What is a mammogram?

A mammogram is an X-ray of the breast used by doctors as a screening tool for breast cancer and to detect abnormalities in breast tissue.

A mammogram is considered a useful test to identify breast cancer early, even before symptoms develop.  In a few cases up to three years before they can be felt or detected. This is called a screening mammogram. While a diagnostic mammogram is advised by a healthcare professional in case you develop any new symptom, such as a lump, pain, nipple discharge or breast skin changes. Breast cancer is the most prevalent cancer worldwide and is one of the leading causes of death in women. Although treatment approaches for breast cancer continue to improve, early diagnosis with the help of screening mammograms has significantly reduced the cancer-related deaths and impacted the survival rates of these patients.

Please note that not all breast lumps are breast cancers. Your doctor can ask for specific tests to differentiate between a cancerous and a noncancerous mass.

Why is a screening mammogram different from a diagnostic mammogram?

A screening mammogram is a routine, in most cases done annually to check for signs of breast tissue abnormalities before you have symptoms. It typically includes at least two pictures of each breast taken at different angles, from top to bottom and from side to side.

However, you can undergo a diagnostic mammogram if your screening mammogram detects an abnormal tissue in your breast. It includes extra views and utilizes additional imaging techniques which are supervised by the radiologist at the time of the study.

Who all should undergo a mammogram?

Various organizations such as American College of Obstetricians and the American College of Radiology, recommend an annual screening mammogram, starting at age of 40 years for all women with an average risk of developing breast cancer. 

The American Cancer Society recommends the following:

  • Women with age 40 to 44 years should have the option to start annual breast cancer screening with mammograms.
  • Women with age 45 to 54 years should undergo mammograms every year.
  • Women who are 55 and older can choose to get mammograms every 2 years, or can continue yearly screening.
  • Screening mammograms should be continued if a woman is in good health and is expected to live 10 more years or longer.
  • All women should be aware with the benefits, limitations, and potential harms associated with breast cancer screening. 

Occasionally, males who are at high-risk of developing breast cancer because of their family history may also get screening mammography. However, about 1 out of 100 males develop breast cancer.

Besides, your healthcare provider may ask you to take annual screening mammograms if you have any of the following risk factors:

  • Family history of breast or ovarian cancer
  • Personal history of breast cancer
  • Inherited genetic mutations
  • Certain noncancerous breast diseases such as atypical ductal hyperplasia or lobular neoplasia
  • Dense breasts.

How is a mammogram done?

A mammogram is a special X-ray designed to check only breast tissues.

  • You will stand in front of the machine and a technician will place your breast on a plastic plate
  • Another plate, known as paddle will firmly press your breast from above which will flatten it, you might feel some pressure at this moment
  • These two plates will hold the breast still while the X-ray is being taken
  • The machine creates X-rays that pass through your breast to a detector located on the opposite side
  • The detector transmits electronic signals to a computer to form a digital image
  • These steps are repeated to capture side views of the breast for both breasts.

How can you prepare yourself for a mammogram?

Although getting a mammogram is not usually an uncomfortable procedure for most women, it takes only a few moments and any discomfort, if present gets over soon. You will be required to remove all clothing and jewellery from your waist up for the imaging procedure.

Points to consider while scheduling your appointment for mammogram:

  • If you have been recently vaccinated for COVID-19, and are due for a mammogram, ask your healthcare provider for how long you should wait after vaccination to get your mammogram done
  • Avoid scheduling your mammogram the week before you get your period or during your period as your breasts may be tender during this time, which could make it uncomfortable
  • Try to inform your doctor if you are breastfeeding, pregnant or suspected to be pregnant
  • If you have breast implants, do not forget to mention it to your healthcare provider.

There are certain guidelines that you are required to follow on the day of your mammogram:

  • Follow your normal routine including regular medicines
  • You should remember to not apply the following substances as they can appear as white spots on the image and will interfere with the accuracy of mammogram:
  • Deodorants
  • Body powders
  • Perfumes
  • Ointments or creams on your breasts or underarms.

How safe are mammograms?

Although mammograms expose your breasts to small amounts of radiation, its benefits outweigh any potential harm from the radiation exposure.

Do you feel pain during mammograms?

A mammogram experience can be different for different people. The level of discomfort that you feel depends on the following factors, such as:

  • The size and density of your breasts
  • The compression your breasts need while capturing the image
  • If you are having or about to get on your period as your breasts may be more tender and sensitive to compression
  • The skill of the radiology technician
  • You will feel less discomfort if you are relaxed and position yourself in the best way for good images.

What does the result of mammogram signify?

If your mammogram is normal, continue to get mammograms according to recommended time intervals. Screening mammograms are most beneficial when a radiologist can compare them to your previous mammograms to analyse the changes in your breasts.

If your mammogram is abnormal, and shows one or more suspicious regions, it does not necessarily mean that you have cancer. You will be advised to undergo additional mammogram views, other imaging tests including a breast ultrasound, or a breast biopsy.

