What is a mammogram?
A mammogram is an X-ray examination of the breast used to detect and screen for breast disease or breast cancer. It can be administered in women who show signs or symptoms of the breast disease such as lumps as well as women who have no sign of breast cancer. The procedure allows for early detection of breast cancer even when the lump is so small that it cannot be felt. Therefore, mammograms play a significant role in early diagnosis of breast cancer and prevention of breast cancer deaths.
Breast cancer is one of the most common cancers and the leading cause of cancer deaths among women in India. Annual mammograms are recommended for women who are 40 and older and also for women who are younger with risk factors of breast cancer. Warning signs and symptoms for breast cancer can vary greatly. If you experience any changes in the breast, nipple or underarm, schedule an appointment with your doctor.
Technical advancements in the medical field have hugely improved both the technique and results of mammography. High quality techniques such as digital mammography and 3D breast imaging ensure high quality results as they create images which are much clearer and easier to read.
What are the different types of mammograms?
A mammogram can be used in two ways, as a screening tool and a diagnostic tool.
- Screening mammogram
A screening mammogram is used to look for or detect signs of breast cancer in women with no signs or symptoms of breast cancer. It is recommended by doctors as a routine test to detect any cancer or changes in the breast. In this procedure, X-rays of each breast are taken from two different angles. This allows for early detection of breast problems in cases when a lump cannot be felt or symptoms are not noticeable.
- Diagnostic mammogram
A diagnostic mammogram is used to investigate or diagnose abnormal changes in the breast such as a lump, breast pain, nipple thickening or discharge, or a change in breast size or shape. It is also used to examine and investigate abnormalities or suspicious findings detected on a screening mammogram. A diagnostic mammogram is more extensive than a screening mammogram as it requires more X-rays or pictures of the breast from multiple positions. The doctor recommends a diagnostic mammogram in the case of symptoms of breast cancer such as lump. If you have breast implants, you’ll probably need a diagnostic mammogram. It is appropriate for women experiencing breast changes, irrespective of how old they are.
- Screening mammogram
How to prepare for a mammogram?
Before going for a mammogram, the patient needs to keep certain guidelines in mind and follow them.
Avoid using deodorants, powders, antiperspirants, lotions, perfumes, ointments or creams on the breasts or under the arms. The particles of these substances could be visible as white spots on the monogram and can create confusion or interfere with the test results.
If the patient is visiting a new facility and had any prior mammograms, do not forget to bring all the old mammograms to allow the doctor to make comparisons with the new ones. It is also advisable to visit the same facility in case of annual mammograms, for better results and understanding of the condition.
In the case of a patient who has not reached menopause yet, it is best to book an appointment when the breasts are least tender. Therefore, avoid scheduling the test at least a week before or after the period.
In the case of pregnant or lactating women, inform the doctor before administering the test. Since mammogram is not recommended for pregnant or breastfeeding women, the doctor might suggest other methods.
What happens during a mammogram?
The patient will be asked to remove any necklace or jewellery piece she is wearing. At the same time, she will be asked to remove her clothing from the waist-up and wear a gown provided by the facility.
During a mammogram, the patient needs to stand in front of an X-ray machine which will take the images of the breasts. The technician will adjust the machine according to the patient’s height and instruct on the body posture to capture full view of the breasts.
The breasts are compressed between two platforms to spread out or flatten the breast tissue. The patient will also be asked to hold breath when the images are being taken. This might cause slight discomfort, but it is short-lived and is not harmful.
The black and white images of the breasts captured by the X-ray are displayed on a computer screen which are reviewed by the doctor. The doctor examines the signs of breast cancer closely and can demand more images in case of clarity issues or if there are any areas that need further attention.
What do the mammogram results mean?
The doctor will review the results by closely examining the mammogram to look for high density areas of abnormalities such as microcalcifications or tiny bits of calcium deposits in the breasts. These sites may indicate presence of cancerous tumors, non-cancerous masses called benign tumors, or complex cysts. In other words, the size, shape, and an abnormal region can indicate the possibility of cancer or malignancy.
Breast Imaging Reporting and Database System (BI-RADS) is a diagnostic system for reading mammograms. There are seven categories ranging from zero to six which assist in reading mammograms . Each category details requirements such as whether more images are needed or not, which area is likely to have a noncancerous or cancerous lump, and the follow-up plan required.
In case of a potential abnormality which needs further investigation, the doctor will order a follow-up exam. A follow-up exam also helps to see if there has been any change in an abnormality over time and to see if treatment is working or not. After examining and reviewing the results carefully, the doctor will explain the next steps during a follow-up appointment.
What are the risks of mammograms?
Mammogram exposes the patient to a very small amount of ionizing radiation. However, the benefit of the test outweighs any possible harm or risk posed from this exposure. Moreover, the advanced technology uses extremely low radiation doses to take breast x-rays and produce high-quality images.
In case of pregnant women, the doctor should be informed about the condition beforehand who will decide the best possible options. Mammograms are normally not considered to be safe during pregnancy, and are therefore not recommended for pregnant women who are not at increased risk for breast cancer.
Meet the radiologists at Yashoda Hospital & Research Centre, Nehru Nagar, Ghaziabad.
Dr. Alok Tripathi (Consultant Radiologist, Radiology)
Dr. Alok Tripathi is a consultant in Radiology Department at Yashoda Hospital & Research Centre. He pursued his M.D. in Radiodiagnosis as well as M.B.B.S. degree from King George’s Medical University, Lucknow. He has also worked as a consultant in radiology at the Charak Diagnostic Centre till 2014. Dr. Tripathi possesses ample experience in all imaging modalities with a good exposure to cross-sectional imaging including Computed Tomography (CT) and Magnetic Resonance Imaging (MRI).
Dr. Pankaj Agarwal (Consultant Radiologist, Radiology)
Dr. Pankaj Agarwal has been working extensively and efficiently in the field of radiology for a decade now. He is highly skilled and trained in all high-end imaging. He has been a senior resident (MRI) at Rajiv Gandhi Cancer Hospital, New Delhi and at Deen Dayal Upadhyay Hospital, New Delhi. He expertise lies in MRI (head & neck), neuro imaging, musculoskeletal imaging, MRA (abdomen), MDCT (whole body, head & neck including CT Angiography), non-vascular interventional radiology & elastography.