mam­mo­gram

What is a mammogram?

A mam­mo­gram is a safe, low-dose x-ray exam of the breasts to look for changes that are not nor­mal. The results are recorded on x-ray film or directly into a com­puter for a doc­tor called a radi­ol­o­gist to examine.

A mam­mo­gram allows the doc­tor to have a closer look for changes in breast tis­sue that can­not be felt dur­ing a breast exam. It is used for women who have no breast com­plaints and for women who have breast symp­toms, such as a change in the shape or size of a breast, a lump, nip­ple dis­charge, or pain. Breast changes occur in almost all women. In fact, most of these changes are not can­cer and are called “benign,” but only a doc­tor can know for sure. Breast changes can also hap­pen monthly, due to your men­strual period.

What is the best method of detect­ing breast can­cer as early as possible?

A mam­mo­gram plus a clin­i­cal breast exam, an exam done by your doc­tor, is the most effec­tive way to detect breast can­cer early. Find­ing breast can­cer early greatly improves a woman’s chances for suc­cess­ful treatment.

Like any test, mam­mo­grams have both ben­e­fits and lim­i­ta­tions. For exam­ple, some can­cers can’t be found by a mam­mo­gram, but they may be found in a clin­i­cal breast exam.

Check­ing your own breasts for lumps or other changes is called a breast self-exam (BSE). Stud­ies so far have not shown that BSE alone helps reduce the num­ber of deaths from breast can­cer. BSE should not take the place of rou­tine clin­i­cal breast exams and mammograms.

If you choose to do BSE, remem­ber that breast changes can occur because of preg­nancy, aging, menopause, men­strual cycles, or from tak­ing birth con­trol pills or other hor­mones. It is nor­mal for breasts to feel a lit­tle lumpy and uneven. Also, it is com­mon for breasts to be swollen and ten­der right before or dur­ing a men­strual period. If you notice any unusual changes in your breasts, con­tact your doctor.

How is a mam­mo­gram done?

You stand in front of a spe­cial x-ray machine. The per­son who takes the x-rays, called a radi­o­logic tech­ni­cian, places your breasts, one at a time, between an x-ray plate and a plas­tic plate. These plates are attached to the mam­mo­gram machine and com­press the breasts to flat­ten them. This spreads the breast tis­sue out to obtain a clearer pic­ture. You will feel pres­sure on your breast for a few sec­onds. It may cause you some dis­com­fort; you might feel squeezed or pinched. This feel­ing only lasts for a few sec­onds, and the flat­ter your breast, the bet­ter the pic­ture. Most often, two pic­tures are taken of each breast — one from the side and one from above. A screen­ing mam­mo­gram takes about 20 min­utes from start to finish.

Are there dif­fer­ent types of mammograms?

• Screen­ing mam­mo­grams are done for women who have no symp­toms of breast can­cer. It usu­ally involves two x-rays of each breast. Screen­ing mam­mo­grams can detect lumps or tumors that can­not be felt. They can also find micro­cal­ci­fi­ca­tions (my-kro-kal-si-fi-KAY-shuns) or tiny deposits of cal­cium in the breast, which some­times mean that breast can­cer is present.
• Diag­nos­tic mam­mo­grams are used to check for breast can­cer after a lump or other symp­tom or sign of breast can­cer has been found. Signs of breast can­cer may include pain, thick­ened skin on the breast, nip­ple dis­charge, or a change in breast size or shape. This type of mam­mo­gram also can be used to find out more about breast changes found on a screen­ing mam­mo­gram, or to view breast tis­sue that is hard to see on a screen­ing mam­mo­gram. A diag­nos­tic mam­mo­gram takes longer than a screen­ing mam­mo­gram because it involves more x-rays in order to obtain views of the breast from sev­eral angles. The tech­ni­cian can mag­nify a prob­lem area to make a more detailed pic­ture, which helps the doc­tor make a cor­rect diagnosis.

