A mammogram is an x-ray of the breast used to detect breast cancer. Modern mammography machines use low doses of radiation that are considered safe. Screening mammograms are used to check women without symptoms, while diagnostic mammograms are used to investigate abnormalities. Mammograms produce images of breast tissue that radiologists analyze for signs of cancer such as masses or microcalcifications. The BI-RADS system is used to classify mammogram results. Mammograms can miss some cancers and detect abnormalities that turn out to be non-cancerous, but regular screening is still recommended as the best way to find cancers early.
2. A mammogram is an x-ray exam of
the breast to detect and evaluate
any change in the breast
3. History of mammography
• X-rays were first used to examine breast
tissue by the German surgeon
ALBERT SALOMON about a century ago
• Modern mammography came in to
existence since the late 1960
• Technology has advanced and today’s
machine is different even from those of
the 1980s and 1990s
4. Mammography machine
• Today’s mammography machine expose
the breast to much less radiation
• X-rays do not go through tissue as easily
as those used for routine chest x-ray or x-
rays of extremity
5. Radiation from mammogram
• Modern machine is safe and uses the
lowest dose of radiation possible
If a woman with breast cancer is treated with radiation, she
will get several thousand rads.
If she has yearly mammogram starting at age of 40 and
continues until 90 she will get total of 20-40 rads
Benefits of mammography outweigh any possible harm
from the radiation exposure
7. Screening mammogram
• Mammogram of the breast for the women
who have no sign or symptom of breast
cancer, usually with two x-ray views
• Finding breast cancer early greatly
improves a woman’s chance for
successful treatment
• Risk factors: gene
mutation,strong family history
or other factors
8. Diagnostic mammogram
• X-ray of the breast for a woman
with breast problem like lump or
nipple discharge or an abnormal
area found in screening by taking
spot view or magnification view
9. What diagnostic mammogram
does? One of three ways----
• It may reveal that an area that looked abnormal
on screening is actually NORMAL—routine
checkup
• It could reveal that an area of abnormal tissue
probably is NOT CANCER but radiologist may
not ready to say it normal based on these
x-rays--- re-check up in 4-6 months
• The results could also suggest that a biopsy is
needed to find out if the abnormal area is
CANCER
10. How is mammogram done?
• Breast is briefly compressed between 2
plates attached to the mammogram
machine– an adjustable plastic plate on
top and a fixed plate on bottom which
holds the x-ray film or the digital detector
that makes the image
11. Typical views
• For screening: Cranio- caudal view(CC)
Medio-lateral oblique(MLO)
• For diagnostic: CC
MLO
- lateromedial(from side towards center of chest)
- mediolateral(from the center of the chest out)
- Spot compression view
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15. How mammogram are read?
• Its challenging must be interpreted by
radiologist
• Must to compare with previous
mammogram
16. Mammogram: Changes in
breast tissue
• Calcification: macrocalcification
microcalcification
• Mass
• Breast density
17. Calcification: Macrocalcification
• Due to changes in breast caused by aging of
breast arteries, old injuries or inflammation
• Coarse/ large Calcium deposit
• Seen in 1 0f 10 women under 50 and about half
over 50
These deposit are related to Non-
cancerous condition and do not require
biopsy
19. Mass
• Mass with or without calcification
• Noncancerous mass:
Cystic– fluid filled sacs/ simple cyst
Solid – Fibro adenoma
• Complex or mixed mass: suspect cancer
needs FNAC or biopsy
Breast ultrasound is complementary
20. Breast density
• Density is based on
: how much fibrous and glandular
tissue
: how is the distribution within breast
tissue
: how is breast made up of fatty tissue
Dense breasts are not abnormal but they
are linked to higher risk of breast
cancer
21. Findings on mammogram
• Primary signs of breast cancer may
include spiculated masses or clustered
pleomorphic microcalcification
• Secondary signs of breast cancer may
include asymmetrical tissue density, skin
thickening or retraction or focal distortion
of tissue
28. Impression
• Overall assessment of the radiological
findings often includes a classification of
the mammogram using the BI-RADS
system developed by the American
College Of Radiology(ACR)
29. Breast Imaging
Reporting and Data
System(BI-RADS)
•Category0: additional view or ultrasound
and or compare prior film
•Category1: negative
•Category2: benign(noncancerous)
•Category3:probably benign,repeat in
6mth
30. BI-RADS category
• Category4: suspicious abnormality
consider biopsy
4A: finding with low suspicion of
being cancer.
