Mammography Health Article

Preparation

The compression or squeezing of the breast necessary for a mammogram is a concern of many women. Mammograms should be scheduled when a woman's breasts are least likely to be tender. One week after the menstrual period is usually best.

Women should not put deodorant, powder, or lotion on their upper body on the day the mammogram is performed. Particles from these products can get on the breast or film holder and may look like abnormalities on the mammogram film.

Aftercare

No special aftercare is required.

Risks

The risk of radiation exposure from a mammogram is considered virtually nonexistent. Experts are unanimous that any negligible risk is far outweighed by the potential benefits of mammography.

Some breast cancers do not show up on mammograms, or "hide" in dense breast tissue. A normal (or negative) study is not a guarantee that a woman is cancer-free. Mammograms find about 85% to 90% of breast cancers.

"False positive" readings are also possible, and 5% to 10% of mammogram results indicate the need for additional testing, most of which confirms that no cancer is present.

Normal results

A mammography report describes details about the x ray appearance of the breasts. It also rates the mammogram according to standardized categories, as part of the Breast Imaging Reporting and Data System (BIRADS) created by the American College of Radiology (ACR). A normal mammogram may be rated as BIRADS 1 or negative, which means no abnormalities were seen. A normal mammogram may also be rated as BIRADS 2 or benign findings. This means that one or more abnormalities were found but are clearly benign (not cancerous), or variations of normal. Some kinds of calcification, lymph nodes, or implants in the breast might generate a BIRADS 2 rating. A BIRADS 0 rating indicates that the mammogram is incomplete and requires further assessment.

Abnormal results

Many mammograms are considered borderline or indeterminate in their findings. BIRADS 3 means an abnormality is present and probably (but not definitely) benign. A follow-up mammogram within a short interval of six months is suggested. This helps to ensure that the abnormality is not changing, or is "stable." This stability in the abnormality indicates that a cancer is probably not present. If the abnormality were a cancer, it would have grown in the interval between mammograms. Some women are uncomfortable or anxious about waiting and may want to consult with their doctor about a having a biopsy. BIRADS 4 means suspicious for cancer. A biopsy is usually recommended in this case. BIRADS 5 means an abnormality is highly suggestive of cancer. The suspicious area should be biopsied.

Resources

BOOKS

Henderson, Craig. Mammography & Beyond. Developing Tech nologies for the Early Detection of Breast Cancer: A Non technical Summary. Washington, DC: National Academy Press, 2001.

Love, Susan M., with Karen Lindsey. Dr. Susan Love's Breast Book, 3rd ed. Boulder, CO: Perseus Book Group, 2000.

PERIODICALS

Letich, A., et al. "American Cancer Society Guidelines for the Early Detection of Breast Cancer: Update 1997." CA: A Cancer Journal for Clinicians 47 (May/June 1997): 150-53.

"The Mammography Muddle." Harvard Women's Health Watch 7 (March 1997): 4-5.

Weber, Ellen. "Questions and Answers About Breast Cancer Diagnosis." American Journal of Nursing (October 1997):34-8.

ORGANIZATIONS

American Cancer Society. 1599 Clifton Rd., Atlanta, GA30329. (800) ACS-2345. <http://www.cancer.org.>

Federal Drug Administration. 5600 Fishers lane, Rockville, MD 20857. (800) 532-4440. <http://www.fda.gov.>

National Cancer Institute. Office of Cancer Communications, Bldg. 31, Room 10A31, Bethesda, MD 20892. NCI/Cancer Information Service: (800) 4-CANCER. <http://cancernet.nci.nih.gov.>

Ellen S. Weber, M.S.N.

QUESTIONS TO ASK THE DOCTOR

• What do the results mean?
• If there is something abnormal, shouldn't we immediately find out what it is?
• What future care will I need?

Breast biopsy

—A procedure in which suspicious tissue is removed and examined by a pathologist for cancer or other disease. The breast tissue may be obtained by open surgery or through a needle.

Radiographically dense

—Difficult to see details of breast tissue on x ray.