What is a mammogram?

A mammogram is an x-ray examination of the breast. It is used to detect and diagnose breast disease in women who either have breast problems such as a lump, pain, or nipple discharge, as well as for women who have no breast complaints.

What are the different types of mammograms?

A screening mammogram is an x-ray of the breast used to detect breast changes in women who have no signs of breast cancer. It usually involves two x-rays of each breast. Using a mammogram, it is possible to detect a tumor that cannot be felt.

A diagnostic mammogram is an x-ray of the breast used to diagnose breast changes, such as a lump, pain, nipple thickening or discharge, or a change in breast size or shape.

A diagnostic mammogram is also used to evaluate abnormalities detected on a screening mammogram.

Mammography has been used for over 30 years. In the past 10 years, technical advancements have greatly improved both the technique and results. Today, specialized equipment, used only for breast x-rays, produces studies that are high in quality but low in radiation dose.

How is a mammogram performed?

Usually, a mammogram is done on an outpatient basis, although it can be part of inpatient care. A woman should not wear deodorant, powders, or lotions under the arms on the day of the examination, as these substances can interfere with the images.

Although each hospital may have specific protocols in place, generally, a mammogram procedure follows this process:

1. The patient should describe any symptoms or problems to the technologist prior to the examination (if any).
   
   
2. The patient undresses from the waist up and is given a gown to wear.
   
   
3. The patient is positioned at the mammography unit, seated, standing, or lying down.
   
   
4. The breast is positioned between two plates of the mammography unit, and pressure applied to compress the tissue. (This may produce temporary discomfort.) Breast compression is necessary in order to obtain the best image with the least amount of radiation possible.
   
   
5. The patient is asked to hold her breath for a few seconds while the x-rays are taken.
   
   
6. The technician steps behind a protective window and the image is taken.
   
   
7. Each breast may be x-rayed at least two times, from above and from the side, to produce the films for the physician to review.
   
   

What conditions does a mammogram show?

A mammogram helps to identify the following conditions:

• calcifications - tiny mineral deposits within the breast tissue. There are two categories of calcifications:
  
  
  • macrocalcifications - coarse calcium deposits that usually indicate degenerative changes in the breasts, such as the following:
    
    
    • aging of the breast arteries
      
    • prior injuries
    • prior inflammation
    
    
  • microcalcifications - tiny (less than 1/50 of an inch) specks of calcium. When many microcalcifications are seen in one area, they are referred to as a cluster. This is one of the x-ray signs of breast cancer.
    
    
• masses - may occur with or without associated calcifications, and may be due to different causes, including the following:
  
  
  • cyst - a non-cancerous collection of fluid in the breast. Cysts cannot be diagnosed with certainty by physical examination or mammography alone. Breast ultrasound or aspiration with a needle may be required. If a mass is not found to be a cyst, then further imaging may be necessary.
    
    
  • benign breast mass - Some can be monitored with periodic mammography; others may require immediate or delayed biopsy.
    
    
  • breast cancer

Mammography guidelines:

In the United States, breast cancer is the most common form of cancer in women. Almost 185,000 new cases of breast cancer are diagnosed each year. Only lung cancer causes more cancer deaths in women than breast cancer.

Consider the following additional breast cancer facts:

• More than 40,000 women die of breast cancer in the United States each year.
  
  
• One in nine women in the United States may develop breast cancer.
  
  
• Breast cancer risk increases with age. The greatest incidence of breast cancer occurs in women over the age of 50.
  
  
• Mammography can detect 90 percent of breast cancers before they become large enough to feel or cause symptoms.

What are the risk factors for breast cancer?

The following risk factors can increase the likelihood of developing breast cancer.

1. Risk factors that cannot be changed:

• gender
  Breast cancer occurs nearly 100 times more often in women than in men.

• aging
  The majority of cases of breast cancer occur after age 50.

• previous breast cancer

• previous breast irradiation

• family history and genetic factors
  Having a close relative, such as a mother or sister, with breast cancer increases the risk.

• benign breast disease

• previous breast biopsy in which the tissue showed atypical hyperplasia

• menstrual periods that began unusually early in life

• menopause that began unusually late in life

2. The most frequently cited lifestyle-related risk factors:

• smoking
• not having children
• not breastfeeding
• oral contraceptives
• obesity and a high-fat diet
• physical inactivity
• alcohol
• estrogen replacement therapy
• induced abortion

3. Environmental risk factors:
Exposure to pesticides, or other chemicals, is currently being examined as a possible risk factor for breast cancer.

It has been found that 70 percent of the women diagnosed with breast cancer had no significant risk factors. This means that monthly self-examination of the breasts, regular screening mammograms, and breast examinations by a physician are important in the early detection of breast cancer.

National Cancer Institute Guideline for Screening Mammography:	American Cancer Society Guideline for Screening Mammography:
Women in their 40s and older should have a screening mammogram on a regular basis, every one to two years.	Women 40 years of age and older should have a screening mammogram every year.