Author: MedicText team
What is a Mammogram and Who Should Have it Done?
Simply put, a mammogram is an x-ray of the breast.
Mammograms can be used for early (or late) detection of breast cancer in women who have no signs or symptoms of the disease. This type of mammogram is called a selective or screening mammogram, ie this procedure is chosen according to the characteristics and preferences of women to find breast cancer when there are no manifested symptoms. Usually, a mammogram requires two radiographs or images of each breast. These images make it possible to detect possible tumors which can not be felt through the skin or to find microcalcifications (tiny deposits of calcium in the breast) that sometimes are an indication of the presence of breast cancer.
Mammograms can also be used to find breast cancer after having found a lump or other sign or symptom of the cancerous tumor. This type of mammogram is called a diagnostic mammogram. Certains signs of breast cancer are pain, skin thickening, nipple discharge or a change in breast size or shape. Nonetheless, these signs can also be a sign of a benign abnormal celular growth. A diagnostic mammogram may also be used to evaluate changes found during a screening mammogram or to view breast tissue when it is difficult to obtain a screening mammogram because of special circumstances, for example, the presence of breast implants.
What is the difference between a screening mammogram and a diagnostic mammogram?
Diagnostic mammograms take longer than screening mammograms because more x-ray exposure is required to obtain views of the breast from various angles. The technician can magnify a suspicious area to produce a detailed picture that helps the doctor make an accurate diagnosis.
What are the benefits of the screening or selective mammogram?
Early detection of breast cancer with a screening mammography means that treatment can comence sooner in the course of the disease, possibly even before it has begun to spread. The results of randomized clinical trials and other studies suggest that mammography screening can help reduce deaths from breast cancer among women 40 to 74 years of age, especially for those older than 50. However, studies conducted to date have not indicated that there are any benefits in performing regular screening mammograms (or diagnostic mammograms for that matter) in women under 40.
What are some of the potential harms of performing screening mammograms?
Finding cancer does not always mean saving lives: Even though mammography can detect cancers that can not be felt over the skin surface, treating a small tumor does not always mean success in saving the life of the patient. A fast-growing or a highly malignant cancer may have spread to other parts of the body before being detected. In addition, mammography screening may not help a woman suffering from other health conditions that put her life in danger.
False negatives: These occur when mammograms appear normal even though breast cancer is present. In general, up to 20% of breast cancers present are not detected when doing a screening mammograms.
The main cause of false negative results is the high density of the breast. The breasts contain both dense tissue (ie glandular tissue and connective tissue, which together are known as firbroglandular tissues) and adipose tissue (fat). Adipose tissue appears dark on mammograms (radiolucid tissue), while the dense tissue and tumors appear as white areas (radiopaque or radio-opaque tissue). Since the fibroglandular tissue and tumors have a similar density (they are both Radiopaque tissues, meaning, they block radiation from x-rays and appear as white areas on the x-ray film), detecting tumors in women with dense breasts may prove more difficult.
False negatives occur more frequently among young women than in older women since younger women are more likely to have dense breasts. As women age, their breasts become more fatty and false negative results are less likely. False negatives can lead to delayed treatment and a false sense of security of women affected.
False positives: These occur when radiologists conclude that mammograms are abnormal but no cancer is actually present. All abnormal mammograms should be followed with additional testing (diagnostic mammography, ultrasound, or biopsy) to determine the presence of cancer. False positives are more common in younger women, in women who have had prior breast biopsies, in women with a family history of breast cancer, and in women taking estrogen (for instance, as in hormone therapy).
False positive mammograms can lead to anxiety and other forms of psychological distress in patients. Any additional testing required to rule out cancer can also be costly and time consuming and can cause physical discomfort.
Overdiagnosis and overtreatment: Screening mammograms can find cancers and cases of ductal carcinoma in situ (DCIS, a noninvasive tumor in which abnormal cells that may turn cancerous are formed in the lining of the breast ducts) in need of treatment. However, these types of mammograms can also find cancerous tumors and cases of DCIS that will never cause symptoms or endanger the lives of women, in which case we run into an "overdiagnosis." No treatment is required for the latter, thus any treatment would actually be an "over-treatment". Excess or redundant treatment needlessly exposes women to the adverse effects associated with anti-cancer therapy.
Since in reality doctors can not distinguish between cancerous tumors and DCIS cases requiring treatment from those which do not need treatment at all, in consequence all of these cases end up being treated.
Radiation exposure: Mammograms require very small doses of radiation. The risk of damage from exposure to this radiation is very mild, but repeated exposure to x-rays could in fact cause cancer. However, the overall benefits usually outweigh the risks.
Women should consult their physician on the real need for each individua radiography. Additionally, she should always inform the doctor or technician of the possibility of being pregnant.
Recommendations from the National Cancer Institute (NCI) concerning screening mammograms
Women 40 years of age or older should have mammograms done every 12 to 24 months.
Women at higher risk of developing breast cancer should talk with a health professional about the need to have mammograms done before the age of 40 and about their frequency.
Factors that increase the risk of breast cancer
The strongest risk factor for breast cancer is age. As women age, the risk of developing breast cancer increases. However, the risk of breast cancer is not the same for all women from the same age group. Research has shown that women with the risk factors mentioned below have a greater chance of developing breast cancer:
Personal history of breast cancer: Women who have suffered from breast cancer in the past have a greater chance of developing breast cancer a second time.
Family history: The probability of a woman developing breast cancer increases if her mother, sister, or daughter has been diagnosed with it, especially if the diagnosis has been made before 50 years of age. Having a male relative with breast cancer also increases a woman's risk of developing the illness.
Genetic alterations (mutations): Inherited changes in certain genes (eg BRCA1, BRCA2, and others) increase the risk of breast cancer. It is estimated that these changes do not represent the cause of developing breast cancer in more than 10% of all cases. However, women who carry certain changes in these genes present increased risk of breast cancer than women who do not carry these changes.
Breast density: Women with a high percentage of dense tissue in the breast have a higher risk of breast cancer than women of similar age who have little or no dense tissue. Some of this increase may be caused by the "mask" effect from fibroglandular tissue in the ability to detect tumors in mammograms (as explained above).
Article Source: http://www.articlesbase.com/womens-health-articles/what-is-a-mammogram-and-who-should-have-it-done-3520525.html
About the AuthorWe are medical translators, health article writers, and healthcare professionals in different fields (Radiology, MTC, etc).
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Links
- Hope for the Journey through Cancer: Inspiration for Each Day
- Cancer Is a Bitch: (Or, I'd Rather Be Having a Midlife Crisis)
- Be a Survivor: Your Guide to Breast Cancer Treatment
- Stand by Her: A Breast Cancer Guide for Men
- I Am Not My Breast Cancer: Women Talk Openly About Love and Sex, Hair Loss and Weight Gain, Mothers and Daughters, and Being a Woman with Breast Cancer
- What Your Doctor May Not Tell You About(TM): Breast Cancer: How Hormone Balance Can Help Save Your Life (What Your Doctor May Not Tell You About...)
- The Breast Cancer Companion: A Guide for the Newly Diagnosed
- Five Lessons I Didn't Learn From Breast Cancer (And One Big One I Did)
- Promise Me: How a Sister's Love Launched the Global Movement to End Breast Cancer
- Breast Cancer: The Complete Guide: Fifth Edition
