c l i n i c a l f o l i o s : n a r r a t i v e





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Breast Cancer: Mammography: 1

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A mammogram is a low dose x-ray of the breast. It is performed by specially trained and certified radiology technicians and read by specialized radiologists (M.D.'s) in an accredited center. Each breast is flattened from top to bottom (cranio-caudal view) and from side to side (mediolateral view) between plates to spread out the breast tissue. The compression is briefly uncomfortable or even painful if the breast is tender to start with. Oblique views may be obtained if necessary and magnification views with additional compression may be done to clarify indistinct features.

Mammography has become highly sensitive for very small, early changes in the breast. Current guidelines are for a baseline mammogram at age 35. If a mammogram is done in the absence of a specific area of concern it is called a screening mammogram. If there is a specific concern it is called a diagnostic mammogram. The reason that a mammogram is not usually done on women under 35 is that the breast tissue of young women is very glandular and dense and the mammogram is of little benefit. In addition, the risk of breast cancer below this age is minimal. 

As a woman ages, the glandular tissue regresses and the relative amount of fat in the breast increases. The less dense fat allows more x-ray penetration and increased accuracy. Women without a strong family history usually have a mammogram every other year between 40 and 50, and every year after 50 when the risk is greatest.

Sequential mammograms are best done at the same center so that the technique and equipment used is the same from year to year and comparisons are more meaningful.

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Breast Cancer: Mammography: 2

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Abnormal mammographic findings include clustered calcifications, a mass, especially one that is irregular, architectural distortion or asymmetry. Comparison of previous studies is important to determine if there are new findings or changes in previously noted areas that were thought to be benign. Most breast calcifications are benign. If calcifications are deemed suspicious, there is about an equal probability that they are benign or malignant. The mammogram can detect the earliest breast lesions months or years before they grow large enough to be felt.     

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Breast Cancer: Mammography: 3

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Mammography plays another important role in the diagnostic sequence. A lesion seen only on mammography and not felt, can be sampled using an x-ray-guided biopsy needle. This procedure is called a stereotactic or a core-needle biopsy.       

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This page was last modified on 7/11/1999.