4B: finding with an
intermediate suspicion of
being cancer
4C: finding of moderate concern of
being cancer but not as high as
category5
31. BI-RADS category
• Category5: highly suggestive of
malignancy, biopsy is
recommended
• Category6: known biopsy proven
malignancy, appropriate action
should be taken. It is only to see
how well the cancer is responding
to treatment
32. Limitations of mammogram
• Breast cancer screening is the best way
to find cancer early but finding cancer
early does not always reduce a woman’s
chance of dying from breast cancer
• Detecting breast cancer early may not
help prolong the life of a woman who has
other kind of serious or life threatening
health problem like CCF,
ESRD,COPD…..
33. False-negative results
• A false-negative mammogram appears
normal even though with breast cancer
• It occur more often among younger
women usually had dense breast
• False-negative results can delay treatment
and promote a false sense of security for
the woman
Overall, screening mammogram miss
about 1 in 5 breast cancers
34. False- positive results
• A false- positive mammogram looks
abnormal but no cancer is actually present
• It requires diagnostic mammogram,
ultrasound, MRI or even biopsy
• It is common in younger woman, have
dense breast, have had breast biopsy or
cancer in family or are taking oesterogen
35. Over diagnosis and
over treatment
• While mammogram can find invasive breast
cancer and DCIS that need to be treated, it
is also possible that some invasive cancer
or DCIS detected on mammography will not
keep growing so not so life threatening and
never would have been detected if a woman
had not gotten a mammogram. Doctors
often cannot be sure which cancers & cases
of DICS will become life-threatening, they
are all treated
36. Mammogram – in younger
women
• Difficult to read because breast tissue is
dense and it can hide the tumour
• In some younger women who are at high
risk yearly MRI or mammograms are
recommended at age of 30years
Risk factors: gene mutation,strong family
history or other factors
37. Mammogram plan after
BCT : Breast conserving treatment
• Radiation and surgery both cause
changes in the skin and breast tissue
• These changes on mammogram, making
it harder to read
• The changes usually peak 6mth after RT
• Mammogram done at this time serves as
a new baseline for the affected breast
38. Mammogram after mastectomy
without reconstruction
• Women who had total or modified radical or
radical mastectomy for breast cancer need
no further routine screening mammogram of
the affected side
• Mammograms are usually continued on the
UNAFFECTED breast each year
• Follow up mammogram does require only in
the cases who had gone for Subcutaneous
mastectomy
39. Mammogram after mastectomy
with reconstruction
• Women who have had a breast fully
removed and reconstructed (rebuilt) with
silicone gel or saline implant do not need
routine mammogram
40. Mammogram after BCT
• BCT: Breast conserving treatment
• Partial Mastectomy (sometimes called
Lumpectomy) is another name for BCT
• It always followed by radiotherapy
• Woman after BCT will need to continue
having regular mammogram of both
breast
41. Mammogram with implants
• Its special challenge to do mammography
of breast with implant
• In order to see as much breast tissue as
possible it needs 4 extra and 4 standard
picture (2 on each breast)
• Extra picture is implant displacement(ID)
view pushing back implant against chest
wall and the breast is pulled forward over
• MRI IS BEST WAY TO CHECK IMPLANT
42. TOMOSYNTHESIS
3D mammography
•
•
Newer technique
Basically it is an extension of digital
mammogram
• Breast is compressed once, machine
takes many low dose x-rays as it moves
over the breast in an arc, images can then
be combined into a 3-dimensional picture
44. Mammogram report
• Patient information
• Clinical history
• Procedure: Screening or Diagnostic
• Findings: mass, calcification, asymmetry
architectural distortion or associated
lesion
• Comparision to previous study/Any U/S
• Impression/ Final assessment
• Management Recommendation (optional)
45. 69
Male Mammography
• 1300 men get breast cancer per year
– 1/3 die
• Most are 60 years or older
• Nearly all are primary tumors
• Symptoms include:
– Nipple retraction
– Crusting
– Discharge
– Ulceration