In nutshell, mammography is a fast and safe procedure. A mammogram can save your life as early detection of breast cancer reduces your risk of dying from the disease by 25-30% or more. Consult your doctor about your need for mammograms, so you can make sure to start screening as early as possible.

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bb_breast_self_exam image

In 2020, there were 2.3 million women diagnosed with breast cancer and 685,000 deaths worldwide. What is more worrisome is that the incidence is alarmingly increasing globally.

After skin cancer, breast cancer has been cited as the most common cancer diagnosed in women across the world. Breast cancer can occur in both men and women, but it’s far more common in women.

Women are better multitaskers than men, say studies. However, “the multitasker” needs to take care of her health too. Book a TruHealth Package today- specially designed for women.

Breast cancer awareness: The need of the hour

Breast cancer can begin in different parts of the breast. A breast is made up of three main parts: lobules, ducts, and connective tissue. The lobules are the glands that produce milk. The ducts are tubes that carry milk to the nipple. The connective tissue (which consists of fibrous and fatty tissue) surrounds and holds everything together. Most breast cancers begin in the ducts or lobules. Breast cancer can spread outside the breast through blood vessels and lymph vessels. When breast cancer spreads to other parts of the body, it is said to have metastasized.

Breast cancer symptoms

Though the symptoms can vary to some extent from person to person, and not all women experience all the symptoms, the most common symptoms of breast cancer include:  

  • Skin changes, such as swelling, redness, or other visible differences in one or both breasts
  • A lump or an increase in size or change in shape of the breast(s)
  • Discharge other than breast milk from nipples
  • Pain or ulceration in/on any part of the breast along with lumps or nodes felt on or
    inside of the breast

A study has reported that women aging above 40 with high cholesterol were 45% less likely to develop breast cancer than those without high cholesterol. Track your cholesterol levels from time to time.

What can you do to keep yourself safe from breast cancer?

A breast self-exam is a simple check-up which women can do at home to look for changes or problems in their breast. This method requires a woman to look at herself and feel each breast for possible lumps, distortions or swelling. With medical awareness being what it is today, many women around the world feel that doing this is important for their health.

When to do a breast self-exam?

The best time to do a breast self-exam is about 3 to 5 days after your period starts as breasts are not as tender or lumpy at this time of your monthly cycle. If you are pregnant, never had a period, no longer have periods or your period cycle is irregular, choose a specific day each month to perform your self-check. After menopause, try to do this on the same day every month. To prepare for your breast self-test, you can ask your doctor for a demonstration or seek support following the below given steps.

Steps to be followed while doing a breast self-examination

Step 1

Undress from the waist up and stand straight with your hands on your waist in front of a large mirror in a well lighted room. Observe your breasts; they might not be equal in size or shape and that’s perfectly okay. For most women that’s the case. Take your time and look for any changes in shape, size or position, or any change in skin around it. Check if there is any puckering, dimpling, sores or discoloration. The first time you do this, you might not notice anything but with regular examination you will soon know if there are any changes. If you notice any change, bulging of the skin, visible distortion or swelling, you should bring it to the notice of your doctor.

Check your nipples, examine them carefully for any sores, peeling or change in their direction- a nipple that has changed position or has redness, rash or swelling.

Strep 2

Raise your arms high and look for the same changes in the mirror. See if there is any sign of fluid coming out of any nipple, it can be watery, milky or yellowish fluid or even blood.

Step 3

Lie down on a bed and then touch your left breast with your right hand and vice versa. With the fingertip pads of your hand check your breast using a firm smooth circular motion. Examine the entire breast from top to bottom, side to side- from your collar bone to the top of your abdomen, from your armpit to your cleavage. Follow a pattern so as to cover the whole breast area. Start from the nipple, moving in larger and larger circles until you reach the outer edge of the breast.

Or as more women prefer, you can also move your finger pads up and down vertically, in rows like while you are mowing a lawn. Be sure to check all the tissues from the front to the back of your breast.

Step 4

Now feel your breasts while standing or sitting. You can even do this while your skin is wet and slippery in the shower. It’s a fact that many women prefer doing it in the shower. Cover your entire breast, using the same movements described in the previous step.

When you are self-examining yourself, do not panic if you feel a lump in your breast or other breast changes. There can be a number of causes behind this. It might be due to hormonal changes, a benign breast condition or an injury. On first self-examination many women might find lumps or lumpy areas in their breast but these are common amongst most women and they are not all cancerous. Moreover, many times, changes and lumps disappear automatically over a period of time. But if it persists for a long duration it’s better to consult a doctor and clear any doubts.

The more you examine your breasts the more you learn about them

And the easier it becomes for you to find any changes in them. Breast awareness is sometimes considered as an informal alternative to breast self-examination. Form a habit of doing a self-examination once a month so that you become familiar with how your breasts normally feel and look. Your goal is to get used to the feel of your breasts which will help you to detect any changes in them over a period of time. There are many conditions that can cause changes in your breast, cancer alone might not be the reason. But if you become familiar with your breast type, then it significantly increases the chances of discovering any lump formation or changes which might be the first sign of breast cancer.

