What is a mammogram?
A mammogram is an x-ray picture of the breast.
Mammograms can be used to check for breast cancer in women who have no signs or symptoms of the disease. This type of mammogram is called a screening mammogram. Screening mammograms usually involve two x-ray pictures, or images, of each breast. The x-ray images make it possible to detect tumors that cannot be felt. Screening mammograms can also find microcalcifications (tiny deposits of calcium) that sometimes indicate the presence of breast cancer.
Mammograms can also be used to check for breast cancer after a lump or other sign or symptom of the disease has been found. This type of mammogram is called a diagnostic mammogram. Besides a lump, signs of breast cancer can include breast pain, thickening of the skin of the breast, nipple discharge, or a change in breast size or shape; however, these signs may also be signs of benign conditions. A diagnostic mammogram can also be used to evaluate changes found during a screening mammogram or to view breast tissue when it is difficult to obtain a screening mammogram because of special circumstances, such as the presence of breast implants.
How are screening and diagnostic mammograms different?
Diagnostic mammography takes longer than screening mammography because more x-rays are needed to obtain views of the breast from several angles. The technician may magnify a suspicious area to produce a detailed picture that can help the doctor make an accurate diagnosis.
What are the benefits and potential harms of screening mammograms?
Early detection of breast cancer with screening mammography means that treatment can be started earlier in the course of the disease, possibly before it has spread. Results from randomized clinical trials and other studies show that screening mammography can help reduce the number of deaths from breast cancer among women ages 40 to 74, especially for those over age 50 (1). However, studies to date have not shown a benefit from regular screening mammography in women under age 40 or from baseline screening mammograms (mammograms used for comparison) taken before age 40.
The benefits need to be balanced against the harms, including:
False-positive results. False-positive results occur when radiologists decide mammograms are abnormal but no cancer is actually present. All abnormal mammograms should be followed up with additional testing (diagnostic mammograms, ultrasound, and/or biopsy) to determine whether cancer is present.
False-positive results are more common for younger women, women who have had previous breast biopsies, women with a family history of breast cancer, and women who are taking estrogen (for example, menopausal hormone therapy).
False-positive mammogram results can lead to anxiety and other forms of psychological distress in affected women. The additional testing required to rule out cancer can also be costly and time consuming and can cause physical discomfort.
Overdiagnosis and overtreatment. Screening mammograms can find cancers and cases of ductal carcinoma in situ (DCIS, a noninvasive tumor in which abnormal cells that may become cancerous build up in the lining of breast ducts) that need to be treated. However, they can also find cancers and cases of DCIS that will never cause symptoms or threaten a woman’s life, leading to "overdiagnosis" of breast cancer. Treatment of these latter cancers and cases of DCIS is not needed and leads to "overtreatment." Overtreatment exposes women unnecessarily to the adverse effects associated with cancer therapy.
Because doctors often cannot distinguish cancers and cases of DCIS that need to be treated from those that do not, they are all treated.
False-negative results. False-negative results occur when mammograms appear normal even though breast cancer is present. Overall, screening mammograms miss about 20 percent of breast cancers that are present at the time of screening.The main cause of false-negative results is high breast density. Breasts contain both dense tissue (i.e., glandular tissue and connective tissue, together known as fibroglandular tissue) and fatty tissue. Fatty tissue appears dark on a mammogram, whereas fibroglandular tissue appears as white areas. Because fibroglandular tissue and tumors have similar density, tumors can be harder to detect in women with denser breasts.
False-negative results occur more often among younger women than among older women because younger women are more likely to have dense breasts. As a woman ages, her breasts usually become more fatty, and false-negative results become less likely. False-negative results can lead to delays in treatment and a false sense of security for affected women.
Some of the cancers missed by screening mammograms can be detected by clinical breast exams (physical exams of the breast done by a health care provider).
Finding cancer early does not always reduce a woman’s chance of dying from breast cancer. Even though mammograms can detect malignant tumors that cannot be felt, treating a small tumor does not always mean that the woman will not die from the cancer. A fast-growing or aggressive cancer may have already spread to other parts of the body before it is detected. Women with such tumors live a longer period of time knowing that they likely have a fatal disease.
In addition, screening mammograms may not help prolong the life of a woman who is suffering from other, more life-threatening health conditions.
Radiation exposure. Mammograms require very small doses of radiation. The risk of harm from this radiation exposure is extremely low, but repeated x-rays have the potential to cause cancer. The benefits of mammography, however, nearly always outweigh the potential harm from the radiation exposure. Nevertheless, women should talk with their health care providers about the need for each x-ray. In addition, they should always let their health care provider and the x-ray technician know if there is any possibility that they are pregnant, because radiation can harm a growing fetus.
Where can I find current recommendations for screening mammography?
Many organizations and professional societies, including the United States Preventive Services Task Force (which is convened by the Agency for Healthcare Research and Quality, a federal agency), have developed guidelines for mammography screening. All recommend that women should talk with their doctor about the benefits and harms of mammography, when to start screening, and how often to be screened.
What is the best method of detecting breast cancer as early as possible?
Getting a high-quality screening mammogram and having a clinical breast exam on a regular basis are the most effective ways to detect breast cancer early.
Checking one’s own breasts for lumps or other unusual changes is called a breast self-exam, or BSE. This type of exam cannot replace regular screening mammograms or clinical breast exams. In clinical trials, BSE alone was not found to help reduce the number of deaths from breast cancer.
Although regular BSE is not specifically recommended for breast cancer screening, many women choose to examine their own breasts. Women who do so should remember that breast changes can occur because of pregnancy, aging, or menopause; during menstrual cycles; or when taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for breasts to be swollen and tender right before or during a menstrual period. If a woman notices any unusual changes in her breasts, she should contact her health care provider.
What is the Breast Imaging Reporting and Database System (BI-RADS®)?
The American College of Radiology (ACR) has established a uniform way for radiologists to describe mammogram findings. The system, called BI-RADS, includes seven standardized categories, or levels. Each BI-RADS category has a follow-up plan associated with it to help radiologists and other physicians appropriately manage a patient’s care.
Breast Imaging Reporting and Database System (BI-RADS)
Assessment and suggested follow up for different categories
Category 1 - Negative assessment. Continue regular screening mammograms (for women over age 40).
Reference: National Cancer Institute
Last updated February 9, 2016.