Norm of Mammography (Mammogram, Screen Film Mammography [SFM])
Radiographic image of normal breast tissue. Calcification, if present, is evenly distributed. Normal duct contrast with gradual narrowing of branches of the ductal system is evident.
Benign or malignant masses in the breast tissue or nipple. Radiographic signs of breast cancer include asymmetric density; a poorly defined spiculated mass; fine, stippled clustered calcifications, which are seen as white specks on the x-ray film; and skin thickening. Malignant cancers are irregular and poorly defined and tend to be unilateral.
Usage of Mammography (Mammogram, Screen Film Mammography [SFM])
Indicated to detect tumors that are clinically nonpalpable in women over age 40 y as part of routine annual screening; to survey the opposite breast after mastectomy; to screen for breast cancer in clients at high risk for breast cancer; to evaluate breasts when symptoms are present, such as skin changes, nipple or skin retraction, nipple discharge or erosion, breast pain, “lumpy” breast (such as multiple masses or nodules); to rule out breast cancer in a client with adenocarcinoma of undetermined site; to localize a mass before a biopsy is performed; to follow-up after a previous breast biopsy or cancer treatment to determine its effectiveness. Used to diagnose benign breast masses, cysts, or abscesses; benign breast calcifications; breast cancer; fibrocystic breasts; intraductal papilloma of the breast; occult cancer (such as client with metastatic disease and unknown primary tumor); suppurative mastitis; and Paget's disease of the breast.
Description of Mammography (Mammogram, Screen Film Mammography [SFM])
Mammography is a soft-tissue x-ray examination of the breast. Careful interpretation of these x-ray films can detect cancer, even before a lesion becomes palpable. Accuracy of breast cancer detection is approximately 85% and gives less than 10% false-positive diagnoses. It is believed that survival rates are improved with early detection of breast cancer. A “xeromammogram” provides the same information as a routine mammogram and has the same risks and benefits. However, xeromammograms are positive prints, unlike regular radiographs, which are negative prints. This test has four views: oblique, lateral, craniocaudal, and chest wall. At least two views of each breast should be performed, one of which should be of the chest wall. A newer digital technique called full-field digital mammography (FFDM) is approved for use in screening for breast cancer. Digital mammography has improved detection in clients with dense breasts, usually younger women.
Professional Considerations of Mammography (Mammogram, Screen Film Mammography [SFM])
Consent form IS required.
Breast implant rupture (Brown et al, 2004).
The U.S. National Cancer Institute estimates the risk of mammographically induced carcinogenesis at 3.5 cancers/1 million women/yr/rad for Western women over age 30 y at the time of exposure after a latent period of 10 years.
During pregnancy, risks of cumulative radiation exposure to the fetus from this and other previous or future imaging studies must be weighed against the benefits of the procedure. Although formal limits for client exposure are relative to this risk:benefit comparison, the United States Nuclear Regulatory Commission requires that the cumulative dose equivalent to an embryo/ fetus from occupational exposure not exceed 0.5 rem (5 mSv). Radiation dosage to the fetus is proportional to the distance of the anatomy studied from the abdomen and decreases as pregnancy progresses. For pregnant clients, consult the radiologist/ radiology department to obtain estimated fetal radiation exposure from this procedure.
In clients who are pregnant because of the risk of fetal damage.
- Ask client to identify areas of lumps or thickening, if any.
- Ask the client if she is pregnant.
- Record client history of prior biopsies or breast surgeries or treatments.
- See Client and Family Teaching.
- The client is taken to the radiology department and stands or is seated in front of the mammography machine.
- The breast(s) is (are) exposed, and one breast is placed on the x-ray plate.
- The x-ray cone is brought down on top of the breast to compress it firmly between the broadened cone and the x-ray plate.
- The x-ray film is exposed. This creates the craniocaudal view.
- The x-ray plate is turned perpendicularly to the floor and then is placed laterally on the outer aspect of the breast.
- The broadened cone is brought in medially, and the breast is gently compressed. This is the lateral, or axillary, view.
- Occasionally a third view, the oblique view, is required. At least two views of each breast should be performed.
- For clients with implants, the implant is pushed back and extra views are taken.
- This procedure is performed in 10–20 minutes by a radiologic technician.
- A hand-held scanner helps detect early breast cancer that cannot be identified with conventional mammography.
- In the United States, the Mammography Quality Standards Act, phased in the 1990s, established standards for reporting of findings to the client within 5 days after the procedure if the findings may indicate malignancy and within 30 days after the procedure for findings not suggestive of malignancy.
Client and Family Teaching
- The mammogram takes 10–20 minutes for both breasts to be x-rayed.
- Mammography is the best method for detecting breast cancer in a curable stage.
- Some discomfort is experienced when the breast is compressed. Compression allows better visualization. Discomfort is minimized if the test is scheduled during the week after your menstrual period ends.
- Do not use any powder, deodorant, perfume, or ointments in the underarm area. Residue on the skin from these agents can obscure the visualization.
- A minimal radiation dose will be used during the test.
- Wear a blouse with a skirt or slacks, rather than a dress, because you will need to remove clothing from the upper half of the body.
- If experiencing painful breasts, refrain from coffee, tea, cola, and chocolate 5–7 days before testing.
- American Cancer Society mammography screening guidelines: screening mammogram by age 40 and then annually thereafter.
- Call your doctor for results if you have not received a written or telephone test result within 10 days after the procedure.
- Perform a monthly breast self-examination if 20 years of age or older and have a clinical breast examination by a health care provider at least every 3 years until age 40 and then every year. Breast self-examination should be performed after each menstrual period.
- 80% of lumps found by a mammogram are benign.
Factors That Affect Results
- False-positive mammograms are more common in younger women and may result from calcifications of fibrocystic changes, calcification-like deposits in the skin secondary to tattoos, sebaceous gland secretions, and talcum powder.
- False-negative results are possible. Up to 25% occur in women 40–49 years of age, and up to 10% occur in women 50–69 years of age. The principal cause of false-negative mammograms is dense parenchymal tissue because masses show up more clearly in fatty breasts.
- Postoperative and postradiotherapy changes may be mistaken for carcinomas.
- Jewelry worn around the neck can preclude total visualization of the breast(s).
- More breast tumors (55%) are missed when implants are present than in women without implants (33%) (maglioretti et al, 2004). The scintimammography test may pose lower risk for rupture and better chance of detection for women with implants.
- Magnification mammography is limited because of its higher radiation doses, but it can be useful in postoperative and postradiotherapy examinations, possibly preventing unnecessary biopsy.
- Mammography immediately after stereotaxic breast biopsy is suboptimal for establishment of a new baseline view as a result of the frequent finding of hematoma.
- According to one study, women undergoing mammography preferred to have their doctor call them with the result if the results were normal. If the results were abnormal, the subjects preferred to be told by their own physician in the office.
- Molecular breast imaging, a nuclear medicine technique, is being studied and shows promise for being superior to mammography in detecting small breast lesions and early-stage cancer.