Women between the ages of 20 and 39 who have no symptoms of breast disease should have a clinical breast examination every 3 years. A physician, a nurse practitioner, a nurse, or a physician assistant can perform this examination. The health care professional will examine both breasts for discrepancies in size or shape. The examiner will also palpate (feel) each breast to detect any lumps or masses. The area under both arms will be examined as well, to check for enlargement of lymph nodes.
A mammogram is an x-ray examination of the breasts, used to detect and diagnose breast diseases. Mammography is the most effective method of detecting cancer at an early stage, before the woman or a physician can feel it.
Screening mammography is used as a preventive measure for women who have no symptoms of breast disease. A screening mammogram usually involves two views of each breast. The American Cancer Society recommends that all women aged 40 and over have a screening mammogram every year as part of a breast health program, which also includes an annual breast examination by a healthcare professional.
Diagnostic mammography involves additional views of the breast, and is used when an abnormality is found during screening, or in women who have breast complaints, such as a breast mass, nipple discharge, breast pain, or skin irritation.
There are a number of steps a woman can take to prepare for a mammogram:
· If you have had mammograms or other breast procedures performed at another facility, bring a list of places and dates of procedures. If possible, bring previous mammography films with you, or have them forwarded to the facility before your visit.
· You will need to undress above the waist, so wear a two-piece outfit with a pullover top or a blouse that buttons in the front. Avoid wearing bulky jewelry that will have to be removed during the procedure.
· Do not wear deodorant, powder, or cream under your arms. These products could interfere with the quality of the mammogram.
· Schedule your appointment at the time of month when your breasts are the least tender. In general, the week after a period is when breasts are less tender, and the week before or during a period is when the breasts are most tender.
Sometimes, a doctor may order a fine-needle biopsy of the suspicious spot to determine if it is malignant (cancerous). In this type of biopsy, cells from the suspicious area of the breast are removed using a needle, and then spread on a slide. The slide is sent to the laboratory to be examined under a microscope.
The value of mammography is early detection. Early detection saves lives and, in many cases, also saves the woman's breast by identifying the cancer at a very early stage when it is most easily treated and is not life-threatening.
When a woman has a mammogram, she must undress above the waist and wear an open wrap, which is provided by the mammography facility. A breast-imaging technologist will place the patient in front of the machine and position each breast, one at a time, on the mammography equipment. The technologist will position the patient and the breast in the appropriate location for obtaining the best image of the breast. A paddle is then used to gently compress the breast so that the tissue is flattened.
Compressing the breast is necessary to obtain the best image. Compression thins and evens the breast tissue, so that a lower x-ray dose can be used. Even distribution of breast tissues reduces x-ray scatter, or the spread of radiation from the targeted tissue, which provides a better quality image. Compression also prevents the breast from moving during the procedure, thus reducing or eliminating blurred images. Breast compression lasts for a few seconds. It is uncomfortable, but should not be painful.
Some women find breast compression to be more uncomfortable than others; in fact, some women avoid having mammograms because they fear it will be painful or they had a past experience that was painful. There is a breast cushion, the MammoPad, that can be used during the exam to reduce the discomfort associated with mammography.
When the breast is positioned and compression is complete, the technologist will leave the room or step behind a screen. Once shielded, the technologist will turn on the x-ray source to transfer the image of the breast onto the x-ray film or the digital detector. The process of positioning and radiating is repeated for additional views of the same breast and for the other breast.
If a screen-film examination is being conducted, the technologist will take all of the x-rays needed for the examination. She will then develop the films before the patient leaves, to make sure each film shows the right view and exposure.
In digital mammograms, the image for each exposure will appear on the technologist's computer screen, and she will be able to make sure each image is acceptable before positioning the patient for the next view.
The entire procedure for screening mammography should take 15 to 20 minutes for a screen-film examination and 5 to 10 minutes for digital mammography. The procedure may take longer if additional views are needed, as is the case in diagnostic mammography or for mammography of women with breast implants. Breast implants create a unique imaging situation, because some breast tissue will be covered by the implant and cannot be seen on x-rays. To compensate for this, additional films are taken, to allow as much breast tissue as possible to be imaged.
The mammography films are interpreted by a radiologist, who will look for abnormalities and compare the new films to previous mammograms, to detect any changes. The radiologist prepares a report for your mammography facility. The mammography facility is responsible for notifying the patient of the results.