Mammograms, which are x-ray examinations, are used to determine whether a breast lump is an indication of breast cancer. In order to find out more about the topic, we conducted an interview with Professor Mats Danielson from Philips Healthcare.
At what age should healthy women begin having regular mammograms, and how often should they have them?
Different countries have different recommendations for the age that women should start their regular screenings.
In Singapore, women between the ages of 40-49 should have mammograms once every year. Thereafter, they are recommended to go once every two years. Women who are at higher than average risk of breast cancer (for example, because of a family history of the disease) should talk with their health care providers about whether to have mammograms before age 40 and how often to have them.
How long does it take to have a mammogram and how/when do you find out the results?
For screening mammogram, this procedure requires 2 standard views for each breast. Total procedure may take 4 to 5 minutes. The mammography images are reviewed by the radiologist. In BreastScreen Singapore, the patient will receive the results in the form of a letter within 3 weeks from the date of screening. The letter will state whether further tests are needed.
What is the difference between a screening mammogram and a diagnostic mammogram?
A screening mammogram is done to screen people who are at risk for developing the cancer but have no symptoms of it. The goal of screening is to save lives by discovering the disease early, before people know that they have it.
These screenings are done routinely on women who have no signs or symptoms of breast cancer to screen for the disease. These screenings may show a lump that a woman didn’t know was present. The mammogram can detect micro calcifications, tiny deposits of calcium in the breast that may be indicators of breast cancer, or a tumor that cannot be felt through clinical breast exam.
A diagnostic mammogram is done to help make a diagnosis once signs or symptoms have appeared, such as a lump, pain, thickening, nipple discharge, or a change in breast size or shape.
A diagnostic mammography is also indicated for women with a possible abnormality detected on their screening mammogram. A diagnostic mammogram uses the same mammography machine, additional views may be required which may relate to longer examination time. (Such as special projections from various angles, magnification views etc).
If something suspicious is found on a mammogram, what is the chance that it might be breast cancer?
If any mammogram image is supposedly found to have cancer-like lumps/images, there will be a need for further imaging such as additional mammography views, ultrasound of the breast or breast MRI.
To confirm the diagnosis, the doctor will usually perform a breast biopsy where a sample tissue of the suspicious area in your breast is taken. A pathologic evaluation of the biopsied tissue is the only way to tell if cancer is present.
Is digital mammography better at detecting cancers?
Digital and conventional (analog) mammography both use x-rays to produce an image of the breast.
In conventional (analog) mammography, the image is stored directly on film.
However, in digital mammography, an electronic image of the breast is stored as a computer file. This digital information can be enhanced, magnified, or manipulated for further evaluation more easily than information stored on film.
Because digital mammography allows a radiologist to adjust, store, and retrieve digital images electronically, digital mammography offer the following advantages over conventional mammography:
- less radiation exposure per breast image
- a better breast image, especially in younger women with dense breasts (breast that have a lower-than-average amount of fat tissue)
- Health care providers can share image files electronically, making long-distance consultations between radiologists and breast surgeons easier.
- Fewer follow-up procedures may be needed.
- Fewer repeat images may be needed, reducing the exposure to radiation.
- Retrieval and comparison of previous examinations can be done more efficiently.
- Computer Aided Detection (CAD) software can be used for digital mammography as a second reader to help the radiologist pick up suspicious lesions.
Will a digital mammography hurt?
Image source: iStock
During the mammography procedure, the breast is compressed for a few seconds to spread the tissue apart and get a good image of the breast. Some women may find this uncomfortable or painful, but this is temporary and will last only a few seconds.
Pain experienced during mammography depends on the amount of compression force applied and density of the woman’s breast as well.
With Philips MicroDose, the system’s breast support is anatomically curved for a comfortable fit, and has a warmed surface to reduce discomfort during compression. The result is an enhanced and more comfortable patient experience.
What are the main advantages of MicroDose?
Philips MicroDose is the only FDA-cleared mammography system that uses X-ray photon-counting technology.
Lower Radiation Dose: Similar to light-emitting diode (LED) lighting that uses less wattage than traditional incandescent bulbs while providing high light output, the Philips MicroDose patented photon-counting detector utilizes less radiation while delivering excellent image quality.
The patented photon counting detector is more efficient compared to standard detectors and therefore the x-ray dose can be reduced. Low dose mammography enhances the efficiency of screenings, by increasing the diagnostic confidence of clinicians while avoiding unnecessary radiation exposure for patients.
Excellent Image Quality: The Philips MicroDose produces high resolution images despite the lower radiation dose. The 50 micron pixel size of the system enables the radiologist to pick up very fine details on the image, such as micro-calcifications.
Higher Patient Comfort and Clinician Examination Time: Philips MicroDose was designed with both the patient and clinician in mind. Its ergonomic design lets the technologist perform the examination in about four minutes, which means a shorter and more convenient visit for women.
What is the chance that a mammogram will save the life of a woman with breast cancer?
A study by the World Health Organisation showed that mammography is the only screening method that is proven to be effective. The earlier a tumour is diagnosed, the greater the chances of survival. In high-income countries where the screening coverage is over 70 percent, mammograms can reduce breast cancer mortality by up to 20 to 30 percent of women aged over 50.
Studies have also shown that mammograms can spot tumours by up to three years before they might be detectable by touch, and early detection provides a wider range of treatment options – including less aggressive surgery and adjuvant therapy.
Is there reason to worry that the radiation exposure from mammograms will have any health risks?
Mammograms require very small doses of radiation. The risk of harm from this radiation exposure is extremely low. The benefits of mammography, however, nearly always outweigh the potential harm from the radiation exposure. Nevertheless, women should talk with their health care providers about the need for each x-ray. In addition, they should always let their health care provider and the x-ray technician know if there is any possibility that they are pregnant, because radiation can harm a growing fetus.
FYI: Patients typically absorb about 0.5 mSv during MicroDose screening mammography. Annual background radiation in Singapore is 0.9mSv.
Source: Singapore National Environment Agency (NEA)