Why would I need this test?

A mammogram, an x-ray of the breast, is used to detect breast cancer at its earliest stage, when treatment is more successful. Traditional mammography involves taking X-ray film images of the breasts. It can detect 90 percent to 95 percent of breast cancers.

A woman's risk of getting breast cancer increases as she gets older. Because of this, the National Cancer Institute recommends women 40 or older get mammograms every one to two years. However, women with a family history of breast cancer, women with benign breast disease and women who have had breast cancer themselves should consult their physician about the recommended schedule and starting age for mammograms.

You may also need a mammogram if you have any of these signs:

• Unexplained lump or thickening in the breast or armpit.
• Puckering or dimpling of the skin on the breast.
• Discharge or bleeding from the nipple.
• A recent change in the nipple, such as a retracted nipple (one that is pulled inward).
• A change in the skin of the breast.

Digital mammography (DM), a new breast cancer screening technique offered at some mammography facilities, uses computerized digital images to scan the breast for abnormalities. While digital mammography has not yet been proven superior to film mammography in detecting cancers, it has some potential advantages:

• A DM images is faster - about 10 seconds compared with two minutes for a conventional film mammogram, which must be developed.


• Better contrast resolution, which may be an advantage in detecting cancers.


• Because DM images are computerized, they are faster and easier to retrieve. Also, radiologists will be able to share digital images via computer hookups, so breast-imaging experts can examine images taken at other locations.


• Radiologists are able to manipulate images to correct for under- or over-exposure, possibly saving women from the need for another mammogram when initial results appear inconclusive.

The accuracy of mammography depends a lot on the skill of the x-ray technician who is performing the exam, along with the skill of the radiologist who is interpreting the x-rays. When selecting a mammography facility ask if the center is a certified mammography facility. Certification implies that the facility had met the standards for mammography testing set by the Food and Drug Administration (FDA). To find a certified mammography facility in your region log on to the FDA site.

(Note that new guidelines in 2007 recommend that women with a 20 to 25 percent greater lifetime risk of breast cancer get a Magnetic Resonance Imaging screening instead of a mammogram. Your doctor can tell you if you are in this high-risk category.)

How do I prepare for this test?

The best time to schedule a mammogram is when your breasts are the least tender. For women who are pre-menopausal, this is about a week after your menstrual period. On the day of your mammogram, wear a two-piece outfit to make undressing more convenient. You will be given a hospital gown that opens in the front and asked to remove all jewelry and clothing above the waist. You should avoid using lotions, talcum powder or deodorant, which may interfere with the procedure.

Ask your doctor or radiologist ahead of time whether you should bring films from your prior mammograms or a copy of your complete health history. You are entitled to receive x-ray films from your mammography facility upon request.

Since this test involves exposure to radiation (x-rays), it is imperative that you inform the doctor if there is any chance that you might be pregnant.

How is this test performed?

During a mammogram, you will be standing in a private testing area and be asked to rest one uncovered breast between two flat plastic plates above an x-ray cassette. A registered mammography technologist will assist you. During mammography, the two plates are then pressed together. Spreading the tissue out makes any abnormal details easier to spot with the least amount of radiation. You'll be asked to hold your breath and remain still while the technologist takes the x-ray. The procedure is then repeated for the next view. A standard screening mammogram actually consists of four x-rays: a top view and a side view of each breast.

The pressure from the plates can be uncomfortable, or even somewhat painful for some women. You should talk to your technician if you are concerned about discomfort or if you experience pain during the procedure. If you do find it painful, it helps to remember that each x-ray takes less than one minute - and could help save your life.

A woman who has had breast implants should continue to have mammograms. If you have breast implants, tell the technologist and radiologist beforehand and make sure they are experienced x-raying women with breast implants. Because there is some risk that the implant may become damaged during mammography, extra care should be taken when compressing the breast area.

How long does the procedure take?

An entire mammogram screening lasts about five to 10 minutes, and the time of actual exposure to x-rays is only seconds. However, you may be asked to wait while the films are being checked to make sure they are clear and no additional x-rays are needed.

Before you leave the mammography facility, you should ask your radiologist when your results will be ready. Don't assume that "no news is good news." If you don't hear from your doctor or the staff at the mammogram facility, be sure to call and ask for your results directly.

What happens if an abnormality is found?

A mammogram is used as a screening tool for breast cancer, which means that it is used to identify suspicious areas of breast tissue, but not to make a diagnosis of breast cancer. If there are abnormal or suspicious findings on your mammogram, you will be asked to return for additional, more detailed pictures. You may also be referred for additional testing, which could include:

• Ultrasound of the breast, which uses sound waves to help distinguish between breast masses that are solid compared to those that are fluid filled.


• Needle aspiration, in which a needle is inserted into the lump to determine whether it is fluid filled or solid; a sample of fluid or tissue may be withdrawn for study under a microscope.


• Biopsy, a surgical procedure in which a small incision is made in the breast to remove the entire growth or a sample for study under a microscope.

Are there any risks associated with this test?

The amount of radiation a woman is exposed to during a standard mammogram is very low - similar to that received when getting dental x-rays. A rad, which stands for radiation absorbed dose, is a unit of measure for radiation exposure. FDA regulations require mammograms to be less than 2 rads. In practice, however, most mammograms deliver just a small fraction of that amount.

What is a desirable result?

A normal mammogram will show healthy breast ducts, glandular tissue and fat. No abnormal lumps or masses should be seen.