Breast Cancer screening

It is believed that regularly examining your breasts on your own can be an important way to detect cancer early and get proper treatment. But at the same time one should not depend only on self-exam to rule out cancer. No single test can detect all breast cancer early but breast cancer organisations believe that performing a breast self-exam along with other screening methods can increase the odds of early detection. Regular physical examination by a doctor, mammography and if necessary ultrasound or MRI; all or any might be needed.

Apart from breast self-examination, your doctor might do a breast exam and refer to certain imaging tests to learn more about your breast.

  • Mammogram. This detailed X-ray gives doctors a better view of lumps and other problems.
  • Magnetic resonance imaging (MRI). This body scan helps create detailed images of the insides of your breasts.
  • Biopsy. For this test, the doctor removes tissue or fluid from your breast and looks at it under a microscope to check for cancer cells and, if they’re there, learn which type they are. Common procedures include:
    • Fine-needle aspiration
    • Core-needle biopsy
    • Surgical (open) biopsy
    • Lymph node biopsy
    • Image-guided biopsy

Breast self-exam is the most convenient no-cost tool that one can use regularly anytime and at any age. It is recommended that all women who are at an average risk or have a family history of cancer, perform breast self-exam as part of their overall breast cancer screening strategy.

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Women of any age group may encounter any of these abnormal changes in their breasts. Yes, if you find any of these unusual signs in you, it can be scary. But one must refrain from panicking and must consult doctor immediately so that appropriate testing and treatment (if needed) can be carried out.

Flat or inverted Nipples

Some women naturally have flat or inverted nipples. Check yourself for flat or inverted nipples by placing your thumb above and finger below your breast on the edge of areola and gently pressing your areola. The nipple should protrude or stick out. If it flattens or indents, you have a flat or inverted nipple. Women with inverted or flat nipples may encounter some difficulties during breastfeeding their child.

Consult your gynecologist or breast care specialist if you have flat or inverted nipples. There are some simple techniques that would help you in correcting this.

Breast pain and tenderness

Breast pain or tenderness in breasts is highly common in females during their periods. The hormones and hormonal changes that play role in regulating menstrual cycle may cause breast pain. This kind of breast pain is normal and usually the pain stops on its own after the menstrual cycle. This can also be called as cyclical breast pain.

The breast pain that happens due to some skin injury, muscle or tissue injury, acidity/heartburn, chest pain or some other reason is called acyclical breast pain.

If you suffer from severe breast pain very often, then you must talk to your doctor.

Change in the skin color or texture of breasts

Skin infections may occur on or around your breasts. Skin related problems in breasts like redness, rashes, dimpling, itching, crusting, moles, cyst formation or changes in breast skin color can occur. Most of these changes might not be very serious. In certain conditions only, changes in breast appearance can be a symptom of Paget’s disease or breast cancer.

Self-breast examination also includes keeping a check on change in skin color or texture of breasts. If you notice dimpling or scarring or skin of breasts appearing like an orange peel, get yourself examined and consulted by a doctor immediately.

Breast Lump/s

While self-examining your breasts if you find some abnormal growth or unusual lump, you must not panic but should immediately consult your gynecologist or breast care specialist.

Lumps in breasts can be an indication of breast cancer. Although, all breast lumps are NOT cancerous. Some lumps can be fluid-filled cysts that are usually not caused by cancer and only require treatment if they cause discomfort.

If you find any sort of breast lump or an unusual growth in your breast you must consult a doctor. The doctor may examine you. Mammography and breast biopsy are other methods of diagnosis to determine the nature of lump. After that the doctor might decide the appropriate treatment, if you need any.

Change in the skin color or texture of breasts

Skin infections may occur on or around your breasts. Skin related problems in breasts like redness, rashes, dimpling, itching, crusting, moles, cyst formation or changes in breast skin color can occur. Most of these changes might not be very serious. In certain conditions only, changes in breast appearance can be a symptom of Paget’s disease or breast cancer.

Self-breast examination also includes keeping a check on change in skin color or texture of breasts. If you notice dimpling or scarring or skin of breasts appearing like an orange peel, get yourself examined and consulted by a doctor immediately.

Nipple discharge or bleeding from nipples

Just like other ducts in the body, breast ducts also have their own secretions.

Women after giving birth, produce milk secretions for feeding their baby. Those suffering with hypothyroidism (lesser secretion of thyroid hormones) might also show nipple discharge from both breasts.

Many women can squeeze out from their nipples, small amount of yellowish, greenish, or brownish discharge. This is often called “physiologic” discharge. Physiologic discharge is not bloody and most of the times is not cause of concern.

If a nipple discharge is involuntary, comes out spontaneously and has blood, then one must immediately consult a doctor. Bleeding from nipples is one of the symptoms of breast cancer. The doctor may advice you to take diagnostic tests like ductogram (examination of breast ducts) as well as mammogram to understand the cause of bloody discharge and the condition of your breasts.

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Contributed by Dr. Shefali Desai – Breast Care Expert and Surgeon

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