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Breast cancer: mammography as diagnostic investigation. BREAST CANCER: MAMMOGRAPHY AS DIAGNOSTIC INVESTIGATION.
There are various investigations which can be carried out at a hospital or special clinic if any disease of the breast is suspected. The more common ones will be described here, before the actual process of diagnosis is explained. All doctors and all hospitals and clinics have their own way of doing things, although there are plans to standardize this care.
Mammography
Mammography involves taking X-rays of the soft tissues of the breast and armpit. It is used for routine breast screening and as a tool in the diagnosis of breast diseases.
The natural contrast due to the breast's fat content is exploited in mammography. Most breast cancers occur in women over the age of 45, and it is around this age that glandular tissue within the breast begins to be replaced by fat. The appearances of different types of growth vary, allowing quite accurate distinction between some benign and malignant lumps.
Young women, who are concerned about breast cancer, perhaps because they have a family history of this disease, may find that their request for a mammogram is refused; some then arrange for mammography at a private clinic. However, mammograms are not normally helpful in women under the age of 35 as their breast tissue is too dense for most abnormalities to be visible.
Seen on an X-ray, benign breast tumours and cysts tend to have a smooth outline, sometimes surrounded by a 'halo' of fat. Malignant tumours, on the other hand, are usually poorly defined, more diffuse masses with diagnostically important tendrils extending randomly into the surrounding tissue. Both types of tumour can contain calcium deposits, but these are more numerous, irregular and less coarse in a malignant growth. If mammography reveals a lump in the breast, it may be followed by further investigations such as a biopsy.
When is mammography necessary?
Apart from its use as a screening tool for women over the age of 50 in the UK, and for those who are particularly at risk of developing breast cancer, mammography is important in the diagnosis of various breast diseases. The following are some signs and symptoms which may need to be investigated by X-ray mammography.
* A lump of unknown origin.
* Several small lumps which can be felt within the breast.
* Unexplained discharge from the nipple.
* Unexplained inversion of the nipple.
When malignant disease is suspected, mammography is also used to:
* confirm the clinical diagnosis,
* determine the extent of the disease - there may be more than one cancer in the breast,
* look for disease which cannot be felt but which may be apparent on a mammogram as areas
of calcification,
* look for cancer in the other breast.
Mammography can also help in the planning of surgical treatment as a lumpectomy will not be suitable for all women. It may also be used to look for signs of recurrent disease or further breast lumps following cancer treatment.
Some small benign lumps, and occasionally cancers, within the central ducts of the breast near the nipple are difficult to detect by mammography, and X-ray following the injection into the duct of a radio-opaque substance may be required if these are suspected.
The process of mammography
You will be asked to remove your clothing down to your waist, and a radiographer will then help to position you for the X-ray. Each breast in turn will be placed on a shelf-like plate on the mammography machine, and another plate will then be lowered onto the breast to compress it. You will be asked to keep very still while the X-ray is taken.
The pressure on the breast as it is compressed between the two plates can be quite uncomfortable, but lasts only a few seconds. Many women are anxious about having a mammogram and so are more than usually sensitive to any discomfort it causes. Some do find the process painful - particularly just before a period - and, rarely, it can cause bruising of the breast and in some cases pain that can last for several days or weeks. However, the pressure of the plates is unlikely to cause any harm, and the radiation level from the X-ray is very low, although higher radiation doses are required to take X-rays of the breasts of young women, who therefore should not have more mammograms than necessary. The benefits of mammography as a diagnostic tool and for breast screening do outweigh any discomfort it may cause.
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