, therefore, may be necessary.

What additional investigations may be required?

If a patient is recalled, additional procedures such as ultrasound scans or fine needle aspiration cytology (FNAC) may be recommended.

Ultrasound, commonly used in pregnancy, can differentiate between fluid-filled (cystic) and solid breast lumps. In cases where mammograms reveal abnormalities, ultrasound aids in determining the nature and severity of the abnormality.

Fine needle aspiration cytology involves inserting a needle into the lump to extract cells for microscopic examination, providing a precise diagnosis of whether the lump is benign or malignant.

In instances where an abnormality is impalpable, meaning it cannot be felt, specialized techniques are employed to guide needle insertion accurately. These methods involve using either X-ray or ultrasound guidance to target the abnormal area and obtain diagnostic samples.

For impalpable lesions requiring removal, a hooked wire is inserted under X-ray or ultrasound guidance to guide the surgeon to the affected area for excision.