DEFINITION : Mammogram is a special way of taking x-ray of the breast using low dose x-ray, high contrast, high-resolution, and an x-ray system specially designed for breast imaging. Mammogram plays an important role in the detection of breast cancer. It can show even a small lump before the patient or the physician can reveal by examination. Studies confirm that the early detection helps in treating breast cancer. This does not cure or prevent the breast cancer. It reduces the death rate by breast cancer to 20 to 30%.

In the images of the breast, in the mammogram, any suspicious area like benign or cancerous appears to be white, fat appears to be black and other abnormalities, glands, soft tissues, and microcalcifications as levels of black.

TYPES OF MAMMOGRAM :

The commonly used types are screening mammogram and diagnostic mammogram :

SCREENING MAMMOGRAM : Screening mammogram is the x-ray examination of the woman or asymptomatic that is woman who does not posses any complaints or symptoms of breast cancer. This screening mammogram is recommended in women who have a strong family history of breast cancer.

Women in the age of 40 years are recommended to take a screening mammogram once in every two years. Above 50 years are advised to take an annual screening mammogram. If there is a strong family history of breast cancer, the women below the age 30 is recommended to undergo screening mammogram.

DIAGNOSTIC MAMMOGRAM : It is also an x-ray examination of the breast in woman who are having symptoms of breast cancer, like lump, nipple discharge etc, and who are found to have any abnormalities in the screening mammogram.

Diagnostic mammogram includes additional imaging and views to find out exactly the location, size of the abnormality, and also examine the surrounding glands, tissues, and lymph nodes, to rule out cancer or to predict cancer.

TECHNIQUES USED IN MAMMOGRAM :

There are two views used in mammogram craniocaudal (CC) and mediolateral oblique projection (MLO).

  Craniocaudal view : It is the x-ray imaging of the breast, from above the    breast.

  Mediolateral oblique view: It is an angled viewing or oblique viewing of the    breast.

SPECIAL TECHNIQUES :

These techniques are used in the case if some abnormalities are detected in diagnostic mammogram, which are suspicious and when the images of the screening or diagnostic mammogram are unclear :

Spot Compression View : This by term, applying compression over the area of interest. This provides clear imaging of the abnormality including its location and borders. Compressing a specified area allows better tissue separation and thus provides better visualization of that specified abnormality or mass.

Magnification View : The term magnification refers zooming or images of abnormality or masses or areas of suspicion. This provides clear imaging in assessing the borders and tissue nature of a questionable area. This is mainly used to assess cluster of microcalcifications.

CAD : Using the computer software, mammograms can be obtained from either a conventional film mammogram or digitally acquired mammogram. It finds out abnormal areas of density, mass or other calcifications.

Digital Mammogram : Also known as fluid-filled digital mammogram. The x-ray film is replaced by solid-state detector, which converts x-rays in to electrical signals.

FINDINGS IN A MAMMOGRAM :

Calcification : It is a tiny calcium deposition (flecks) in the soft tissue of the breast, which can sometimes be an early stage of cancer. Calcifications are usually cannot be felt, but appears in mammogram. Depending on it s appearance, size, numbers, shape, and location, the result may vary. Macrocalcifications are usually not associated with cancer. Microcalcifications may occur in a cluster mostly a noncancerous cell growth, but sometimes also appear in early cancerous stage.

Cysts : These are fluid filled masses in the breast. Cysts are common and are rarely associated with cancerous tumors, which are solid in nature. An ultrasound can help in differentiating this.

Fibroadenoma : These are nodules of the breast. They are round, solid, and moveable breast cells. These lumps may grow and in that case they are removed to ensure noncancerous.

BREAST IMAGING REPORTING AND DATA SYSTEM : Mammogram results are indicated in BIRADS (Breast Imaging Reporting And Data System). The categories range from 0 to 6 according to American College of Radiologist.

   BIRADS 0 - Incomplete.

   BIRADS 1 - Normal.

   BIRADS 2 - Benign or negative.

   BIRADS 3 - Probably benign.

   BIRADS 4 - Possibly malignant.

   BIRADS 5 - malignant, biopsy recommended.

   BIRADS 6 - known biopsy - proven malignancy.

SKIN MARKERS : Skin markers are mainly used to identify the nipple, the surgical scars, implants, moles, or other normal appearances of the breast. These markers are applied or paste on the patient's skin before mammography. This saves time for the radiologist in ruling out unwanted confusions.

Markers are of different types, small pellets, S-shaped, triangle, or circular, marking the nipples, the surgical scars, the lumps or moles etc. These are as simple as can be removed easily after mammogram. Nipple markers are useful as they reveal the breast position and also the position of the patient while taking the mammography.

LIMITATIONS : Like all other techniques mammography also has its own limitations. They are as follows

   Mammogram only helps in finding out abnormalities and not in preventing.

   Normal breast tissue can hide a cancerous tissue.

   It cannot detect all the cancers.

   Mammogram are not accurate.

   It is difficult to interpret in younger women.

   Radiation used in the mammogram has a slight chance of causing cancer.

DO'S AND DONT'S :

   The best time for mammogram is one week following the periods.

   Do not wear talcum powder, lotion, deodorant in breast and in underarms.

   If there is any implants or any cosmetic surgery it should be informed to the     doctor or to the technician.

   They should also inform whether they are pregnant or breast-feeding.

   Pain medications such as aspirin and ibuprofen should not be taken before the     mammogram, it will degrade the quality of the test.