Mammography

Mammography is an X-ray of the breasts used for diagnosing breast cancer. The resulting X-ray picture is called a mammogram.

X-rays are a type of radiation, like radio or light waves, that can be focused into a beam, much like a spotlight beam. Unlike light, X-rays can pass through most objects, including our bodies. When X-rays strike photographic film, they produce a picture. Dense tissue such as bones absorb many of the rays and appear white; less dense tissue like ligaments and organs allow more of the rays to pass through and appear in shades of gray. X-rays completely unblocked appear black.

A mammogram is done to help screen for or diagnose breast cancer. Many small tumors can be seen on a mammogram before they can be felt by a woman or her doctor. Cancer that is discovered in an early stage is more easily treated and cured.

Purpose
A mammogram is done to:

• Screen for breast cancer. Mammography is done to screen for breast cancer in women without symptoms.
• Diagnose breast cancer. Symptoms of breast cancer may include a lump or thickening in the breast, nipple discharge, or dimpling of the skin on one area of the breast.
• Locate an area of suspicious breast tissue to remove for examination under a microscope (biopsy) when an abnormality is found.

How to Prepare
If you have previously had mammography done at another hospital or clinic, have the results sent or bring them with you to your exam.

Tell your doctor if you might be pregnant, are breast-feeding, or if you have breast implants.

On the day of the mammography test, do not use any deodorant, perfume, powders, or ointments on your breasts. The residue left on your skin by these substances may interfere with the X-rays.

You might want to have your mammogram done within 2 weeks after your menstrual period ends because the procedure will be most comfortable during that time.

How It Is Done
Mammography is done by a radiology technologist. The X-ray pictures (mammograms) are interpreted by a doctor who specializes in evaluating X-rays (radiologist).

You will need to remove jewelry that might interfere with the X-ray picture. You will need to take off your clothes above the waist, and you will be given a cloth or paper gown to use during the test.

You usually stand during mammography, however, you may also be asked sit or lie down, depending upon the type of X-ray equipment used. One at a time, your breasts will be placed on a flat plate that contains the X-ray film. Another plate is then pressed firmly against your breast to help flatten out the breast tissue. Very firm compression is needed to obtain high-quality pictures. You may be asked to lift your arm or use your hand to hold your other breast out of the way. For a few seconds while the X-ray picture is being taken, you will need to hold your breath. Usually at least two pictures are taken of each breast, one from the top and one from the side.

The test takes about 10 to 15 minutes. You will be asked to wait (usually about 5 minutes) until the X-rays are developed, in case repeat pictures need to be taken. In some clinics and hospitals, X-ray pictures can be viewed immediately on a computer screen (digitally). This will shorten the waiting time.

How It Feels
Mammography is often uncomfortable but rarely extremely painful. If you have menstrual periods, the procedure is usually least uncomfortable when done within 2 weeks after your period has ended.

The X-ray plate will feel cold when you place your breast on it. Having your breasts flattened and squeezed is usually uncomfortable. However, it is necessary to flatten out the breast tissue to obtain the best pictures.

Risks
There is always a slight risk of damage to cells or tissue from being exposed to any radiation, including the low levels of X-rays used for this test. However, if this test is really needed, the risk of damage from the X-rays is very low compared with the potential benefits of the test.

Our advanced technologies have dramatically reduced radiation exposure during mammography. The dose of radiation a woman receives from a mammogram is similar to that from a dental X-ray.

Results
Mammography results are usually available within 10 days. It is not uncommon to be asked to return for another test so an additional view of an area in question can be obtained.

In the United States, all facilities that perform mammography must send a copy of the test results (written in language that is easily understood) within 30 days directly to the woman who had the test.

Breast Biopsy
During a breast biopsy, a sample of breast tissue is removed and examined under a microscope for signs of cancer. A breast biopsy is usually done to evaluate a lump found during a breast exam or to study a suspicious area found on a mammogram.

Stereotactic biopsy
A stereotactic core biopsy is done by a surgeon or a doctor who specializes in evaluating X-ray pictures (radiologist).

You will need to remove all clothing above the waist and drape a paper or cloth covering around your shoulders. You will lie on your stomach on a special table that contains a hole for your breast to hang through. Mammography is used to determine the exact location from which the biopsy sample will be taken.

An injection of local anesthetic will be given to numb the area of the breast where the needle will be inserted. A small incision is then made in the skin of your breast where the needle will be inserted. Under X-ray guidance, the needle is inserted to the correct location of the breast and a biopsy sample is collected quickly (in less than a second). You must remain perfectly still while the biopsy is done.

The small incision made for the needle does not usually require any stitches. Pressure is usually applied to the needle site to help stop the bleeding and a bandage will be applied. This type of breast biopsy takes about an hour. However, most of this time is needed for developing the X-ray pictures.

Purpose
A breast biopsy is done to determine whether a lump found during a breast exam or a suspicious area seen on a mammogram is cancerous (malignant) or noncancerous (benign).

How to Prepare
Before having a breast biopsy, you should tell your doctor if you:

• Are or might be pregnant.
• Have had any bleeding problems.
• Are allergic to any medications, including anesthetics.
• Are taking any blood-thinning medications (anticoagulants).

You will need to sign a consent form that says you understand the risks of a breast biopsy and agree to have the test done. As you read the consent form, you should ask your doctor any questions you have about the test and discuss any worries you may have about the need for the test, the risks of the test, or how it will be done. If an open biopsy is done, be sure to discuss with your doctor what action may be taken following each possible biopsy result.

How to Prepare
No special preparation is needed if you are to receive only a local anesthetic for the biopsy. However, if you are to receive either an intravenous sedative with the local anesthesia or general anesthesia for an open biopsy, do not eat or drink anything for 8 to 12 hours before the test.

If you are taking any medications, ask your doctor whether you should continue taking them.

Sometimes samples of your blood or urine and a chest X-ray may be taken before the biopsy is done. These may help determine whether you have another medical condition that needs to be treated before the biopsy.

Risks
There is a slight chance of developing an infection in the area where the biopsy was done. If an infection occurs, it can usually be treated easily with antibiotics. If general anesthesia is used, there is a small risk of death from the complications of the anesthesia.

Results
Biopsy results are usually available within 48 hours.