1) What is a mammogram?

A mammogram is a specialized radiograph (X-ray) of the breast. A mammography machine delivers a very low-dose X ray to the breast. In traditional film mammography, the image is developed on a film. In digital mammography (akin to digital photography), the image is available for viewing on a computer. A breast radiologist then interprets these images and makes a report with recommendations.

2) Why get a mammogram?

Mammograms can find breast cancers that are too small to be detected by touch or feel. Cancers missed on self-exam by patients and clinical exams by physicians, can be seen as masses or calcifications (spots of calcium)on a mammogram. Women often ask ,“How did I get cancer? I regularly get mammograms." It is important to realize that mammograms don't prevent cancers; they help catch them when they are still small. This allows less invasive treatments and better prognosis. Survival of patients that have small,early-stage cancers is clearly better than those who present at more advanced stages.

When a patient presents with a breast mass or other complaint,mammography is often one of the first tests performed. It helps define the exact location, nature and extent of a problem.

3) How is it performed?

To obtain a mammogram, the breast tissue is placed between compression plates on the mammography machine, while the X-ray beam is shot. A screening exam, (performed on a woman with no breast masses or symptoms) typically involves 2 views of each breast, with one X-ray shot in the top-to-bottom direction, while the other shot sideways. For a diagnostic exam (performed to evaluate a known mass or specific complaint) additional views may be taken with magnification, change of direction etc. to better define an identified problem.

4) How do I prepare for a mammogram?

If you are planning a regular screening mammogram, try to schedule your test one week after your menstrual period when the breasts are less tender.

Do not apply deodorants, talcum powders and anti-perspirants around the breast or armpits before your exam, as the salts contained in these may cause “specks” to appear on the mammogram.

Remember to gather your previous mammography and ultrasound reports as well as images on films or CDs. Decisions in reporting involve comparison with images from prior years and noting changes over time. Any prior breast biopsy or surgery reports should also be made available to the radiologist reading your mammogram.

5) What if I have a lump or a complaint?

If there is a particular area that is bothering you, point this out to the person obtaining your mammogram. A skin marker that is visible on an X-ray may be temporarily placed on the area of concern to point it out to the radiologist. Additional views or an ultrasound many be needed to evaluate the problem. If the area you feel is seen as an abnormality on the mammogram, you may be advised more imaging,biopsy etc. as appropriate. If no specific area is noted on the mammogram but you feel something abnormal, don’t let it stop you from seeing a breast specialist. Mammograms are not perfect; your concern may still be valid.

6) Where should I go for a mammogram?

A team of technicians and radiologists that is experienced and competent in breast imaging should perform mammography. If possible, have all your exams performed at one place that keeps your old records and has them available for comparison.

The facility should ideally provide ultrasound and needle biopsy facilities in the same environment. They should have a well-established referral network, should you need a breast surgeon or oncologist. Strive to find a team you like and you’ll be more likely to adhere to your scheduled follow-up.

7) What if the mammogram is normal?

If a screening mammogram is completely normal, a woman maybe reassured and asked to follow up at her regular interval. It is important to realize however that mammography may still miss up to 20% of cancers. Some women have dense breast tissue that may mask a potential tumor; this is especially true in young women. An ultrasound or MRI may be recommended as an additional tool to overcome this limitation of mammography. I stress again that if you feel a breast lump, notice bloody nipple discharge, skin changes or some other concern, a normal mammogram should not stop you from seeking attention.

8) What if the mammogram is abnormal?

Abnormalities may be described as suspicious calcifications,densities or masses. An abnormal mammogram doesn't always mean cancer. Some abnormalities can be observed with short-term (e.g. 6 month) mammography follow-up,while others need more imaging (additional mammography views, ultrasound, MRI etc.) Still some others clearly need to be biopsied. I think the discussion, “Who will I see if the mammogram is abnormal?” should be had before you actually have one. The last thing you want is to be handed an abnormal mammogram and not know whom to see next.

9) What if I am advised a biopsy?

Just because you need a biopsy, does not mean you have cancer. A lot of different breast diseases look similar on mammograms. The only certain way to tell them apart is to take a sample of the suspicious area and look at it under the microscope. A needle biopsy under local anesthesia removes a small piece of tissue and is the quickest and simplest way to obtain a diagnosis. This causes minimal discomfort and is a low risk procedure. For problems identified on mammography or ultrasound alone (that cannot be felt by the hand), the biopsy should be performed under careful imaging guidance (stereotactic or ultrasound guided biopsy). This ensures that the correct area is sampled. A tiny metallic clip should be placed to mark the area of biopsy on subsequent mammograms.

A needle biopsy can prevent a lot of unnecessary surgery. If a cancer is found on the needle biopsy, better planning allows a more complete cancer operation to be performed at the first go. Excisional biopsy (open surgery to obtain a diagnosis) should be needed only in a few cases, when a needle-biopsy is not feasible. If a cancer is found on an excisional biopsy done for diagnosis, the patient will often need a second operation to complete cancer treatment. To know more about breast biopsy click here

10) When should I start screening mammography?

Recommendations for screening mammography vary widely across the world and are often a matter of debate. In the US, women usually are advised to start screening at the age of 45, unless needed earlier due to family history or other risk factors. In India, there is currently no population-wide screening mammography program. Initiate a discussion about mammography at age 40 with your breast consultant who can analyze your risks, address any concerns you may have, discuss possible benefits and formulate a screening plan that is right for you.

11) Are there risks to mammography screening?

When we’re trying to find small cancers in healthy women, it means several women may undergo mammography that don’t have cancer and may never get breast cancer. This may be a source of anxiety, expenditure and some unnecessary biopsies and surgeries.

Another concern often raised is the impact of radiation to the breast tissue and the risk of mammograms causing cancer. Most experts advise that for an individual patient, the cancer risk from mammography is very small and the benefits of early detection far outweigh this possible risk. The radiation dose from a single mammogram is very small, compared to say, a CT scan. Having a mammogram in pregnancy does not cause harm to the fetus.

12) Are mammograms fun?

No :) but they aren’t that bad and they might do you a lot of good.

Author: Dr Pranjali Gadgil is a Breast Surgical Oncologist in Pune, India

Disclaimer: The content here-in is the author's individual opinion. It is not intended to substitute clinical judgement or guide treatment.