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Interpreting Mammograms

Posted Aug 24 2008 1:49pm
ANNOUNCER: One of the most important exams a woman can take is a mammogram. But some women are unsure of exactly what this test can reveal, and there are many common misperceptions about this screening procedure. So, what exactly is a mammogram and what does it show?

HILDEGARD TOTH, MD: A mammogram is an x-ray of the breast, consisting of two pictures per breast that we obtain generally on an annual basis.

The current recommendations are that an asymptomatic patient should begin screening once a year after 40 years old. If you have a first-degree relative that has had diagnosed breast cancer in the premenopausal period, so for instance if your sister was diagnosed with breast cancer at age 42, if you are 32, you should begin screening at that age, every year thereafter.

What we look for on a mammogram of course is small breast cancers. How they manifest themselves on a mammogram is by showing us a mass or a lump.

The most common presentation for breast cancer would be what is called a spiculated mass. That is a white area on the mammogram that sort of looks like a star-burst appearance. It has lines, straight lines emanating to the mass, and that is very suspicious for a cancer.

Other things we look for are tenting, or changes in the normal very harmonious architecture of the breast, called architectural distortion.

We also look for calcifications, white spots, granules similar to grains of salt.

ANNOUNCER: A common misunderstanding assumes these deposits are related to how much calcium a woman consumes in her diet.

HILDEGARD TOTH, MD: Calcium intake has absolutely nothing to do with the calcium that we detect on mammography. The calcium that we see on the mammogram or anywhere else on the body is really just a process that the body has to facilitate metabolism.

ANNOUNCER: There are several terms associated with calcifications.

HILDEGARD TOTH, MD: Monomorphic is a term that describes calcifications. It indicates a uniformity of shape and size for calcifications and also implies benignity, as opposed to the term pleomorphic, which describes varying shapes, varying sizes, varying densities. That term would lead you to think more of a malignant process.

Microcalcifications are very fine particles of calcium that are deposited in a region of the breast. There are many kinds of microcalcifications. There are the benign kind and a malignant type.

The benign type of calcification, are extremely common. They can occur, probably one in three women will have these types of calcifications.

Macrocalifications are the large, course calcifications that are found in the breast. They are very commonly seen on mammography. They are of no clinical significance.

ANNOUNCER: And there are other common findings associated with breast tissue.

HILDGARD TOTH, MD: Fibroadenomas are benign tumors of the breast, most often seen in the patients younger than 40. They are painful at times, in a cyclical fashion. Occasionally they can get quite big. But they are again, a benign growth and hormonally responsive.

A cyst is just a mass found on a mammogram or frequently felt by the patient. It is a totally benign structure. It is a fluid-filled mass. They are frequently painful. If they are not symptomatic, it's just fine to leave them there.

ANNOUNCER: Once a mammogram is completed, the results will indicate if the test was normal or not.

HILDEGARD TOTH, MD: If it's normal, it would be just described as a normal mammogram and characterized as such. If we are describing an abnormality, a mass for instance, the characteristics that we're concerned about, of course is the size, the location, the density of the mass, the margins of the mass.

ANNOUNCER: Mammograms are not the only breast examinations women will encounter. For years, women have been encouraged to test themselves at home by doing regular breast self-exams. But recently a report in the Journal of the National Cancer Institute sparked a controversy: it reported that intensive breast self-exam instruction does not reduce the risk of death.

HILDEGARD TOTH, MD: The smallest cancer that one can detect on physical exam is 2 centimeters in size which is quite large. There has never been a proven mortality benefit related to the performance of breast examination by palpation, either by the patient herself or by the doctor. Less than 20 percent of all breast cancers are detected by palpation even in experienced hands.

ANNOUNCER: But many still agree that breast self-exams are important.

HILDEGARD TOTH, MD: You are getting an idea of what your own breast feels like. And there are a certain percentage of cancers, approximately 5-6 percent, where the only finding is a lump that the patient feels where the mammogram may be negative and the sonogram is negative. So, yes there is still value to doing it.

ANNOUNCER: When going for a mammogram, there are a few tips that women should remember.

HILDEGARD TOTH, MD: Usually we require the patient not to have powder or deodorant because that can create artifacts that mimics calcifications and can be misinterpreted by the radiologist.

It's most important that the patient go to a facility that is FDA-approved. And all standing facilities right now are being inspected. Therefore, you can go anywhere to really have your mammogram. However you should have your prior mammograms available for comparison.

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