Mammography, which is a recommended method for early detection, can identify breast cancer as many as two years before the lesion becomes palpable. Regular mammography screenings have been demonstrated to reduce breast cancer mortality by 30% among women aged 50-69, and in accordance with some statistics, it could produce comparable benefit to women between 40-50 years of age as well. For screening mammography to be viewed as effective, many criteria of equal value should be met.
A fundamental prerequisite is primarily a quality mammography machine, then technically well-performed scanning, image development using high-quality films, and indispensable skill required from the physician who must be able to precisely interpret a mammogram. So, for proper diagnosis, not any mammography but good quality mammography is required.
At our Polyclinic we, therefore, take special care of reconciling the expertise of our mammography team and the quality of the machine and other equipment required to perform mammographic procedures, successfully combining the proficient team with appropriate modern technology. Mammography can detect a breast cancer as large as 5-6 mm. Some changes that might be the only sign of the disease, including microcalcification clusters, are detectable solely by this technique. Diagnostic mammography, however, is not a perfect and infallible tool, and about 10-15 percent of breast cancers cannot be detected using this method. Ultrasound imaging is therefore used as an advantageous adjunct to mammography.
Nevertheless, due to its simplicity, low cost and benefits, mammography remains the gold standard for breast cancer detection. Mammography is done using a special x-ray device called mammograph, designed exclusively for breast imaging and mammogram-guided procedures. Actually, the breast is an organ that is entirely composed of soft tissue, including 15 to 20 lobes of lactating glands, variable amount of fat tissue, supporting connective tissue, blood and lymph vessels, nerves, and possibly lymph nodes that also might occur within the breast. As the consensual standard, two views are taken of each breast: the so-called craniocaudal (x-ray film labeled CC) with the breast inserted between two parallel plates and slightly compressed downwards, and another, the so-called mediolateral or oblique view (x-ray film labeled ML) with the breast placed also between these two parallel plates but in the lateral direction, at an angle of 30-45 degrees.
On mammography positioning, breast compression is necessary for a better visualization of the breast’s inner structure by x-ray-exposed films to be developed immediately after imaging. Two images of each breast are obtained, and if necessary, images of other views may also be taken. For instance, a change in the breast, if any, requires two views for a more in-depth analysis to ensure the presence of the breast change. Because if the lesion of one breast is visible in only one view, and not in another, it may be an artifact or accidental overlapping of tissues within the breast giving the wrong impression of a change that actually does not exist. It is also important that mammography is done within the first 10 days of the menstrual cycle, when the breasts are less painful and sensitive to indispensable compression during the imaging, and also to avoid exposure to ionizing radiation in potential early pregnancy that a woman may not be aware of, as it is more likely in the second half of the cycle, i.e. from the time of ovulation until the next period begins. The imaging process and film development are operated by medical radiology technologist, and the obtained images are then interpreted, i.e. in-depth analyzed by a physician, usually a specialist in medical radiology, although it can also be done by any other specialist with adequate training and experience in the field.
Mammograms and result reports should be kept for future mammographies for comparison. Any new changes developed between the two mammographies are thus more easily seen, or changes identified on previous mammograms can be followed up. Physicians usually name them differently, depending on their type, so written mammography reports may contain terms such as soft tissue shadows, tissue condensation, microcalcifications, macrocalcifications, thicknesses, architectural distortions, and alike. The purpose of mammography, of course, is to detect changes that might be malignant. However, not all shadows produced on the mammogram are cancer. Many benign changes are also shown on mammography (cysts, fibroadenoma, lypoma and alike). For their detailed evaluation, such mammography examinations are usually supplemented with an ultrasound test, too. The decision on whether additional diagnostic examinations should be done is left to the discretion of the physician interpreting the mammogram.
