Mammography at the RMC
What Is Mammography?
Mammography is a specific type of imaging that uses a low-dose x-ray
system and high-contrast, high-resolution film for
examination of the breasts. Successful treatment of breast cancer depends on
early diagnosis. Mammography plays a central part in early detection of breast
cancers. Mammography can show changes in the breast up to two years before a
patient or physician can feel them. The Food and Drug Administration (FDA) says
that mammography can detect 85 to 90 percent of breast cancers in women over 50.
Current guidelines from the American Medical Association (AMA) and the American
College of Radiology (ACR) recommend that beginning at age 40 women get annual mammograms.
What are some common uses of
Mammography is used to diagnose breast diseases in women. The use of
screening mammography can assist in the detection of disease even if you have no
complaints or symptoms.
While the AMA and ACR recommend that women aged 40 and older get annual
mammograms, the National Cancer Institute (NCI) says women who are at increased
risk due to a genetic history of breast cancer, or who have had breast cancer,
may need to get mammograms at an earlier age.
The initial two mammography images themselves are not always enough to determine
the existence of a benign or malignant disease with certainty. If a suspicious
finding or spot is seen, the radiologist may recommend further diagnostic studies.
How should I prepare for the
Before scheduling a mammogram, the American Cancer Society (ACS)
recommends that you discuss any new findings or problems in your breasts with
your doctor. In addition, inform your doctor of any prior surgeries, hormone
use, and family or personal history of breast cancer.
Do not schedule your mammogram for the week before your period if your breasts
are usually tender during this time. The best time is one week following your
period. Always inform your doctor or x-ray technologist if there is any
possibility that you are pregnant.
ACS also has these recommendations:
|Do not wear deodorant, talcum powder, or lotion under your arms on
the day of the exam. These can appear on the x-ray film
as calcium spots.|
|Describe any breast symptoms or problems to the technologist
performing the exam.|
|If possible, obtain prior mammograms and make them available to
the radiologist at the time of the current exam.|
|Ask when your results will be available; do not assume the results
are normal if you do not hear from your doctor or the mammography
In addition, before the examination, you will be asked to remove all jewelry
and clothing above the waist and you will be given a gown or loose-fitting
material that opens in the front.
What does the equipment
A mammography unit looks similar to any radiographic equipment that
produces x-rays to obtain an image of some part of the human body;
such as chest organs or bones. The main part of a mammography unit looks like a
rectangular box that houses the tube in which x-rays are produced.
A mammography unit is "dedicated equipment," because it is used
exclusively for x-ray exam of the breast. The unit has special
accessories that allow only the breast to be exposed to the x-rays.
Attached to the unit is a device that holds and compresses the breast and
positions it so images can be obtained at different angles.
How does the procedure work?
The breast is exposed to a small dose of radiation to produce an
image of internal breast tissue.
The image of the breast is produced as a result of some of the x-rays
being absorbed (attenuation) while others pass through the breast to expose the
film. The exposed film is either placed in a developing machine, producing
images much like the negatives from a 35-mm camera, or images are digitally
stored on computer.
How is the procedure
During mammography, a specially-qualified
radiologic technologist will position the patient and image the breast. The
breast is first placed on a special cassette and compressed with a paddle (often
made of clear Plexiglas or other soft plastic).
Breast compression is necessary in order to:
|Even out the breast thickness so that all of the tissue can be
|Spread out the tissue so that small abnormalities won’t be
obscured by overlying breast tissue|
|Allow the use of a lower x-ray dose since a thinner
of breast tissue is being imaged
|Hold the breast still in order to eliminate blurring of the image
caused by motion|
|Reduce x-ray scatter which also leads to poor image
The technologist will go to behind a glass shield while making the
exposure, which will send a beam of x-rays through the breast to
the film behind the plate, thus exposing the film.
You will be asked to change positions slightly between images. The routine views
are a top-to-bottom view and a side view. The process is repeated for the other
The examination process should take about half an hour.
When the mammography is completed you will be asked to wait until the
technologist examines the images to determine if more are needed.
What will I experience during
Generally, this is a painless procedure. You will feel pressure on
the breast as it is squeezed by the compressor. Some women with sensitive
breasts may experience discomfort. If this is the case, schedule the procedure
when your breasts are least tender. The technologist will apply compression in
gradations. Be sure to inform the technologist if pain occurs as compression is
increased. If discomfort is significant, less compression will be used.
What are the benefits vs.
|Imaging of the breast improves a physician's ability to detect small
tumors. When tumors are small, effective treatment and cure are more
|The use of screening mammography increases the detection of small
abnormal tissue growths confined to the milk ducts in the breast,
called ductal carcinoma in situ (DCIS). These early tumors cannot harm
patients if they are removed at this stage and mammography is the only
proven method to reliably detect these tumors.|
|Radiation exposure. Mammography is an x-ray imaging
procedure. Federal mammography guidelines limit the radiation used for
each exposure of the breast to 0.3 rad. The exposure to radiation
received from two mammographic views is equivalent to six months of
natural background exposure. This amount of exposure is believed to be
|Special care is taken during x-ray examinations to
ensure maximum safety for the patient by shielding the abdomen and
pelvis with a lead apron, with the exception of those examinations in
which the abdomen and pelvis are being imaged. Women should always
inform their doctor or x-ray technologist if there is any
possibility that they are pregnant.|
|False Positive Mammograms. Between 5 and 10 percent of mammogram
results are abnormal and require more testing (more mammograms, fine
needle aspiration, ultrasound, or biopsy), and most of the follow-up
tests confirm that no cancer was present. It is estimated that a woman
who has yearly mammograms between ages 40 and 49 would have about a 30
percent chance of having a false-positive mammogram at some point in
that decade, and about a 7 to 8 percent chance of having a breast
biopsy within the 10-year period. The estimate for false-positive
mammograms is about 25 percent for women ages 50 or older. |
What are the limitations of
Interpretations of mammograms can be difficult because a normal
breast can appear differently for each woman. Also, the appearance of an image
may be compromised if there is powder or salve on the breasts or if you have
undergone breast surgery. Because some breast cancers are hard to visualize, a
radiologist may want to compare the image to views from previous examinations.
Not all cancers of the breast can be seen on mammography. Actually the
sensitivity of mammography to detect breast cancer is 84% only, according
to published data.
Breast implants can also impede accurate mammogram readings because silicone
implants are not transparent on x-rays and can block a clear view
of the tissues behind them, especially if the implant has been placed in front
of, rather than beneath, the chest muscles. But the NCI says that experienced
technologists and radiologists know how to carefully compress the breasts to
improve the view without rupturing the implant. When making an appointment for a
mammogram, women with implants should ask if the facility uses special
techniques designed to accommodate them. And before the mammogram is taken, they
should make sure the technologist is experienced in performing mammography on
patients with breast implants.
Recent data further indicates that the traditional
breast exam has little value on the early discovery of breast cancer. For all
these reasons, continuance vigilance and additional evaluation with ultrasound
or MRI's should be considered in the high risk individuals.