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 to two weeks after the first day of the menstrual period is usually best, as the breasts may be tender during a menstrual period. Some women with sensitive breasts also find that stopping or decreasing caffeine intake from coffee, tea, colas, and chocolate for a week or two before the examination decreases any discomfort. Women receiving hormone therapy may also have sensitive breasts. Over-the-counter pain relievers are recommended an hour before the mammogram appointment when pain is a significant problem.

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 show up as abnormalities on the mammogram. Most facilities will have special wipes available for those patients who need to wash before the mammogram.

Aftercare

No special aftercare is required.

Risks

The risk of radiation exposure from a mammogram is considered minimal and not significant. Experts are unanimous that any negligible risk is by far outweighed by the potential benefits of mammography. Patients who have breast implants must be x rayed with caution and compression is minimally applied so that the sac is not ruptured. Special techniques and positioning skills must be learned before a technologist can x ray a patient with breast implants.

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. The false-negative rate is estimated to be 15–20%, higher in younger women and women with dense breasts.

False positive readings are also possible. Breast biopsies may be recommended on the basis of a mammogram, and find no cancer. It is estimated that 75–80% of all breast biopsies resulted in benign (no cancer present) findings. This is considered an acceptable rate, because recommending fewer biopsies would result in too many missed cancers.

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 there are one or more abnormalities but they are clearly benign (not cancerous), or variations of normal. Some kinds of calcifications, enlarged lymph nodes or obvious cysts might generate a BIRADS 2 rating.

Many mammograms are considered borderline or indeterminate in their findings. BIRADS 3 means either additional images are needed, or an abnormality is seen and is probably (but not definitely) benign. A follow-up mammogram within a short interval of six to 12 months is suggested. This helps to ensure that the abnormality is not changing, or is "stable." Only the affected side will be x rayed at this time. Some women are uncomfortable or anxious about waiting, and may want to consult with their doctor about 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. A biopsy or other appropriate action should be taken.

Screening mammograms are not usually recommended for women under age 40 who have no special risk factors and a normal physical breast examination. A mammogram may be useful if a lump or other problem is discovered in a woman aged 30–40. Below age 30, breasts tend to be "radiographically dense," which means the breasts contain a large amount of glandular tissue which is difficult to image in fine detail. Mammograms for this age group are controversial. An ultrasound of the breasts is usually done instead.

Patient education

The mammography technologist must be empathetic to the patient's modesty and anxiety. He or she must explain that compression is necessary to improve the quality of the image but does not harm the breasts. Patients may be very anxious when additional films are requested. Explaining that an extra view gives the radiologist more information will help to ease the patient's tension. One in eight women in North America will develop breast cancer. Educating the public on monthly breast self-examinations and yearly mammograms will help in achieving an early diagnosis and therefore a better cure.

PERIODICALS

Carmen, Ricard, R. T. R. Mammography: Techniques and Difficulties. O.T.R.Q., 1999.

Gagnon, Gilbert. Radioprotection in Mammography. O.T.R.Q., 1999.

Ouimet, Guylaine, R. T. R. Mammography: Quality Control. O.T.R.Q., 1999.