Mammography

Reviewed by Dr Sarah Burnett, consultant radiologist

Is mammography safe?

Modern screening equipment emits an extremely low dose of radiation and the chances that a mammogram will cause a cancer to develop is therefore extremely small. The benefits in terms of the number of cancers detected far outweigh the small risks of mammography.

Although there is a lot of very negative publicity about screening, repeated studies have shown that the number of deaths from breast cancer in the age group 50 to 64 are reduced by 40 per cent in those who attend for breast screening.

Can mammography show whether a tumour is benign or malignant?

Mammograms are a good way of identifying abnormalities in the breast but they don't always show whether those abnormalities are benign (non-cancerous) or malignant (cancerous). Further tests are sometimes necessary.

What further investigation may be necessary?

If a patient is recalled, then as well as further mammograms she may require an ultrasound scan or a fine needle aspiration cytology (FNAC).

Ultrasound, which is familiar to many women because it is used to look at babies during pregnancy, can also be used in the breast to tell whether a lump is fluid or solid. If an abnormal shadow is seen on the mammogram, ultrasound is an accurate way of judging whether any abnormality is benign and straight forward or whether it is more likely to be serious.

Inserting a needle into the lump will show whether it is full of fluid (a cyst) or solid. The needle can allow a sample of cells to be removed for examination under the microscope and this is a very accurate method of finding out whether the lump is benign or malignant.

Because any abnormality in the breast may be so small that it is impalpable, meaning that the doctor cannot feel it (impalpable), there are techniques for allowing samples of such lesions to be removed either using the mammogram machine or the ultrasound to guide a needle into the area of abnormality.

If there is an abnormality on the mammogram but no lump to feel, then by using either the X-ray machine or the ultrasound machine it is possible to guide the needle into the area of abnormality and to obtain enough cells or tissue to obtain a definite diagnosis.

Sometimes these impalpable lesions need to be removed. This is achieved by placing a hooked wire using the X-rays or ultrasound to guide the wire into the tissue. The surgeon then follows the wire to the end and removes the abnormal area.

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