What is Mammography?
Breast cancer is the most frequently occurring cancer in women. On estimation, 1 in 8 women will get breast cancer at an early or later stage in their lives. Early detection increases survival rate and reduces the severity of treatment required. Mammography has an essential role in detecting breast cancer at an early stage.
One of the most common questions asked regarding mammography is: "At what age should we begin with mammograms?" To answer that question, women first need to understand the difference between screening and diagnostic mammography.
Screening Mammography is a routine examination and is done on an annual basis.
Current guidelines recommend screening mammography every year for women, beginning at age 40. Screening mammography can be done without a referral letter from your general practitioner, gynecologist or surgeon. Screening mammography plays a central part in early detection of breast cancers in women experiencing no symptoms because it can show changes in the breast up to two years before a patient or physician can feel them. Annual mammograms lead to early detection of breast cancers, when they are most curable and breast-conservation therapies are available. Women who have had breast cancer and those who are at increased risk due to a genetic history of breast cancer should seek expert medical advice about whether they should begin screening before age 40 and about the frequency of screening.
Diagnostic Mammography is used to evaluate a patient with abnormal clinical findings - such as a breast lump or nipple discharge - that have been found by a woman or her doctor. Diagnostic mammography is done irrespective of the patients age (i.e. 20 – 80 years). Your doctor will complete a referral letter requesting a mammogram. It is important that you bring the letter at the time of your examination.
While most doctors believe mammography is the best screening tool for breast cancer available today, a small portion of mammograms indicate that a cancer could possibly be present when it is not. These are called false-positive results.
Mammograms also have a history of missed tumors, or "false-negatives." False-negatives can sometimes be attributed to dense tissues obscuring the cancer. There are many other reasons as well, including errors by the observer. It is commonly agreed that false-negatives are more common in younger women than in older women.
How should I prepare for a mammogram?
Do not schedule your mammogram for the week before your menstruation because your breasts are usually tender during this time. The best time for a mammogram is one week following your menstruation.
You should wear comfortable clothes. Preferably a two piece set (skirt and blouse / trousers and blouse).
Do not wear deodorant, talcum powder or lotion under your arms or on your breasts on the day of the exam. These can appear on the mammogram as calcium spots.
If possible, obtain prior mammograms and make them available to the radiologist at the time of the current exam.
Always inform your doctor or radiologist if there is any possibility that you may be pregnant.
How is the mammogram performed?
Mammography is performed on an outpatient basis.
You will be asked to complete a pre – mammogram questionnaire. Please mention any family or personal history of breast cancer, prior surgeries, hormone usage and any new findings or problems in your breasts. Clearly state any area of concern.
A mammography unit is used exclusively for x-ray examinations of the breast, with special accessories that allow only the breast to be exposed to the x-rays. Attached to the unit is a device that holds and compresses the breast and positions it so images can be obtained at different angles.
Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation.
During mammography, a specially qualified radiographer will position your breast in the mammography unit.
Your breast will be placed on a special platform and compressed with a paddle (often made of clear Plexiglas or other plastic). The radiographer will gradually compress your breast.
Breast compression is necessary in order to optimize diagnostic quality of the images. Breast tissue is likened to marbles in a bag. All the breast tissue lies on top of each other and needs to be compressed to even the tissue out so that you can ensure that optimal breast tissue is imaged. This, in turn, reduces the amount of radiation delivered to the breast.
You will be asked to change positions between images. The routine views are a top-to-bottom view (the cranio-caudal view) and an angled side view (the medio-lateral oblique view). The process will be repeated for the other breast.
You must hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image.
Breast implants can also impede accurate mammogram readings. Experienced radiographers know how to carefully compress the breasts to improve the view without rupturing the implant.
When the examination is complete, you will be asked to wait until the radiologist determines that all the necessary images have been obtained.
Because some breast cancers are hard to visualize, the radiologist may want to compare the images to views from previous examinations.
After the radiologist has examined and compared the mammogram images, a dedicated ultrasound of the breast may follow (at no additional cost).
Mammographic and ultrasound images may not be enough to determine the existence of a benign or malignant disease with certainty. If a finding or spot seems suspicious, your radiologist may recommend further diagnostic studies.
If you are told that your mammogram is abnormal or that there is a "spot" on your mammogram, as hard as it may be, doctors urge that you should NOT panic. This does not always mean you have something as extreme as breast cancer. The radiologist will discuss his findings with you and indicate whether you should go back to your referring doctor
(i.e. when a mass was found) or merely inform your doctor next time you visit him / her (i.e. when the mammogram was normal).
The examination process should take about 30 – 60 minutes.
What will I experience during and after the mammogram?
You will feel pressure on your breast as it is squeezed by the compression paddle. Some women with sensitive breasts may experience discomfort or even pain but it usually of short duration. Be sure to inform the radiographer if discomfort is significant - less compression will be used.
What will a mammogram cost?
Most medical aids will cover the cost of mammography provided that you have not exceeded your annual imaging limit. Pre – authorization is usually not required by medical aids, but please consult with your medical aid if you are uncertain.
Private patients who pay immediately with cash or with Master or Visa Cards will be charged medical aid rates.
The account remains your responsibility.
In the event of non – payment by your medical aid, you will be held liable for the account and it should be paid within 30 days.