A dig­i­tal mam­mo­gram also uses x-ray radi­a­tion to pro­duce an image of the breast, but instead of stor­ing the image directly on film, it stores the image of the breast directly on a com­puter. This allows the recorded data to be mag­ni­fied for the doc­tor to take a closer look. Cur­rent research has not shown that dig­i­tal images are bet­ter at show­ing can­cer than x-ray film images in gen­eral. But, women with dense breasts who are pre– or per­i­menopausal, or who are younger than age 50, may ben­e­fit from hav­ing a dig­i­tal rather than a film mam­mo­gram. Dig­i­tal mam­mog­ra­phy may offer these benefits:

• Long-distance con­sults with other doc­tors may be eas­ier because the images can be shared by computer.
• Slight dif­fer­ences between nor­mal and abnor­mal tis­sues may be eas­ily noted.
• The num­ber of follow-up tests needed may be fewer.
• Fewer repeat images may be needed, reduc­ing expo­sure to radiation.

How often should I get a mammogram?

• Women 40 years and older should get a mam­mo­gram every 1–2 years.
• Women who have had breast can­cer or other breast prob­lems or who have a fam­ily his­tory of breast can­cer might need to start get­ting mam­mo­grams before age 40, or they might need to get them more often. Talk to your doc­tor about when to start and how often you should have a mammogram.

What can mam­mo­grams show?

The radi­ol­o­gist will look at your x-rays for breast changes that do not look nor­mal and for dif­fer­ences in each breast. He or she will com­pare your past mam­mo­grams with your most recent one to check for changes. The doc­tor will also look for lumps and calcifications.

• Lump or mass. The size, shape, and edges of a lump some­times can give doc­tors infor­ma­tion about whether or not it may be can­cer. On a mam­mo­gram, a growth that is benign often looks smooth and round with a clear, defined edge. Breast can­cer often has a jagged out­line and an irreg­u­lar shape.
• Cal­ci­fi­ca­tion. A cal­ci­fi­ca­tion is a deposit of the min­eral cal­cium in the breast tis­sue. Cal­ci­fi­ca­tions appear as small white spots on a mam­mo­gram. There are two types:
  • Macro­cal­ci­fi­ca­tions are large cal­cium deposits often caused by aging. These usu­ally are not a sign of cancer.
  • Micro­cal­ci­fi­ca­tions are tiny specks of cal­cium that may be found in an area of rapidly divid­ing cells.

If cal­ci­fi­ca­tions are grouped together in a cer­tain way, it may be a sign of can­cer. Depend­ing on how many cal­cium specks you have, how big they are, and what they look like, your doc­tor may sug­gest that you have other tests. Cal­cium in the diet does not cre­ate cal­cium deposits, or cal­ci­fi­ca­tions, in the breast.

What if my screen­ing mam­mo­gram shows a problem?

If you have a screen­ing test result that sug­gests can­cer, your doc­tor must find out whether it is due to can­cer or to some other cause. Your doc­tor may ask about your per­sonal and fam­ily med­ical his­tory. You may have a phys­i­cal exam. Your doc­tor also may order some of these tests:

• Diag­nos­tic mam­mo­gram, to focus on a spe­cific area of the breast
• Ultra­sound, or imag­ing test that uses a device with sound waves to cre­ate a pic­ture of your breast. The pic­tures may show whether a lump is solid or filled with fluid. A cyst is a fluid-filled sac. Cysts are not can­cer. But a solid mass may be can­cer. After the test, your doc­tor can store the pic­tures on video or print them out. This exam may be used along with a mammogram.
• Mag­netic res­o­nance imag­ing (MRI), which uses a pow­er­ful mag­net linked to a com­puter. MRI makes detailed pic­tures of breast tis­sue. Your doc­tor can view these pic­tures on a mon­i­tor or print them on film. MRI may be used along with a mammogram.
• Biopsy, a test in which fluid or tis­sue is removed from your breast to help find out if there is can­cer. Your doc­tor may refer you to a sur­geon or to a doc­tor who is an expert in breast dis­ease for a biopsy.

Where can I get a high-quality mammogram?

Women can get high qual­ity mam­mo­grams in breast clin­ics, hos­pi­tal radi­ol­ogy depart­ments, mobile vans, pri­vate radi­ol­ogy offices, and doc­tors’ offices. The Food and Drug Admin­is­tra­tion (FDA) cer­ti­fies mam­mog­ra­phy facil­i­ties that meet strict qual­ity stan­dards for their x-ray machines and staff and are inspected every year. You can ask your doc­tor or the staff at the mam­mog­ra­phy cen­ter about FDA cer­ti­fi­ca­tion before mak­ing your appoint­ment. A list of FDA-certified facil­i­ties can be found on the Inter­net at: http://www.fda.gov/cdrh/mammography/certified.html.

