What Is A Mammogram or Digital Mammography?

A mammogram, also known as a digital mammography, is a low dose x-ray which captures a picture of the breast tissue. The breast is carefully positioned on a film cassette and gently compressed with a special paddle so that the maximum amount of tissue will appear in the image. This flattening also helps spread the tissue in dense parts of the breast more evenly so that a clearer picture of these areas can be obtained. It also helps doctors determine which changes are noncancerous (benign) and which are cancerous (malignant). Unlike the standard mammography, the digital mammography captures the images electronically and allows them to be viewed on a computer screen. Although the test is administered the same, the digital mammography enhances visibility by up to 300% making it more likely to see lumps and other abnormal changes that may be present in the breast tissue.

When To Get A Mammogram

Women should begin their first mammogram at age 35 (first mammogram is a baseline x-ray). If the results of this screening are normal, then begin annual mammograms at age 40. For all women regardless of age, the Maurer Foundation recommends a monthly breast self-examination and a yearly clinical breast exam with a doctor.

There has been much confusion about whether the importance of cancer screenings have been overstated. The United States Preventive Services Task Force (USPSTF) has even recommended that women ages 40-49 no longer needed to undergo routine mammograms. We couldn’t disagree more! It is our firm position and that of our founder breast surgeon Dr. Virginia Maurer that screenings can only give you knowledge and knowledge saves lives. (See our official statement.)

Many women ages 40-49 have had their breast cancer caught in it’s early stages as a result of a routine mammogram. Had these same women waited until age 50, their survival rate would certainly be lower as a result of their more advanced stage of breast cancer. According to a 2010 Swedish study, breast cancer mortality was reduced 29% for women ages 40-49 who received mammograms. Sandra Palmaro, CEO, Canadian Breast Cancer Foundation – Ontario Region explains, “Since 1-in-6 women who die from breast cancer are diagnosed in their 40s, we simply cannot afford to see missed opportunities for earlier detection.”

Until there is a cure for breast cancer, early detection must play a vital role in safe-guarding lives; mammograms are a significant part of a breast cancer early detection strategy.

Screening Vs. Diagnostic Mammograms

Screening mammograms are the routine basic mammograms that most women receive annually. Diagnostic mammograms take longer, are usually performed to receive a proper diagnosis and involve more pictures from different angles and even the magnification of suspicious areas.

Before Your Mammogram

Discuss your plan to get a mammogram with your doctor if you are pregnant, have breast implants, or you are positive for the breast cancer gene BRCA1 or BRCA2; special mammography recommendations may apply in these situations. Review our mammogram tips to prepare for the day. There’s also some great mammogram videos that explain the process and will help you visualize the process and the mammography machine a little better.

Mammogram Pictures & Images

These are some example mammograms. The one on the left is normal. The one on the right shows an abnormality that would require further investigation.

Other Types of Breast Imaging

Mammograms are only one type of breast imaging. Other types include breast MRIs and breast ultrasounds. These two types of breast imaging are usually only performed if a routine mammogram is inconclusive or if the patient has a high risk for breast cancer, due to lifestyle, genetics, or other breast cancer risk factors.

[Photos by istockphoto]

•    Precancerous cells that consume sugar more common in this population.
•    Prediabetes or gestational diabetes could speed development of cancer cells.

Certain cancer signaling pathways that are activated in aggressive cancer can be detected very early, even in precancerous cells, among young African-American women at high risk for breast cancer. This may allow for earlier detection and prevention of cancer.

However, the early activation of these pathways, which are linked to how the body’s cells consume and break down sugar, also raise the concern that certain conditions such as gestational diabetes and prediabetes, where the body produces more sugar, might stimulate precancerous cells promoting a conversion into cancerous cells.

Victoria L. Seewaldt, M.D., presented these study results at the Fourth AACR Conference on The Science of Cancer Health Disparities, held Sept. 18-21, 2011, in Washington, D.C.

“We see a lot of very aggressive triple-negative breast cancers among young African-American women and a very high death rate, with only 14 percent alive at five years,” explained Seewaldt, professor of medicine and co-director of the breast and ovarian cancer program at Duke University in Durham, N.C. “We wanted to figure out why this was occurring among these women.”

