Breast cancer will affect an average of one in eight women sometime in their lifetime. It is the second most common cause of cancer-related deaths in women. Numerous studies have proven that early detection is a vital component in the successful treatment of breast cancer.
The American College of Obstetrics and Gynecology recommends that women have annual mammograms once they reach the age of forty. Women with a strong family history of breast cancer or a prior personal history of breast issues may require earlier or more frequent screening.
Mammograms play a central role in the early detection of breast cancer because they can detect changes in the breast that may be early signs of cancer, but are too small or subtle to be felt. The use of mammography has greatly enhanced the ability to detect breast cancers at earlier stages. Now a new technology called full field digital mammography shows great promise in the fight against breast cancer.
What is Full Field Digital Mammography?
Digital mammography uses computers and specially designed digital detectors to produce an image that can be displayed on a high-resolution computer monitor, and transmitted and stored just like computer files.
From a patient’s point of view, having a digital mammogram is very much like having a conventional screenfilm mammogram. Both film-based and digital mammography use compression and x-rays to create clear images of the inside of the breast. During all mammography exams, the technologist positions the patient to image the breast from different angles and compresses the breast with a paddle to obtain optimal image quality.
Unlike film-based mammography, digital mammograms produce images that appear on the technologist’s monitor in a matter of seconds. There is no waiting for film to develop, which can mean a shorter time spent in the breast imaging suite.
The Benefits of Digital Mammography
Unlike other parts of the body, the breast is composed mainly of soft tissue. When breast tissue is x-rayed, it creates an image that looks something like a smoky haze, making it difficult to see tiny “spots,” called microcalcifications, and other subtle signs of early cancer.
With digital mammography, the radiologist reviews electronic images of the breast using special high resolution monitors. The physician can adjust the brightness, change contrast, and zoom in for close-ups of specific areas of interest. Being able to manipulate images is one of the main benefits of digital technology.
Another convenience of digital mammography over film-based systems is that it can greatly reduce the need for retakes due to over or under exposure. This potentially saves additional appointment time and reduces your exposure to x-rays.
Mammography leads the way in the fight against breast cancer
Like all medical tests, mammography is not a perfect examination—it cannot always detect breast cancer, and is not 100% accurate. Screening mammography can detect about 85% of breast cancers. It will also show areas that may appear to be abnormal, but are actually benign (noncancerous) changes in the tissues of the breast. This may nevertheless lead to a biopsy (removal of tissue from the breast) in order to determine whether the abnormality is due to breast cancer.
Screening mammography is the best tool for asymptomatic patients
Screening mammography is performed on women who have no sign or symptom of breast cancer. It can detect many cancers at their earliest stage, before physical symptoms develop, and up to two years before cancer is large enough to be felt as a lump. In fact, 40% of breast cancers that are detected by screening mammography are “in situ”, meaning they are at the earliest stage, and are not invading through the ducts of the breast. The size of a cancer and how far it has spread are key predictors of health outcome from the disease. When disease is localized in the breast, survival is greater than 90%. Detection of breast cancer at its earliest stage is therefore crucial to the goal of curing breast cancer.
A diagnostic study is ordered for patients who have a personal history of breast cancer, or have a specific symptom or problem that could indicate breast cancer. Some of these symptoms may include lumps, discharge or breast pain. Please alert your health care provider if you have these symptoms to ensure that you are scheduled for a diagnostic study.
CAD boosts mammography performance
Computer-aided detection (CAD) acts as a second pair of eyes by analyzing patterns in the mammogram and marking areas for the radiologist to review in more detail. The radiologist then makes a final assessment of the images to determine whether there is anything that is truly of concern, or may require additional assessment. Studies have shown that the use of CAD with mammography can increase the detection rate for cancer.
The majority of screening mammograms are normal and do not require additional testing. Most women receive a normal screening mammography report. However, after a screening mammogram, about 10% of patients will have to return to the mammography facility for further testing, which may include additional mammography images, breast ultrasound or MRI (magnetic resonance imaging) of the breasts. The radiologist who interprets the mammogram looks for several types of possible abnormalities. These include masses (abnormal growths of tissue), asymmetry or distortion (abnormal patterns of tissue), or calcifications (calcium deposits). Even when a potential abnormality is detected on a screening mammogram, the additional imaging that is performed when the patient returns will often show that the area in question on the screening mammogram is normal or represents noncancerous changes.
About 10% of screening patients return for further evaluation of calcifications, masses and asymmetries
There are two types of calcifications: microcalcifications (tiny) and macrocalcifications (large). Macrocalcifications indicate a benign condition and do not require a biopsy. Microcalcifications are tiny specks of calcium that may appear alone or in clusters. An area of microcalcification does not always mean that cancer is present. In fact, the majority of microcalcifications are benign. In some cases, the radiologist will determine that the calcifications have a benign type of appearance, but should be followed closely with another mammogram in 4 – 6 months to ensure that they do not change. In other cases, the calcifications may have an uncertain or suspicious appearance, and a biopsy will be ordered.
Masses and asymmetries in the breast can be cancerous or noncancerous. Noncancerous masses can be due to a fluid–filled cyst or tissue mass, such as a fibroadenoma. Masses are evaluated by obtaining additional specialized mammography pictures by using ultrasound of the breast, or occasionally with an MRI scan of the breast. After masses have been fully evaluated, some can be carefully monitored with a repeat mammogram or breast ultrasound in 4 – 6 months, while others may require a biopsy.