Mammography for breast cancer screening – A primer

The intent of screening mammography is to detect breast?cancer at an early stage.

It has been noted that women screened mammographically for breast cancer had a 25% reduction in the risk of advanced breast cancer and a 41 % reduction in the risk of dying of breast cancer within 10 years (Duffy et al). These findings have been replicated in a number of studies.

This post addresses a few common queries regarding mammography.

Mammography

X-ray imaging of the breast for screening and diagnosis of breast cancer.

Some common terms that you may encounter in mammogram reports are explained below:

Breast Density

Breast tissue comprises of connective, glandular and fat tissue. The amount of fibrous and glandular tissue impacts the density of breast in a mammogram. Factors such as age, parity and menopause impact breast density.

Breast density based on BI-RADS are;

(A) Almost entirely comprises of fatty tissue (noted in 10% of women)

(B) Scattered areas of dense fibrous connective and glandular tissue (noted in 40% of women)

(C) Heterogeneously Dense breast tissue with high areas of glandular and fibrous connective tissue (noted in 40% of women)

(D) Extremely Dense Breast tissue (noted in 10% of women)

BI-RADS

The Breast Imaging Reporting and Data System helps us interpret mammogram on the basis of varying breast density.

• BI-RADS 0: incomplete (needs additional evaluation)
• BI-RADS 1: negative (no masses, architectural distortion, or suspicious calcifications and asymmetry)
• BI-RADS 2: benign (extremely low probability of malignancy)
• BI-RADS 3: probably benign (low probability of malignancy and will require short interval follow-up)
• BI-RADS 4: suspicious for malignancy (higher probability of malignancy)
• BI-RADS 4A: low suspicion for malignancy
• BI-RADS 4B: moderate suspicion for malignancy
• BI-RADS 4C: high suspicion for malignancy
• BI-RADS 5: highly suggestive of malignancy (very high probability of malignancy and requires immediate intervention)
• BI-RADS 6: already known and/or biopsy-proven malignancy

Indication

• The frequency for screening is based on age. Breast cancer occurs more frequently in younger women in India as compared to Western countries. There are no guidelines spelt out for Indian women and the recommendation is to screen annually between 45 to 55?years and then once in 2 years.
• Focal pain/ tenderness in the breast tissue
• Lump/ nipple inversion identified by qualified physician
• New asymmetry or dimpling in the breast

Do

• Give complete clinical and family history to your primary physician
• Eat before the test, if you wish to; fasting doesn’t interfere with the test.
• Clarify doubts regarding the procedure with the Physician and Technologist

Don’t

• Use deodorants, lotion or talcum around the area being exposed for imaging
• Have caffeine or any stimulants that can make breast tissue sensitive and aggravate pain
• Wear strenuous or difficult clothes

Conclusion

Mammograms are an effective tool to detect breast cancer early. ?It is important that we understand this and spread awareness about the benefits of screening mammograms.?