It was already known that aggressive cancer cells actively consume glucose and produce lactic acid, even in the presence of adequate oxygen. Seewaldt and colleagues said this shift toward lactate production is called the Warburg effect.

“One of the hallmarks of really aggressive cancers is that they start taking sugar, breaking it down and turning it into energy,” she said. “It becomes their primary source of energy and that allows the cancer cells to grow rapidly.”

Although the Warburg effect is normally assumed to be a late event in breast cancer, previous research indicated that this process occurs early, even during cancer initiation, in high-risk African-American women. Because this process is occurring earlier, the researchers theorized that they could test for it in young African-American women as a method of breast cancer prevention.

Seewaldt and colleagues looked at two independent groups of 39 and 38 high-risk premenopausal African-American women. High-risk women were normally those women who had mothers or sisters who died from breast cancer at an early age, according to Seewaldt.

“We found that in a high proportion of high-risk African-American women these precancerous cells were taking in a high amount of glucose, and they also had activation of insulin signaling,” she said. “In these women, we would worry that if they developed gestational diabetes that the condition could really stimulate precancerous cells.”

Luckily, conditions like obesity and gestational diabetes can be avoided or treated, said Seewaldt.

“Exercise, weight loss and the diabetes drug metformin provide important opportunities for preventing aggressive breast cancer in African-American women. These are things where a community approach could really make a difference,” she said.

[Photo by bodytel]

As the mom of a nine year-old boy, this is a question I find myself asking every morning before school and every evening before bed.

The question I should be asking all my sisters, colleagues and girlfriends is, “Did you check your breasts yet?”

It’s really that simple; examining our breasts each month should be as routine and as easy as brushing our teeth twice a day.  And just like taking care of our teeth, it’s our responsibility to take care of our breasts.

I know so many women who tell me their husband found their lump or their boyfriend found a lump.  The question I really want to ask (but never do) is, “why didn’t you find it yourself”?

If we examine our breasts on a regular basis (preferably once a month) we are much more likely to discover a lump sooner, while it is still small and can be more easily dealt with.

The best thing about self-breast exam:  it’s free, it’s easy and you don’t have to coordinate it with anyone else’s schedule!

Patricia Brett is a BRCA1+ pre-vivor, mom, and founder and designer of Veronica Brett, the new luxury collection of swimwear for breast cancer survivors, pre-vivors and anyone who just wants to look great in a swimsuit again!  Available at www.veronicabrett.com.

People of all ages and ethnicities need to be educated about breast cancer because it unfortunately, affects everyone. Our focus remains on early detection. The earlier you find any type of cancer, the better. Despite all the controversy out now about what age you should get mammography, we at the Maurer Foundation still emphasize getting annual mammograms done starting at 40 years old, in addition to annual clinical breast exams, and doing monthly breast self exams.  There has also been much debate about the benefits of breast self exams, however, so many women are finding cancer lumps through doing this exam, that it is still something we recommend.

Most recent data shows that 17% of breast cancer deaths happened in women who were diagnosed in their 40s, and 22% occurred in women diagnosed in their 50’s. In terms of cost-effectiveness, practical use, and precision, digital mammography is the best screening tool for the early detection of breast cancer.  To limit its use will mean that breast cancers will go undiagnosed for a longer period of time.  Early detection often allows for breast conserving surgery and possible avoidance of chemotherapy. The limitation of an annual digital mammography screening potentially crushes these options for women 40-49.

Like the American Cancer Society I will continue to recommend annual screening using digital mammography to all women beginning at age 40 and clinical and breast self examinations for women beginning at the age of 18. There is no known cure for breast cancer, though the earlier it is caught increases a woman’s chance of survival. A breast self-exam is not a diagnostic practice but a tool that encourages a woman to recognize any changes that may occur in her breast; a clinical examination allows an expert to confirm any suspicious changes and a digital mammography enhances visibility by up to 300% making it more likely to see lumps and other abnormal changes that may be present in the breast tissue. Women need to fight this disease from a position of strength and knowledge and advocate for their own health with these three components of early detection. Breast cancer is a major health problem to too many women; a digital mammography screening reduces breast cancer mortality and saves lives.