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Diagnostic-Imaging

Mammography

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

Mammography captures sharp, digital images of the breasts. Once the digital images are obtained and transmitted to a digital mammography workstation, our radiologists analyze the images to determine the precise location and extent of the disease.

A mammography is an X-ray exam that may also identify breast changes and locate tumors that are too small or too deep to be detected with a breast examination. For women experiencing symptoms such as a lump, pain, skin dimpling or nipple discharge, a mammogram may determine whether the side effects are a result of cancer or another condition.

Mammography is an important tool in the early detection of breast cancers because it may show changes in the breast months or years before a patient is able to feel them. Current guidelines from the U.S. Department of Health and Human Services and the American College of Radiology recommend mammography screening every year for women, beginning at the age of 40. A mammogram may also help determine whether a woman has dense breasts, meaning their breasts have more of the type of glandular tissue that is of higher risk for developing cancer.

The mammography unit is designed to accommodate virtually any size breast, large or small. During a mammogram, the breasts are compressed, one at a time, between two firm surfaces that flatten the breast tissue for improved imaging. Some patients may experience mild discomfort depending on the sensitivity of their breasts, but the pressure lasts only a few seconds. Multiple images of the breast are taken with X-ray technology, and the images are displayed on a computer screen and examined for signs of cancer.

If an abnormality is detected, it may or may not require treatment. Your doctor may recommend further tests, such as an ultrasound or MRI. If the radiologist believes the abnormality needs further study, a biopsy may be performed to determine whether the mass is cancerous.

Some types of mammography include:

Computer-aided detection (CAD) for mammography

CAD for mammography is used to analyze mammographic images and check for the presence of breast cancer. The CAD system analyzes digital information collected by a mammogram and then computer software searches for abnormal areas of density, mass or calcification. The system highlights suspicious areas, alerting doctors to the need for further analysis.

The CAD system may improve the detection of cancer in the breast by acting as a second set of eyes to find abnormal areas on a mammogram.

Digital breast tomosynthesis

Digital breast tomosynthesis creates a 3-D picture of the breast. Tomosynthesis is similar to a standard mammogram in that it uses X-ray technology and applies the same amount of pressure to the breast. But rather than providing two views—from top to bottom and side to side—the 3-D approach captures multiple views from a variety of angles in seconds.

During the procedure, an X-ray tube moves in an arc around the breast, capturing multiple images that are used to create a detailed, layer-by-layer view of the tissue. This cross-sectional perspective helps to separate overlapping tissue densities, allowing radiologists to detect cancer at an earlier stage.

Images are sent to a computer to create a clear, highly focused 3-D image. Tomosynthesis may be used along with traditional digital mammography as part of your annual mammogram. The technology is approved by the U.S. Food and Drug Administration as a screening tool for breast cancer.

Full-field digital mammography

This mammography unit captures an electronic picture of the breast in digital format. Once they are transmitted to a high-tech, digital mammography workstation, the images are used to determine the precise location and extent of the disease. Because the images appear on a computer screen, doctors can adjust the image size, brightness and contrast to see certain areas more clearly.

Traditional vs. 3D mammography: Which is better for you?

The development of a 3D-like mammogram, called digital breast tomosynthesis (DBT), has been a major advancement for cancer detection.

Mammography

How to prepare for a mammogram

Before your appointment

  • Find the right facility for you. Your doctor might recommend a specific location, but it’s helpful to do your own research as well. Consider choosing a center or facility that specializes in breast imaging and mammograms.
  • Be consistent. Once you choose a location that fits your needs, try to visit the same location when you schedule a screening. This way, your mammograms can easily be compared year over year. If you do go to a new facility, keep all your mammograms and related documents organized so that the new technologist can more accurately assess your medical history.
  • Schedule your mammogram for the optimal time. Avoid scheduling your mammogram when you are on your period or right before your period, as your breasts may be tender or swollen.
  • Avoid wearing deodorant. The U.S. Centers for Disease Control and Prevention (CDC) recommends not wearing deodorant/antiperspirant, baby powder, perfume or lotion, as some of these products contain substances that can appear as white spots on the X-ray.
  • Dress accordingly. Before the mammogram, you’ll be asked to remove your top and bra for the X-ray, so it might be more convenient to wear a loose top and pants or a skirt versus a dress, one-piece or tight clothing. The facility will provide a wrap or gown for you to wear.
  • Keep your medical records organized. Your technologist will ask for personal and medical history, such as past surgeries, hormone use, breast cancer in the family or if you’ve had breast cancer before.

During the procedure

  • Be prepared for the placement. Each breast will be placed between two plates that will compress or flatten the breast to spread the tissue apart. The imaging machine will then take X-ray pictures, typically from two different angles.
  • Allot enough time. The entire procedure should take about 20 minutes, with each breast compression lasting a few seconds each.
  • Don’t be afraid to speak up. It’s not uncommon to feel some pain or discomfort during a mammography, so speak up to your technologist if the pain is too much. You might also be a little sensitive to the coldness of the plates.
  • Lean on a loved one. If you have anxiety ahead of the appointment, it might help to bring someone with you for support. Check with the facility beforehand to see if there are any restrictions on bringing support.

After the procedure

  • Review test results. You’ll be contacted with the results typically within 10 days, and you'll also receive a full report from your center or clinic typically within 30 days.

Why is screening so important?

In 2021, approximately 281,550 new cases of invasive breast cancer will be diagnosed in the United States, according to the American Cancer Society (ACS). These numbers reinforce the importance of breast cancer screening, which largely includes a traditional mammogram, while some facilities also offer three-dimensional (3D) mammography.

When should you schedule a mammogram?

First and foremost, you should speak directly with your doctor about the benefits and risks of getting a mammogram, when to start screening and how often to get screened based on your individual medical history. The American College of Radiology and the American College of Surgeons' National Accreditation Program for Breast Centers recommend the following screening recommendations for women with average risk:

  • Begin annual screening at age 40.
  • If you’re a woman between 55 to 75 with average risk, schedule a mammogram once every one to two years.
  • If you’re a woman over 75 with average risk, continue to schedule a mammogram depending on overall health, including a life expectancy of 10 years or more.

Additional screening recommendations may be suggested for women with high risk, including those who have a BRCA1 or BRCA2 mutation, who are an untested family member of someone who has BRCA1 or BRCA2 mutation, have a history of mantle or chest radiation occurring before age 30 or who have a family history of breast cancer risk of 20 percent or greater, based on their family history, according to the ACS.

Radiation risk factor

While patients are exposed to a small amount of radiation during the X-ray process that produces the breast imaging, the radiation doesn’t affect everyone the same. The risk is greater for women younger than 40 years old, according to the National Institutes of Health, and your X-ray technologist should always know if you’re pregnant or there is a possibility that you're pregnant. According to the ACS, the benefits of mammography to detect breast cancer under age 40 greatly outweigh the risks of radiation exposure.

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