BREAST CANCER INDIA

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DIAGNOSIS OF BREAST CANCER: MAMMOGRAPHY


What is mammography?

A mammogram or a mammograph is a special type of x ray of the breast and the procedure is called as mammography. A mammography unit is a rectangular box that houses the tube in which x-rays are produced. The unit is used exclusively for x-ray exams of the breast. It has a compression paddle to position the breast properly.



Instructions before undergoing mammography

You must always keep the following points in mind before undergoing mammography:

  • Always inform the doctor about your present breast complaints. Any family history of breast cancer or taking hormone replacement therapy also needs to be known by the doctor.

  • Inform the doctor if you are likely to be pregnant as radiation is harmful to growing fetus.

  • It is best to undergo mammogram within a week of your periods.

  • Do not wear deodorant, talcum powder or lotion under your arms or on your breasts on the day of the exam. These can appear on the mammogram as calcium spots making it difficult to interpret.

  • Prior mammograms should always be carried to make comparisons with the present scans.



The procedure of mammography

Mammography is performed on an outpatient basis. The procedure takes about 15 minutes. During mammography, the technologist will position your breast in the mammography unit on a special platform and is then compressed with a paddle. Many women find having a mammography uncomfortable or even painful, but this is normally just for a short time. However, some women may find that the pain or soreness lasts for a few days.
Why is compression necessary?

  • Breast compression is essential for good mammograms.

  • It diminishes patient movement hence better image acquired.

  • No superimposition of tissues hence lesions seen better.

  • Less radiation as lesser thickness of breast tissue needs to be penetrated.

  • Uniformly spreads out breast tissue hence tumourous tissue stands out better.

Usually 2 views are taken for each breast. i.e in all 4 radiographs are obtained. Additional views like magnification view, Cleopatra view or compression mammograms may be acquired, if required, depending from person to person.



Disadvantages of mammography

  • There is a public misconception that screening mammography detects all breast malignancies. It is important to understand that mammography can miss 10% of the cancers. It is less sensitive in dense breasts which are seen in young women or women taking hormone replacement therapy, and this is a major disadvantage, and it is for this reason that mammography is not routinely recommended for screening for women below 40 years of age.

  • Mammograms can be uncomfortable.

  • Mammograms involve x-rays. They only use a low amount of radiation. The radiation dose given by breast screening x-rays is continually monitored to make sure that it remains as low as possible, while still providing a good-quality image. However, if you start screening at a younger age, over your lifetime you will be exposed to more radiation. There is a very small risk that this could affect your health. The radiation dose for a standard two view examination of both breasts is app 4.5 mGy.

  • A screening mammography may not pick up all breast cancers. It is more likely that cancers will be missed (on mammography) in women who are under 40.



Advantages of a screening mammography

  • Early detection of cancer: In women who have breast screening, most cancers are found at an early stage when there is a good chance that treatment will be successful. In India more than half of the breast cancers are discovered late when they have spread to the lymph nodes close to the breast or beyond that.

  • Screening mammography saves lives: Women who take part in breast screening reduce their risk of dying from breast cancer (by virtue of early detection of cancer.

  • Breast conservation surgery is possible: In women who have breast screening, any cancer is more likely to be found early. This means that the cancer is likely to be small and more likely to be removed by a lumpectomy (removal of the lump) rather than needing a mastectomy (removal of the whole breast).