Mammography

A mammogram is an x-ray of the breast. Diagnostic mammography is used to diagnose breast disease in women who have symptoms.

Screening mammography is used to look for breast disease in women who are asymptomatic, that is, they appear to have no breast problems.

Although breast x-rays have been performed for more than 70 years, modern mammography has only existed since 1969. That was the first year x-ray units dedicated to breast imaging were available. With modern mammography equipment used specifically for breast x-rays, very low levels of radiation are used, usually about 0.1 to 0.2 rad dose per x-ray. Strict guidelines are in place to assure that mammography equipment is safe and uses the lowest dose of radiation possible. Many people are concerned about the exposure to x-rays, and rightly so, but the level of radiation in up-to-date mammograms does not significantly increase the risk for breast cancer. To put dose into perspective, a woman who receives radiation as a treatment for breast cancer will receive several thousand rads. If a woman had yearly mammograms beginning at age 40 and continuing until 90, she will have received 10 rads.

In order to perform a mammogram, the breast is compressed to flatten and spread the tissue. Although this may be temporarily uncomfortable, it is necessary in order to produce a good mammogram. The compression only lasts a few seconds, and the entire procedure for screening mammography takes about 20 minutes. This procedure produces a black and white image of the breast tissue on a large sheet of film that is "read," or interpreted, by a radiologist. The physician reading the films will look for several types of changes.

Screening mammography usually involves two views (x-ray pictures) of each breast. For some patients, such as women with breast implants, additional pictures may be needed to include as much breast tissue as possible. Women who are breast-feeding can still get mammograms. They can express their breast milk before the mammogram.

Calcifications are tiny mineral deposits within the breast tissue that appear as small white spots on the films. Calcifications are divided into two categories, macrocalcifications and microcalcifications.

Macrocalcifications are coarse (larger) calcium deposits that most likely represent degenerative changes in the breasts, such as aging of the breast arteries, old injuries, or inflammations. These deposits are associated with benign (noncancerous) conditions and do not require a biopsy. Macrocalcifications are found in about 50 % of women over the age of 50, and in about 10 % of women under the age of 50.

Microcalcifications are tiny (less than 1/50 of an inch) specks of calcium in the breast. An area of microcalcification that is seen on a mammogram does not always mean that cancer is present. They may appear singly or in clusters. The shape and arrangement of microcalcifications help the radiologist judge the likelihood of cancer being present. In some cases, the microcalcifications do not even indicate a need for a biopsy. Instead, a doctor may advise a follow-up mammogram within 3 to 6 months. In other cases, the microcalcifications are more suspicious and a biopsy is recommended.

Another important change that can be seen on a mammogram is a mass, which may occur with or without calcifications. Masses can be due to many things, including cysts and fibroadenomas, but may be cancer and usually should be biopsied if they are not fluid-filled cysts. A cyst, which is a benign collection of fluid in the breast, cannot be diagnosed by physical exam alone, nor can it be diagnosed by mammography alone. Either breast ultrasound, or removal of the fluid with a needle (aspiration), is used to confirm that a mass is a cyst. If a mass is not a cyst, then further imaging may be obtained. As with calcifications, a mass can be caused by benign breast conditions, or by breast cancer. Some masses can be monitored with periodic mammograms, while others may require immediate or delayed biopsy.

A mammogram, while suggestive, cannot prove that an abnormal area is cancer. To confirm whether cancer is present, a small amount of tissue must be removed and examined under a microscope. This procedure is called a biopsy.

1. Mammogram costs, or a percentage of them, are covered by Medicare, Medicaid, and most private health plans. Low cost mammograms are available in most communities including Jackson County. Call the Jackson County Department of Health & Human Services for additional information at (541) 774-8048 or visit their website.
2. The procedure requires that you undress above the waist. A wrap will be provided by the facility for you to wear.
3. A technologist will be present to position your breasts for the mammogram. Most technologists are women. You and the technologist are the only ones present during the mammogram. The procedure takes about 20 minutes. The actual breast compression only lasts a few seconds.
4. You may feel some discomfort when your breasts are compressed, but you should not feel pain. To help lessen discomfort, don't have a mammogram just before or during your menstrual period. If you experience pain during the mammogram, tell the technologist.
5. Providence Breast Center will send your results to you within 30 days. You will be contacted within 5 working days if there is a problem with the mammogram.
6. Only 1 or 2 mammograms out of every 1,000 lead to a diagnosis of cancer.
7. Approximately 10% of women will require additional mammography. Don't be alarmed if this happens to you. Only 8%-10% of those women will need a biopsy, and 80% of those biopsies will not be cancer.
8. If you are a woman and age 40 or over, you should get a mammogram every year. You can schedule the next one while you're there at the facility and/or request a reminder.

The following are useful suggestions for assuring that you receive a quality mammogram:

• Ask to see the FDA certificate that is issued to all facilities that meet high professional standards of safety and quality.
• Use a facility that either specializes in mammography or performs at least 3 to 5 mammograms a day.
• If you are satisfied that the facility is of high quality, continue to go there on a regular basis so that your mammograms can be compared from year to year.
• If you change facilities, ask for your old mammograms to bring with you to the new facility so that they can be compared to the new ones.
• If you have sensitive breasts, try having your mammogram at a time of the month when your breasts will be least tender. Try to avoid the week right before your period. This will help to lessen discomfort.
• Don't wear deodorant, powder or cream, under your arms — it may interfere with the quality of the mammogram.
• Bring a list of the places, dates of mammograms, biopsies, or other breast treatments you have had before.
• If you do not hear from your physician within 10 days, do not assume that your mammogram was normal — confirm this by calling your physician or the facility.
  

Digital mammography is a relatively new x-ray imaging technology to aid in early detection and diagnosis of breast cancer. The Leila J. Eisenstein Breast Center at Providence Medford Medical Center is one of only a few medical centers in the region to have this sophisticated new imaging equipment. For the patient, the experience is similar to traditional film mammography. Firm compression is needed to obtain the best possible image.

The benefits of digital mammography become evident after the x-ray has been electronically digitized. Within seconds after an exposure is made, the technologist is able to view and assess the quality of the image on a computer monitor. When all of the views have been completed the images are transmitted to a high-resolution computer screen. Radiologists, who are specialists in the field of mammography, read the digital images. A number of enhancing adjustments are available to the interpreting physician. Magnification, image orientation, contrast and brightness controls may be used to facilitate the detection of any questionable areas in the breast tissue.

As with any mammogram it is advised that you wear a two-piece outfit and no deodorant, powder or perfume to your appointment.

The Leila J. Eisenstein Breast Center at Providence Medford Medical Center is located on the ground floor of Providence Plaza, adjacent to Providence Medford Medical Center. To make an appointment, please call: (541) 732-6100.

January 1, 1998, Medicare began covering annual mammograms. This benefit is not subject to the usual deductible, but the standard 20% co-pay applies.

Copyright © 2003 The American Cancer Society, Inc.

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