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What do I need to know for my first mammogram?

Mammography Essentials

Breast cancer is the most common cancer in India, that caused 27.7% of all new cancers and 11.1% of cancer deaths in women in 2018. As the disease is rising fast, it points to one necessity–”Detect cancer early.”

Mammography is a radiological examination of the breast that detects tiny growths within the breast which are not palpable. Although the technology is less perfect (sensitivity 60-70%), it is the most effective technique in reducing breast cancer deaths in tandem with other screening options, making it the central element of breast cancer control. Since mammography can produce nonspecific results and cause unnecessary anxiety, consulting a doctor before having a mammogram is important as it would help you to know about your risk of breast cancer and your need for screening mammography.

What is Mammography ?

Mammography, also called a mammogram, is a specialized imaging modality that uses a series of low-dose X-rays (about 30 kVp) to see through the breast tissues. It detects and diagnoses breast irregularities in women who either have no noticeable breast complaints or have lumps or other breast cancer symptoms. 

What are the types of mammography?

Two commonly used types of mammograms for breast lump screening and diagnosis include:

• Screening mammography: This mammogram, as its name suggests, uses a two-view combination that enables your doctor to detect changes in your breast even before the actual symptoms appear.

• Diagnostic mammography: It is advised when your doctor suspects any breast symptoms such as a lump or nipple discharge during your physical examination or when your screening mammogram is abnormal. The testing is also useful in women who have a history of breast cancer. Besides, it can provide more images to determine the exact size and location of breast abnormalities.

How should you prepare for a mammogram ?

As a mammogram is an integral part in taking care for your breast and overall health, you may want to consider these helpful tips before getting an examination. These include, but are not limited to: 

• Avoid wearing any deodorants, powders, lotions, creams, or perfumes on your breasts or underarms on the day of your examination.
• Avoid planning your mammograms on the days when your breasts are tender or swollen, including the week before you get your period and during your period.
• Choose your outfit prudently since you may have to undress above the waist.
• Avoid wearing your jewelry as it can interfere with the X-ray images.
• Inform your radiologist or technician if you are pregnant or breastfeeding.
• Bring your past mammogram images if you took them in a different facility. This is for comparison with your current exam and to have a correct diagnosis.
• Eat and drink normally.
• Take your daily medication as usual.

How does the procedure work?

Mammography is a quick outpatient procedure that takes 20–30 min.

During your examination, you will either stand or sit before an X-ray machine. A radiologist/technologist will then position your breasts one at a time on a specialized X-ray plate. Using a clear plastic paddle above, your breast will be compressed or flattened against the film. It will spread the breast tissues apart, allowing for a lower dose of radiation to be used while still producing good quality images. At least two images of each breast, one from top to bottom and then a second from side to side, including the part of your breast that extends into your armpit will be taken.

For most women, compression can be uncomfortable, even though it is not harmful and only lasts a few seconds. However, in some women, it can be painful. Be sure to inform your radiologist, if you feel any unusual pressure or pain in your breast.

If you are over 50 years and have dense breast, you might want to consider digital mammography for a more convenient experience.

What do the mammogram results mean?

If you have an abnormal mammogram, do not be alarmed; an abnormal mammogram doesn’t always mean you have cancer or need surgery. However, it will help your doctor in detecting early signs of breast cancer, such as

• Calcium deposits (microcalcification)
• Cysts (fluid-filled sacs)
• Solid masses (cancerous or noncancerous lumps)

Additionally, your doctor may prescribe additional tests, such as a breast biopsy or magnetic resonance imaging (MRI), to evaluate the abnormal area in concern. 

When should you begin taking a mammogram?

Many guidelines are available for conducting mammography. According to the American College of Radiology (ACR) and the National Cancer Institute (NCI), however, women without symptoms should have screening mammography done every 1-2 years starting at the age of 40.

Moreover, talk to your doctor about your options of a yearly mammogram if you have a high risk of breast cancer, a family history of breast or ovarian cancer, or a history of prior radiotherapy to the chest at a young age.  

What are the advantages of a mammogram?

Some of the advantages of mammography include:

• Reduces the risk of death from breast cancer by detecting all breast cancers types such as invasive ductal, ductal carcinoma in situ (DCIS), and invasive lobular cancer.

• Determines the health of your breast.

What are the risks associated with mammography?

Despite being the valuable cancer screening tool, mammogram has certain limitations, which include:

• Risk of radiation exposure, which is comparatively low to the pros of early diagnosis of breast cancer.
• False-positives in women aged 40 to 49, resulting in stressful overdiagnosis and treatment of indolent abnormalities.  The results are more likely to occur in the first-time screening mammography. Every 1 in 10 women who have a single mammogram will have a false-positive result.
• False-negatives in 20 per cent of breast cancers that are not detectable by mammography and are common in younger women with dense breast tissue.

Mammography is a cost-effective approach to breast cancer screening that can save lives.  Failing to have even one examination, however, can sadly raise your risk of dying of cancer. So, talk to your doctor today and see if you need a mammogram.

References

1. Guidelines for Early Detection of Breast Cancer | Breast Cancer India. (n.d.). Retrieved March 4, 2021, from https://www.breastcancerindia.net/early-detection-of breast cancer/early-detection-guidelines.html
2. Bhattacharyya, G. S., Doval, D. C. Desai, C. J., Chaturvedi, H., Sharma, S., & Somashekhar, S. p. (2020). Overview of Breast Cancer and Implications of Overtreatment of Early-Stage Breast Cancer: An Indian Perspective. JCO Global Oncology, 6, 789–798. https://doi.org/10.1200/GO.20.00033
3. Breast Cancer Screening (PDQ®)–Patient Version—National Cancer Institute (nciglobal,ncienterprise). (2020, December 18). [PdqCancerInfoSummary]. https://www.cancer.gov/types/breast/patient/breast-screening-pdq
4. Radiology (ACR), R. S. of N. A. (RSNA) and A. C. of. (n.d.). Mammography (Mammogram). Retrieved March 4, 2021, from https://www.radiologyinfo.org/en/info.cfm?pg=mammo
5. Mammogram—Mayo Clinic. (n.d.). Retrieved March 3, 2021, from https://www.mayoclinic.org/tests-procedures/mammogram/about/pac-20384806
6. Mammograms: Benefits and Risks. (2019, November 6). Breastcancer.Org. https://www.breast cancer.org/symptoms/testing/types/mammograms/benefits_risks
7. Mammogram Procedure | Johns Hopkins Medicine. (n.d.). Retrieved March 4, 2021, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/mammogram-procedure
8. Dr. Pragnya Chigurupati – https://www.drpragnya.com/
9. https://drpragnya.com/blog/relax-every-lump-in-breast-is-not-cancer/

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