Everything You Always Wanted to Know About Mammograms but Were Afraid to Ask

Mammography is a specific type of imaging that uses a low dose x-ray system to examine the breast; a mammogram -- a mammography exam -- is an x-ray photograph of the breast. It's a safe and highly accurate technique that has been around for the past 30 years. It is used both as a screening tool to detect early breast cancer, abnormal growths or changes in the breast tissue in women experiencing no symptoms, and to diagnose breast disease in women experiencing symptoms such as pain, lumps, or discharge from the nipple. In a screening mammogram, the breast is x-rayed from top to bottom and from side to side while in a diagnostic mammogram a particular lump or area of abnormal tissue is focused on.

A mammogram is carried out during a regular physical exam or to investigate any physical changes in the breast. As well as being useful to look for lumps that are too small to be felt during a physical exam, a mammogram can help a physician decide if any lump or growth needs further investigation. Mammography is therefore extremely important in detecting the early stages of breast cancer because it can identify an abnormal growth before it can be felt during a breast examination. There is no doubt that mammography can play a huge part in breast cancer survival -- and research has clearly shown this to be the case.

Mammography is performed on an outpatient basis. Any woman undergoing a mammogram should inform her doctor if she is pregnant or believes she might be pregnant. No changes to diet are required in preparation for a mammogram, and any medication should be taken as usual. Products such as body cream, deodorant, lotion, or powder should not be worn under the arms or on the chest on the day of the mammogram as this might interfere with the x-ray. All clothing should be removed (a gown will be provided for the patient to wear), as should all jewelry. The technologist should be advised of any breast problems and any previous mammogram results should be handed to the radiologist at the time of the current mammogram.

Registered mammography technologists perform the test, most of whom are women. The x-ray images are interpreted by a doctor specializing in this field.

During the test a patient will be asked to stand in front of an x-ray machine, and a technician will position the breast in a mammography unit. The breast will be placed on a platform and compressed with a clear plastic paddle. Compressing the breast is necessary to even out the breast thickness so that all the breast tissue can be visualized. Spreading out the tissue ensures that no small abnormalities are obscured by overlying breast tissue. It also allows for a lower dose of radiation to be used given that a thinner amount of breast tissue is being imaged. The patient must remain very still during the imaging and may be asked to refrain from breathing for a few seconds while the x-ray photo is being taken. The patient may feel a little discomfort during this process but it should only last a few seconds. Once the images have been taken, the technician will ask the patient to wait until she has determined that the images are of sufficient quality to enable the radiologist to make a reading. Compression on the breast will probably cause discomfort but this is necessary in order to get a clear picture with as small a dose of radiation as possible. However, any pain felt should be reported to the technician. One way a woman can minimize the discomfort is to schedule her mammogram seven to 10 days after the start of her last period when there is the least chance of her breasts being tender. The breast will be x-rayed from a number of positions to get an adequate visualization of the breast tissue. During a routine mammogram, two images of each breast are taken which takes about 30 minutes. Additional images of the breasts or an ultrasound may be required after the images have been interpreted to enable a more precise diagnosis to be carried out: this is a routine measure.

After the test, it’s quite normal for a patient to feel tenderness or aching where the breasts were compressed during the screening. There may also be some very slight bruising. A mild painkiller such as aspirin or ibuprofen will help alleviate any discomfort; and normal activities can be resumed immediately after the mammogram.

The results of the mammogram will be sent to the patient’s physician (the patient will also receive the results from the mammography facility). All results are now required to be sent within 30 days of screening and contact will be made with the patient within five days if there’s a problem. However, no one should assume that their results were normal if they don’t hear anything -- they should contact their physician to get confirmation. There are some centers performing mammograms that are able to produce the results while a patient waits.

According to the American Cancer Society, out of every 1000 mammograms only one or two lead to a diagnosis of cancer. Approximately 10 percent of women require additional mammography, and only eight to 10 percent of those women need a biopsy of which 80 percent will not be cancer.

The risk of breast cancer increases with age, so for a woman over 40 it’s important to have a yearly mammogram. Any woman believing that she needs one should contact her physician.

Breast self-examination is still very important, as not all breast cancers are detected by a mammogram. And self-examination is especially important for younger women who have denser breast tissue. All women should perform breast self-examination once a month from age 20. Women should also have their breasts examined by their physician or physician's nurse every three years from age 20 and every year from age 40.

In the US, breast cancer is the most common cancer among women accounting for nearly one of every three cancers diagnosed. In 2001, it was estimated that 192,200 American women were diagnosed with breast cancer for the first time and 40,200 women died from the disease. The National Cancer Institute, the American Cancer Society, and the American College of Radiology all now recommend that women over the age of 40 have annual mammograms.

While breast cancer in men is uncommon, it does happen. Both men and women have breast tissue, although men have much less of it than women; most of the breast tissue in men is located behind the nipple. Breast cancer in men accounts for less than one percent of all breast cancers

Regular mammograms can help reduce a woman’s chance of developing breast cancer, and the higher risk of breast cancer a woman has, then the more important it is to have regular screenings. Once a woman reaches 40 her chances of developing breast cancer increase. Any woman who has a family history of breast or ovarian cancer or has received radiation treatment to her chest in the past is advised to start having annual mammograms from the age of 30. The National Cancer Institute advises those women who have had breast cancer and those who are at increased risk due to a genetic history of breast cancer to seek expert medical advice about whether they should begin screening before age 40 and about the frequency of screening. And anyone who is concerned about the frequency of their mammograms should discuss the issue with their physician.

The bottom line is that mammograms save lives. However, there are a few drawbacks: mammograms don’t detect all types of breast cancer -- they can miss 15-20 percent of breast cancers that are just not visible using this technique. It's also important to remember that mammograms can sometimes produce incorrect readings and result in unnecessary surgery.

Nevertheless, while mammograms can’t guarantee to prevent breast cancer, they can save lives by detecting abnormalities in the breast at a very early stage. Mammograms have been shown to reduce the risk of dying from breast cancer by 35% in women over the age of 50; and for women between 40 and 50 studies suggest mammograms may reduce the risk of dying from breast cancer by 25–35%. Detecting breast cancer in its early stages through mammography also increases a woman's chance of being able to keep her breasts.

Magnetic resonance imaging (MRI) tests are also used to detect breast cancer. However, while MRI tests are more thorough than mammograms they also detect more growths that look suspicious but which in fact turn out to be benign. MRI tests are also much more expensive than mammograms and may not be covered by insurance. Mammography screening remains the best technique to detect breast cancer early.

The cost of a screening mammogram is between $100 and $150. Most states have laws stating that health insurance companies must reimburse individuals all or part of the cost of a screening mammogram. All women aged 40 and over with Medicare can get a screening mammogram each year. Medicare will also pay for one baseline (a woman’s first screening) mammogram for women between the ages of 35 and 39.