Mammograms are probably the most important tool doctors have, not only to screen for breast cancer, but also to diagnose, evaluate, and follow people who do not have breast cancer. Mammograms do not prevent breast cancer, but they can save lives by detecting a cancer as early as possible. Women often stay away from checking their breasts through a mammography either because of fear of the result, the compression or the minimal amount of radiation required to produce the images. The taboos present in society surrounding breast cancer do not help either. We caught up with radiologist Malcolm Crockford to get a better understanding of what is a mammogram.
1. What is a mammogram?
A mammogram is a specialised X-ray of the breast, which uses a dedicated mammography unit. The result is a very detailed radiograph that allows us to see mammary glands and fat tissues mainly. Early breast cancer is well seen on these examinations, often about six to eight months before it can be felt. The technique is highly specialised and requires specific training and expertise. Quality standards must be adhered to throughout the process. Nowadays conventional analogue film-screen mammography is being replaced by new digital mammographic examinations producing much clearer images, which can be manipulated by computers at around a 30 per cent reduction in radiographic dose. These digital images can be stored on a database server and sent also to referring doctors via email.
2. How is it done? What happens during a mammogram?
A radiographer, ideally a female trained in the technique carries out the mammographic examination in a private and relaxed environment. After a few minutes during which time the radiographer is attempting to make the lady feel relaxed, the breasts are placed on a special plate and gently compressed for a couple of seconds. On the initial examination two views are taken but subsequent mammography requires only a single view lateral oblique film. The gentle compression should never be painful and does not damage the breast.
3. How long does it take?
A mammographic examination should take around 10 minutes. The consultant radiologist may require extra views during the procedure if more information is required on a particular area of the breast.
4. What happens after a mammogram?
The films are sent to the examining radiologist who specialises in the interpretation of these images. The images are assessed and a result is generated. Sometimes the density of the breasts, or some presumed abnormality seen on the mammogram, requires that an ultrasound is carried out immediately by the radiologist to help increase the accuracy of the examination. Those few examinations where the result is unclear after both digital mammography and ultrasound move on to requiring some form of biopsy, from a simple aspiration using a syringe under local anaesthetic to a more formal biopsy that may need a general anaesthetic. It is important that the examining radiologist keeps to a minimum the number of women referred on for biopsy, as this is a primary source of anxiety related to the examination.
5. Why should women over 35 do it?
The incidence of breast cancer begins to rise at around the age of 34 years, rising to a peak at around 65 years. Unfortunately after 65 years the numbers do not return to low levels but often the woman experiences other problems, which may take priority over the checking of the breast, like a stroke or severe heart failure. We generally recommend that women start doing a regular mammography at 35 years and continue doing this test at an interval of between 12 and 18 months. The shorter the interval, the more likely the cancer is picked up in its early and curable stage. The radiation dose should never be used to scare off women from undergoing mammography or for stretching out the interval period for examination past 24 months. The radiation levels from digital mammography amount to less than a quarter of the natural background radiation from our sun in a single year.
6. What is the best method of detecting breast cancer as early as possible?
Mammography, now digital mammography, remains the gold standard for the diagnosis of breast cancer. Approximately 70 per cent of breast cancers produce fine 1 to 2 millimetres micro-calcifications which are only really picked up by good quality mammography. Ultrasound, MRI and other newer tests being developed like Digital Tomosynthesis and PE Mammography are only to be used as backup or complementary tests to the mammographic examination. Picking up breast cancer early not only helps to improve the life expectancy of a woman but also means that less aggressive treatment like lumpectomy instead of mastectomy are carried out. Often chemotherapy and sometimes radiotherapy would not need to be given if the cancer is caught early.
7. How much do mammograms help to lower deaths from breast cancer?
Mammography has been found to be the best method to employ to pick up early breast cancer. It is now being used in major National Breast Cancer Screening Programmes across the world because many trials have confirmed that picking up breast cancer early leads to much better treatment and cure of the disease. Currently in Malta approximately 250 women develop the condition every year but we are already noticing that over the last four years or so the number of Maltese women dying from breast cancer is going down thanks to more awareness, more mammography and better treatment of the disease.
In between mammograms women should also learn how to check their breasts themselves, one of the most important tools for early diagnosis. Medics and people in the breast cancer field advise us to show our breasts some TLC. This acronym may stand for tender loving care in day to day terminology and may be carried out by Touching the breasts and feeling about for anything unusual, Looking for changes while being aware of your breasts’ normal shape and texture, and Checking anything unusual with your doctor as well as talking to friends if you are worried about seeing a specialist.