Definition & Overview

A mammogram is a result of a diagnostic procedure called mammography, which exposes the breast to a low-dose radiation to create an image of it, very much akin to an x-ray. Mammograms are recognized as an essential tool for the early detection of abnormalities in women's breasts since they can show minuscule changes that are typically undetected by simple palpation or breast self-examination (BSE).

Though the goal of mammography hasn't changed over the years, the technology being used certainly has. Below are the new innovations to mammography that provide better results:

  • Digital mammography – The only difference between digital and conventional mammography is the format of the x-ray image, the process remains the same. Digital mammography produces clearer digital images that are easily stored and easily referenced by technicians and doctors. They are often viewed from the computer, which also allows them to be stored for a long time.
  • Computer-aided detection (CAD) systems – these are algorithmic programs that can be manipulated by doctors and technicians to search digital mammographic images for any characteristic that may point to breast cancer or some other disease. Those images that were flagged are further assessed by doctors and radiologists to come up with an accurate diagnosis.
  • Breast tomosynthesis – also referred to as 3D mammography, this functions very much like a CT scan where multiple images of the breasts are captured from specific angles and composited to create a full 3D image. Breast tomosynthesis gives a more accurate description of the abnormalities that were previously detected. The images can show vivid clarity when it comes to the size, shape, and location of breast anomalies. Because of this detailed view, the need for additional tests is minimized.

Who should undergo and expected results

Below are the two types of mammography and their purpose:

  • Screening mammography – Screening mammography is a procedure that patients undergo for breast disease checking even when there are no evident symptoms. It is a preventive type of diagnostic procedure that is meant to check or monitor subtle changes in breast tissue even when there are no signs or symptoms that point to it. This is highly recommended for patients who have a predisposition for breast diseases like breast cancer.
  • Diagnostic mammography – this is often the next step when a screening mammography shows abnormalities in the breast tissue. However, there may be cases when the symptoms are more pronounced like the patient has an obvious, palpable breast lump or she is experiencing nipple discharge, that a screening mammogram is precluded, and a diagnostic mammography is deemed more appropriate. A diagnostic mammography is meant to provide further clues as to the nature of the discovered anomalies.

How the procedure works

Mammography is performed in a laboratory clinic as an outpatient procedure. The following bullet points outline how it is typically performed:

  • In the mammography room, the technician will ask the patient for her personal and medical information. Patients who have palpated lumps in the breasts or have had recent breast surgery and/or breast implants must mention such information.
  • The technician will then place stickers on the nipples and other marks (such as birth marks) on the breasts to distinguish them in the pictures.
  • The patient will then be asked to position her breast on the mammography unit. There is a special moveable platform that can be adjusted based on the patient's height to minimize discomfort. The breast will be placed on top of this for support before it is compressed by two flat, clear panels.
  • Images will then be taken to obtain different views of each breast. Once the images are captured, the machine will release the breast, and the process will be repeated on the other breast.
  • The number of views will depend on whether there are anomalies that need to be checked out or if the doctor has requested an angle that is not normally accessed.
  • The procedure ends after the technician obtains the required number of images. The patient is then sent home and is scheduled for a follow-up visit where the results of the test will be discussed.


To ensure the accuracy of the procedure, patients are asked to:

  • Schedule the procedure at least a week after or before their menstrual period when the breasts are not so tender since mammograms may cause a bit of discomfort.
  • Not put on deodorant, lotion or body powder on the day of the mammogram as these may show up on the scan as calcium spots
  • Mention if they prefer a female technician or if they do not mind having a male technician for the procedure
  • Bring previous mammograms for reference
  • Mention if they have breast implants so that the technician can make a note of it.

Possible risks and complications

The risk of mammograms is that some images may result in additional testing, either because there's an anomaly in the image or the image wasn't all that clear to begin with. Some of these turn out to be false positive mammograms, meaning there isn't anything to worry about.

References:

  • American Cancer Society. American Cancer Society Recommendations for Early Breast Cancer Detection in Women Without Breast Symptoms. Last revised October 24, 2013. Available at: www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs. Accessed January 29, 2015.

  • American College of Obstetricians and Gynecologists (ACOG). ACOG practice bulletin no.122. Breast cancer screening. Obstet Gynecol. 2011;118:372-382. PMID 21778569. Available at: www.ncbi.nlm.nih.gov/pubmed/21775869.

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