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Mammography
Overview
A mammogram is a special kind of an x-ray that enables doctors
to detect abnormalities in the breast. These abnormalities can be
benign (harmless) or cancerous. The real usefulness of this tool
lies in its potential to detect cancerous lumps in the breast
before a woman or her physician can feel them. To obtain pictures
of the breast, the technicians use a special machine that allows
them to place the breast on the machine's lower plate, which is
made of a metallic material. A plastic upper plate, is then
lowered to compress the breast for a few seconds as the picture is
taken. In general, two types of mammograms can be ordered: screening
or diagnostic.
A screening mammogram, consists of two views of the breast
obtained from different angles, usually top-down and side views.
This form of mammogram is primarily used for the early detection
of breast cancer in women who do not have any symptoms.
A diagnostic mammogram, consists of more than two views and
may even include object magnification, depending on the patient
being studied. This type of mammogram is indicated when a patient
has a symptom or sign referable to the breast (such as a breast
lump, nipple changes or discharge, or skin changes over the area
of the breast), or if she has had breast cancer previously.
Diagnostic mammogram enables the x-ray doctor characterize breast
lumps and determine the cause of other breast symptoms.
Breast Cancer Screening in the African-American population
Considering the fact that breast cancer is the most prevalent
cancer in the United States, the benefits of mammography cannot be
over-emphasized. In the last decade, the US has noted significant
improvement in the survival rates for women with breast cancer.
This positive outlook for breast cancer is largely due to earlier
detection made possible by screening mammography.
Although a lot of improvement has been noted in overall survival
rates for women with breast cancer in the US, unacceptable
morbidity and mortality from this disease remains in the
African-American women, as well as other black women worldwide.
The single most common reason for this dismal statistic is under
screening of this population. Various socio-economic factors,
limited health care access and massive ignorance are the
underlying reasons for these sobering statistics in the developing
countries. Although the same factors are partly responsible for
inadequate screening in the US, the problem is exacerbated by the
failure physicians to recommend screening mammography to their
patients. For this reason, it follows that if further reduction in
breast cancer morbidity and mortality is to be achieved,
particularly in the African-American population, concerted efforts
by both the patients and the health care providers will be needed
to improve breast cancer screening through the use of mammography.
Primary care physicians must not assume that their patients have
had her routine mammograms, rather they should ask specific
questions, and if possible request for copies of results of the
mammogram. Patients on their own part, should know the risk
factors for breast cancer and also have a good understanding of
screening guidelines, so that they can request when it is due.
Risk Factors For Breast Cancer And Recommendations For
Screening Mammography
Current guidelines on screening mammography for women vary
depending on their individual risk.
The rule of the thumb is to discuss with your physician and using
the recommendations below, appropriate screening strategies can be
tailored to your situation.
- Women at Low-to-Moderate Risk - The American Cancer
Society recommends that women in this group begin screening
mammography at age 40 and annually thereafter.
- Women at Moderate-to-High Risk due to Genetic
Predisposition - A woman is presumed to be genetically
predisposed to have breast cancer if any of the following
applies to her:
(1) The family has had more than two breast cancer cases
and one or more cases of ovarian cancer diagnosed at any age.
(2) The family has had more than three breast cancer cases
diagnosed before the age of 50 years.
(3) Sister pairs with two of the following cancers diagnosed
before age 50: two breast cancers, two ovarian cancers, or an
ovarian cancer and a breast cancer.
(4) A family history of breast cancer occurring at an
unusually early age or cancer involving both breasts..
Women with this genetic background are considered to be at high
risk and the current recommendation for them with respect to
screening mammography, is to begin the test 10 years before the
earliest age at diagnosis of ovarian or breast cancer in a
relative (but not before age 25). Such a patient should have
annual screening mammography, supplemented with breast examination
by a physician every 6 months.
- Women Who Have Received Prior Chest Radiation -
Because women who have received radiation treatment to their
chest at a young age have a much higher risk of breast cancer
than the general population, they are screened as if they were
genetically predisposed. The recommendation is to begin
screening 10 years after their initial radiation exposure, but
not before age 25. Thereafter, they should have breast
physical examinations every 6 months and screening mammography
annually.
Other Mammography Facts You Must Know
(1) The usefulness of mammography as a breast cancer detection
strategy is directly related to the quality of the pictures
obtained and the training of the doctor who reads the film. In
other words, make sure that the facility where you are undergoing
your test is certified by the Food and Drug Administration (FDA),
since this certification guarantees meeting minimum federal
standards for equipment, practices and personnel. If you need to
verify whether a facility is FDA certified or not, for this test,
call NCI's Cancer Information Service at (1-800-4-CANCER).
(2) Note that by federal law, you are entitled to a letter
and/or a report from the radiologist, who conducted the test,
indicating whether the mammogram was abnormal or normal. This is
separate from the report that is also sent to the requesting
physician.
(3) Mammography is generally not useful for evaluating a breast
that has undergone reconstructive surgery following a prior
mastectomy (breast removal).
(4) Like most things in medicine, mammography is not 100%
reliable in detecting or ruling out breast cancers even in the
best of hands. In fact, about 25% of breast tumors in women in
their 40s and about 10% of breast tumors in women older than age
50 are not detected by mammography. These numbers underscore the
continued need for regular breast physical examination by your
physician and monthly Breast Self Examination (BSE) by women of
all races.
Resources
For information about mammography center standards, visit the
FDA's web site
http://www.fda.gov/cdhd/faclist.html
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Mammography