Mammography. (Healthbeat).

According to the American Cancer Society, mammography is an x-ray examination of the breast. A mammogram is used to detect and diagnose breast disease in women who have breast symptoms (lump, pain or nipple discharge) and in women who are asymptomatic. It is important to remember however that mammography cannot find all breast cancers. The American Cancer Society recommends that women without breast symptoms use the following three methods to find breast cancer:

* Mammograms annually

* Clinical breast examinations by your doctor or other health care professional, and

* Breast self examination

Modern mammography has only existed since 1969 when the first x-ray machines used just for breast imaging were available. Since then, the technology has advanced a great deal, so that today's mammogram is very different even from those of the mid-1980's.

The modern technique uses a special machine to produce studies that are high quality but have low radiation dose (usually about 0.1 to 0.2 rad dose per picture). If a woman had yearly mammograms beginning at age 40 and continuing until 90, she will have received 20-40 rads. Mammography is classified as either Screening (yearly breast imaging) or Diagnostic, for women who are having breast symptoms or have had an abnormality detected during routine screening.

The x-ray used for breast imaging is different than for other parts of the body. This type of x-ray does not penetrate tissue as easily. To obtain a quality, usable image using low dose radiation, the breast is squeezed between 2 plates to spread the tissue apart. Although this is temporarily uncomfortable it only lasts a few seconds. The entire procedure for a screening mammogram takes only about 20 minutes.

Reading mammograms

Reading mammograms is difficult because there is a wide range in what is considered normal. It is important for the radiologist to have the films from previous examinations for comparison. The radiologist will look for calcifications within the breast tissue. Macrocalcifications usually non-cancerous, most often do not require biopsy and may be caused by normal aging, old injuries or inflammations. About half the women over 50 and 1 in 10 women under 50 will have breast macrocalcifications.

Microcalcifications may appear alone or in clusters and do not always mean that cancer is present. The shape and layout of microcalcifications help the radiologist determine the likelihood of cancer and if biopsy or follow-up films will be necessary.

A mass, which may occur with or without calcifications, is another important change seen on a mammogram. The mass may be caused by a cyst which is a benign, fluid filled sac. A cyst will be further diagnosed using breast ultrasound or needle aspiration techniques. A mass that is not a cyst may require further imaging tests.

Tips for Having a Good Quality Mammogram

The following suggestions may be useful to you in assuring a positive experience and a quality mammogram.

* Use a facility that specializes in mammography

* When you find a quality facility, continue to use them on a regular basis

* Bring a list of the places and dates of mammograms, biopsies or other breast treatments you have had

* For mammograms done at a different facility, arrange to get those mammograms to the current facility before your visit

* On the day of your examination, do not wear deodorant as this may cause artifacts to appear on the films

* If your breasts are tender the week before your period, avoid mammography during that time

* Describe any breast symptoms you are having to the technologist performing the examination

* If you do not hear from your doctor within 10 days, do NOT assume that your mammogram was normal! Call your doctor or the facility.

For more information on mammography and breast cancer, contact the American Cancer Society at www.cancer.org or 1-800-ACS-2345

This column was provided by Robin Caplan, CDA, QDA, DRT; Owings Mills, MD; ADAA's Third District Trustee.