Mammography

A mammogram is typically performed in an imaging clinic by a technologist specializing in mammography. The patient is asked to undress from the waist up and wear a gown. The breast is placed on a special platform in the mammography unit and gently compressed between two clear plastic paddles for a few seconds while the X-ray image is taken. Usually, two images are taken of each breast (one from top to bottom and one from the side), and additional views may be taken if there is a need to better evaluate a specific area. Compression helps to flatten and spread out the breast tissue to reduce its thickness, which decreases the necessary radiation dose and improves image quality and detail, making it easier to detect small changes. Some women may feel discomfort or mild pain during compression, but it lasts for a very short duration. There are different types of mammography, including 2D Digital Mammography and 3D Mammography (Tomosynthesis), which provides multiple images from different angles to reconstruct a three-dimensional image of the breast, which can be particularly useful in cases of dense breast tissue.

Mammography is a diagnostic and preventive procedure used to evaluate breast health and detect any abnormal changes, whether or not symptoms are present. Reasons for undergoing mammography (both for routine screening or diagnosis) include:

• Routine Screening (Screening Mammography): Performed periodically for women in certain age groups (recommendations vary according to medical guidelines) for early detection of breast cancer before any symptoms appear. The goal is to detect tumors when they are small and more treatable.
• Presence of risk factors for breast cancer: Such as a strong family history of breast or ovarian cancer, personal history of breast cancer, or presence of certain genetic mutations that increase risk.
• Diagnostic Evaluation (Diagnostic Mammography): Performed to evaluate symptoms or abnormal signs in the breast noted by the patient or during a clinical examination, or to evaluate abnormal findings detected on a previous routine mammogram.

Symptoms or signs that may prompt a physician to order a diagnostic mammogram include:

• Presence of a new lump or thickening in the breast or under the arm: Whether painful or painless.
• Change in the size or shape of the breast.
• Changes in the skin of the breast: Such as redness, swelling, dimpling, or resembling an orange peel.
• Changes in the nipple: Such as inversion of the nipple, rash around the nipple, or abnormal discharge from the nipple (especially if bloody or spontaneous from one nipple).
• Persistent breast or underarm pain not related to the menstrual cycle.
• Changes in a clinical breast exam performed by a physician.

Diagnosis" using mammography relies on the interpretation of the breast X-ray images by a radiologist (a specialist in reading breast images). The radiologist looks for any areas of abnormal density, masses, calcifications (tiny calcium deposits), or architectural distortions in the breast tissue that may indicate a benign or malignant tumor. Current images are compared with previous images (if available) to detect any new changes.

"Treatment" is not the mammography procedure itself but rather the treatment plan developed by the treating physician based on the diagnosis reached thanks to the mammogram results, and often requires further examinations to confirm the diagnosis. Mammography plays a crucial role in early detection, allowing for the initiation of treatment at earlier stages of the disease. Stages after a mammogram include:

• Interpretation of results: The radiologist analyzes the images and writes a report describing the findings and classifying them using the BI-RADS (Breast Imaging Reporting and Data System) which indicates the likelihood of cancer and recommends the next step.
• Communicating results to the patient and physician: The report is sent to the treating physician, and the patient is informed of the results. In case of abnormal findings, the patient and physician are contacted for follow-up.
• Additional examinations (if necessary): If the mammogram shows a suspicious area, the physician may recommend additional examinations such as: a diagnostic mammogram with magnified views, breast ultrasound to better evaluate masses (solid or cystic), or breast MRI in specific cases.
• Biopsy: If there is still suspicion of cancer after additional examinations, a small sample of the suspicious tissue is taken (biopsy) and examined under a microscope to definitively confirm the diagnosis.
• Developing a treatment plan: If breast cancer is confirmed, an individualized treatment plan is developed based on the type, stage, and other characteristics of the cancer. The plan may include surgery, chemotherapy, radiation therapy, hormone therapy, or targeted therapy.
• Follow-up: After treatment, regular mammograms may be performed to monitor the breast and detect any signs of disease recurrence.