Breast cancer mammography

, Assistant Editor(s)-In-Chief: Jack Khouri

Overview
Mammography is the modality of choice for detection of early breast cancer. There are many advantages towards diagnostic usage of mammography: it is relatively fast, reasonably accurate, and widely available in developed countries. Breast cancers detected by mammography are usually much smaller (earlier stage) than those detected by patients or doctors as a breast lump.

Breast cancer can present on mammography as a spiculated mass or clustered calcifications.

Advantages

 * Mammography has been estimated to reduce breast cancer-related mortality by 20-30%.

Disadvantages

 * Evidence in favor of mammographic diagnostic screening comes from eight randomized clinical trials from the 1960s through 1980s. Many of these trials have been criticised for methodological errors, and the results were summarized in a review article published in 1993.
 * False positives are a major problem of mammographic breast cancer screening. Approximately 7% of all mammographic screenings are false positives.
 * Data reported in the UK Million Woman Study indicates that if 134 mammograms are performed, 20 women will be called back for suspicious findings, and four biopsies will be necessary, to diagnose one cancer. Recall rates are higher in the U.S. than in the UK.


 * Mammography in women under 50 years of age can be imprecise due to mammographic breast density. Breast density is an independent adverse prognostic factor on breast cancer prognosis.



Procedure

 * After a screening mammogram, some women may have areas of concern which can't be resolved with only the information available from the screening mammogram. They would then be called back for a "diagnostic mammogram". This phrase is essentially a problem-solving mammogram. During this session, the radiologist will be monitoring each of the additional films as they are taken to determine the cause of the abnormal appearance.
 * During the procedure, the breast is compressed by a dedicated mammography machine to:
 * Even out the tissue
 * Increase image quality
 * Hold the breast still (preventing motion blur).


 * Due to imaging limitations, some elements may show up on x-ray as calcium spots. For this reason, women are discourage from applying the following on the day of the mammogram.
 * Deodorant
 * Talcum powder
 * Lotion


 * The outcome of a mammogram may be benign or may require further investigation. If the cause cannot be determined to be benign with sufficient certainty, a biopsy will be recommended.