Your doc­tor, local med­ical clinic, or local or state health depart­ment can tell you where to get no-cost or low-cost mam­mo­grams. You can also call the National Can­cer Institute’s Can­cer Infor­ma­tion Ser­vice toll free at 1–800-422‑6237 (TTY: 1–800-332‑8615). Visit them online at http://www.cancer.gov.

What if I have breast implants?

Women with breast implants should con­tinue to have mam­mo­grams. A woman who had an implant after breast can­cer surgery should ask her doc­tor whether she needs a mam­mo­gram of the recon­structed breast.

If you have breast implants, be sure to tell your mam­mog­ra­phy facil­ity that you have them when you make your appoint­ment. The tech­ni­cian and radi­ol­o­gist must be expe­ri­enced in x-raying patients with breast implants. Implants can hide some breast tis­sue, mak­ing it harder for the radi­ol­o­gist to see a prob­lem when look­ing at your mam­mo­gram. To see as much breast tis­sue as pos­si­ble, the x-ray tech­ni­cian will gen­tly lift the breast tis­sue slightly away from the implant and take extra pic­tures of the breasts.

How do I get ready for my mammogram?

First, check with the place you are hav­ing the mam­mo­gram for any spe­cial instruc­tions you may need to fol­low before you go. Here are some gen­eral guide­lines to follow:

• If you are still hav­ing men­strual peri­ods, try to avoid mak­ing your mam­mo­gram appoint­ment dur­ing the week before your period. Your breasts will be less ten­der and swollen. The mam­mo­gram will hurt less and the pic­ture will be better. 
• If you have breast implants, be sure to tell your mam­mog­ra­phy facil­ity that you have them when you make your appointment.
• Wear a shirt with shorts, pants, or a skirt. This way, you can undress from the waist up and leave your shorts, pants, or skirt on when you get your mammogram.
• Don’t wear any deodor­ant, per­fume, lotion, or pow­der under your arms or on your breasts on the day of your mam­mo­gram appoint­ment. These things can make shad­ows show up on your mammogram.
• If you have had mam­mo­grams at another facil­ity, have those x-ray films sent to the new facil­ity so that they can be com­pared to the new films.

Are there any prob­lems with mammograms?

Although they are not per­fect, mam­mo­grams are the best method to find breast changes. If your mam­mo­gram shows a breast change, some­times other tests are needed to bet­ter under­stand it. Even if the doc­tor sees some­thing on the mam­mo­gram, it does not mean it is cancer.

As with any med­ical test, mam­mo­grams have lim­its. These lim­its include:

• They are only part of a com­plete breast exam. Your doc­tor also should do a clin­i­cal breast exam. If your mam­mo­gram finds some­thing abnor­mal, your doc­tor will order other tests.
• Find­ing can­cer does not always mean sav­ing lives. Even though mam­mog­ra­phy can detect tumors that can­not be felt, find­ing a small tumor does not always mean that a woman’s life will be saved. Mam­mog­ra­phy may not help a woman with a fast grow­ing can­cer that has already spread to other parts of her body before being found.
• False neg­a­tives can hap­pen. This means every­thing may look nor­mal, but can­cer is actu­ally present. False neg­a­tives don’t hap­pen often. Younger women are more likely to have a false neg­a­tive mam­mo­gram than are older women. The dense breasts of younger women make breast can­cers harder to find in mammograms.
• False pos­i­tives can hap­pen. This is when the mam­mo­gram results look like can­cer is present, even though it is not. False pos­i­tives are more com­mon in younger women, women who have had breast biop­sies, women with a fam­ily his­tory of breast can­cer, and women who are tak­ing estro­gen, such as hor­mone replace­ment therapy.
• Mam­mo­grams (as well as den­tal x-rays and other rou­tine x-rays) use very small doses of radi­a­tion. The risk of any harm is very slight, but repeated x-rays could cause prob­lems. The ben­e­fits nearly always out­weigh the risk. Talk to your doc­tor about the need for each x-ray. Ask about shield­ing to pro­tect parts of the body that are not in the pic­ture. You should always let your doc­tor and the tech­ni­cian know if there is any chance that you are pregnant.

mammogram-picture