• What Is A Mammogram?
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|What Is A Mammogram?
A mammogram is a special X-ray examination of the breast that is used to diagnose malignant cancerous tumors or breast abnormalities. When it is used to screen for breast cancer symptoms in women who show no signs, it is called a screening mammogram. If it is carried out on a woman who does display symptoms, such as nipple discharge or a lump, or if a suspicious change was detected in an earlier mammogram, it is known as diagnostic mammography. The particular advantage of mammograms is their ability to show tiny areas of calcified tissues called calcifications and microcalcifications. Although calcifications can be found in innocent breast changes, when they appear in certain shapes or clusters they may be the first sign of carcinoma in situ, or early invasive cancer. Changes detected this early are highly treatable and improves women's breast cancer survival rates dramatically. Mammography is most effective when it is used in combination with a regular clinical breast exam (CBE) at the doctor’s office and a breast self examination (BSE) done at home. On average only 2 to 4 mammography screenings lead to a breast cancer diagnosis. Although about 10 percent of screenings will indicate further tests are required, in most of those cases another mammogram is all that is required.
The whole procedure takes about 20 minutes. The breast is squeezed between 2 plates. The top plate is plastic and the bottom plate is the X-ray. The radiologist compresses the breast to prevent it moving and to flatten the breast tissue as much as possible. This ensures a sharper picture and reduces X-Ray exposure. Some women find the compression particularly uncomfortable but it only lasts a few minutes. Premenopausal women (those who still have a menstrual cycle) may find a mammography less painful in the first week after a period has finished when they are less hormonal. Some also find cutting out caffeine for a week or two before the procedure helps. If you are worried about the pain, tell the technician. She may agree to compress the breast until you signal pain and then will release it slightly. Some health centers are even experimenting by allowing women to control the compression themselves.
Depending on which type of machine is used images from the mammogram will be stored on black and white X-ray film or as an electronic film which can be seen on a computer screen (digital mammograms). Today the electronic machines are becoming more popular. Regardless of which technology is used the results are read by a doctor, normally a radiologist. If you have had any mammograms in the past, these will be compared to the most recent ones. Comparing pictures helps to identify any changes. For this reason it is worthwhile finding one center that you are happy with and sticking to it. It will reduce the administration involved and decrease the likelihood of older pictures going missing. Before leaving the clinic do find out who to call if you do not receive your results within 3 weeks. Do not assume no news is good news. A call to a mammography center after this period of time is perfectly warranted.
The American Cancer Society recommends all women over the age of 40 have a mammogram once a year.
Women in their 20s and 30s should have a regular CBE as part of their periodic examination by their healthcare provider. There may also be some benefit in having a CBE before a mammogram because if the doctor finds any suspicious changes the technician can focus on that area during the mammogram. BSE is another option for women in their 20s. Ask your doctor to explain the benefits and limitations of both techniques.
Women with high breast cancer risk factors, such as a close family history of the disease should start regular CBE's and have an annual mammography from the age of 35. It may also be suggested that they have an annual MRI scan which is an even more sophisticated imaging technique. Genetic counselors can discuss the pros and cons of genetic testing for breast cancer in high risk women. A positive result for the BRCA1 and 2 gene mutations will start a discussion about the benefits of preventative drugs or prophylactic surgery (see Breast Cancer Treatment).
A doctor may order a mammography for a patient if he discovers a lump, thickening of the breast skin or nipple discharge. This is just as true for cases of breast cancer recurrence which show similar symptoms.
Women who are pregnant or breastfeeding should not be tested. However if a lump needs to be evaluated a mammography can be safe as long as the womb is shielded.
Women who have had breast implants can still have clear images taken. However, this needs to be done by an experienced technologist who will take extra images and uses a special technique to move the breast tissue in front of the implant.
Missing The Cancer
If you receive news that some abnormality was detected in your screening, you will be called back for a diagnostic mammogram. During a diagnostic procedure, more images are taken and particular focus is placed on the area of concern. Special pictures are taken to enlarge the problem zone to facilitate accurate evaluation. Results are normally issued within a few days. A recently approved device called a T-Scan 2000 may also be used to evaluate the area. This is a handheld device which is placed directly on the breast and relays images to a computer screen. Its main advantage is that it does not emit radiation. Whether or not is has the potential to save women from invasive biopsy procedures still remains to be seen. If the diagnostic mammogram comes back with no abnormalities the woman returns to annual screening. If abnormalities appear which are not cancerous, then another mammogram is scheduled for 4 to 6 months later. There may also be a discussion about breast cancer prevention. If the results are unclear a breast biopsy may be recommended (a mammogram result is never considered a diagnosis in itself). If you need to undergo a biopsy, try not to be overly worried if you can. 80 percent of all biopsied breast changes turn out to be non-cancerous (benign).
Choose a center which has carried out the greatest amount of procedures in your area. They are more likely to have invested in state-of-the-art equipment. In 1999 the FDA issued comprehensive regulations and guidelines to mammography centers called the Mammography Quality Standards Act (MQSA). This requires centers to be compliant in training, equipment, quality control and follow up of abnormal results. Accreditation needs to be renewed every 3 years. If the reception area of the center does not display their FDA certificate, ask to see it.Do continue to use the same facility once you are happy with it. This will ensure consistency of your records.
Avoid wearing deodorant on the day of your exam as it can show up as white spots on the X-Ray. Also avoid lotions and powders.
Avoid wearing a dress. A skirt or pants means you will only have to remove your top.
Do tell the technologist about any breast problems you may have, do not assume they know.
If you do not hear from the center within 3 weeks, contact them. Do not assume that your results were normal. All centers are required to send results within 30 days. In most cases you will receive results within 5 working days.
The average cost to an uninsured patient ranges from $80 to $120. Low cost facilities are available in most states and the American Cancer Society on 1-800-227-2345 has a complete list. Most health insurance companies cover the complete cost for women over the age of 40. Some may require the woman to pay out of pocket expenses which range from $10 to $35. Medicare and Medicaid cover the costs of screening. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) also provide early detection testing for breast and cervical cancer to women without health insurance for free or reduced cost. To find out more, contact the Centers for Disease Control and Prevention (CDC) on 1-800-CDC INFO (1-800-232-4636) or at www.cdc.gov/cancer.
Modern mammography machines use low doses of radiation (about 0.1 to 0.2 rads per image, a rad being a measure of radiation). Older units used to give higher doses which did cause concern about radiation exposure, but they are no longer used. Just to put the risk into context: A woman who receives radiation therapy as part of her cancer treatment program will be exposed to an average total dose of about 5,000 rads. If she has an annual mammogram from the age of 40 until she is 90, she will be exposed to a total of between 20 and 40 rads.
In the past thermography screening gained some momentum as an alternative breast screening method. It works on the basis that abnormalities in the breast tissue would show up as 'hot spots'– because ‘hungry’ cancer cells develop an increased blood supply to feed themselves - on thermogram images. Each breast is mapped out on a photographic image produced by a heat sensitive device. The FDA does not approve of thermography as an alternative to mammography and consequently it has been abandoned by many centers in recent years. Another alternative is a breast ultrasound scan. This procedure definitively has the potential to eventually replace mammography. This handheld device can check under the arms which is an area that can be missed by mammogram. It can also distinguish between a benign fluid filled cyst and a potentially malignant lump. However, as the accuracy of the test relies heavily on the skill of the technician, and because it cannot identify calcium deposits, it is not recommended as a routine screening tool. But, as it is so practical, this may change in the future.
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