Mammography is a key radiographic method for the early detection of breast cancer, significantly improving treatment outcomes as it can reveal cancer before symptoms appear. The procedure can involve screening and diagnostic mammograms and requires specific patient preparation to ensure accurate results. Breast cancer screening is recommended for women over 40 and those with high-risk factors, with mammography providing various assessments for potential abnormalities.

1. Mammography

2. Introduction
• Mammography is a radiographic modality to detect breast pathology and
cancer.
• Mammography is a specific type of breast imaging that uses low-dose x-
rays to detect cancer early – before women experience symptoms – when it
is most treatable.
• Breast cancer accounts for 32% of cancer incidence and 18% of cancer
deaths in women in the United States.
• Approximately 1 in 8 or 9 women in the US will develop breast cancer over
her lifetime.
• A mammogram can find breast cancer when it is very small --2 to 3 years
before we can feel it.

3. Evidence Of Effectiveness
• Sensitivity of mammography ranges from 75% to 90%
• Specificity from 90% to 95%
• The positive predictive value of mammography for breast cancer ranges
from 20% in women under age 50 to 60% to 80% in women age of 50-69

4. Technique for Mammography
• When you have a mammogram, a skilled technologist positions and compresses your
breast between two clear plates.
• The plates are attached to a highly specialized camera, which takes two pictures of the
breast from two directions.
• Then the technologist repeats the technique on the opposite breast. For some women,
more than two pictures may be needed to include as much tissue as possible.
• Mammography can be painful for some women, but for most it is mildly uncomfortable,
and the sensation lasts for just a few seconds.
• Compressing the breast is necessary to flatten and reduce the thickness of the breast.
• The X-ray beam should penetrate as few layers of overlapping tissues as possible.
• From start to finish, the entire procedure takes about 20 minutes.

6. Types of Mammography
In simplest term
A. Screening Mammography
B. Diagnostic Mammography
In advanced term
A. Convectional Mammography
B. Digital Mammography
C. 3D Mammography

7. …contd
A. Screening mammography:
• It is performed on asymptomatic women with the use of a two view
protocol, usually medio-lateral oblique and cranial caudal, to detect
unsuspected cancer.
• It is typically done every year for all the females over 40 years of age, to
check the breasts for any early signs of breast cancer.
B. Diagnostic mammography
• It is performed on patients with symptoms or elevated risk factors. Two or
three views of each breast may be required.
• It is different from screening mammograms in that they focus on getting
more information about a specific area (or areas) of concern usually due to a
suspicious screening mammogram or a suspicious lump.

8. Other standard techniques used for breast
imaging
a) Real time ultrasound
b) MRI
c) Color Doppler
d) Contrast ultrasound
e) Digital Mammography
f) Scintimammography

9. Patient preparation
• The patient is requested to take proper bath before coming for the procedure
• Patient should not wear deodorant, talcum powder or lotion under her arms or on
her breasts as these may appear on the mammogram and interfere with correct
diagnosis.
• She is suggested to wear loose clothing so that it is easier for her to change for the
procedure
• She is asked to bring along any histopathological report if done before
mammography for clinical correlation
• A clean green hospital gown should be provided to the patient before procedure.
• Patient privacy should be maintained and a conducive environment should be
created.

10. Mammogram
• A mammogram is an x-ray picture of
the breast.
• It is used to check for breast cancer in
women who have no signs or
symptoms of the disease (Screening
mammogram).
• Also be used to check for breast
cancer after a lump or other sign or
symptom of the disease has been
found (Diagnostic mammogram).

11. Density Of Breast Tissue

12. Principles Of Breast Cancer
• Patients in the early stages respond well to extensive surgery
• Patients with advanced disease do poorly
• The earlier the diagnosis, the better the chance of survival
• Mammography is the tool for early detection

13. Indications
• Pain/tenderness
• Swelling
• Nipple discharge (mild)
• Calcification
• Benign or malignant tumor
• Lymph node enlargement
• Screening asymptomatic women aged 50 years and over
• Screening asymptomatic women aged 35 years and over who have a high risk of developing breast cancer
• Women who have one or more first degree relatives who have been diagnosed with premenopausal breast cancer
• women with histologic risk factors found at previous surgery, e.g. atypical ductal hyperplasia
• Investigation of symptomatic women aged 35 years and over with a breast lump or other clinical evidence of breast cancer
• Surveillance of the breast following local excision of breast carcinoma.
• Evaluation of a breast lump in women following augmentation mammoplasty
• Investigation of a suspicious breast lump in a man

14. Contraindications
• Breast implant
• Severe nipple discharge
• Pregnancy and breastfeeding
• Large palpable mass
• Inflammation
• Women within reproductive age 15-40 (benefit over risk)

15. BIRADS Mammography assessment
categories
• Category 0 : incomplete
• Category 1 : negative / normal
• Category 2 : benign finding
• Category 3 : probably benign
• Category 4 : suspicious abnormality
• Category 5 : highly suspicious of malignancy
• Category 6 : known biopsy with prone malignancy

16. References
• https://emedicine.medscape.com/article/346529-overview#a2
• https://www.cancer.org/cancer/breast-cancer/screening-tests-and-
early-detection/american-cancer-
• http://www.isahd.ae/content/docs/Guidelines%20For%20Breast%20
Cancer%20Screening_Booklet.pdf
• https://www.cancer.gov/types/breast/mammograms-fact-sheet#q1
• https://www.uptodate.com/contents/breast-imaging-for-cancer-
screening-mammography-and-
ultrasonography?search=mammography%20screening&source=searc
h_result&selectedTitle=2~150&usage_type=default&display_rank=2