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Clinical Breast Exams and the Mammogram

The best tool for detecting breast cancer early is the mammogram. Experts believe that mammography can find breast tumors years before they can be felt in a physical breast exam. They estimate a mammogram finds a breast tumor 80 percent of the time.

What Is Mammography?

Mammography is a type of breast exam in which the doctor uses an x-ray of the breasts to evaluate the breast tissue. It is used to look for any breast tumor or cysts that might be present. It is also used to tell the difference between cancerous and non-cancerous disease. Mammography is the only proven method to reliably detect certain tumors.

Using screening mammography increases the ability to locate any abnormal tissue growths in the milk ducts of the breast. These abnormal growths are early tumors that do not cause harm if they are removed at this early stage.

What to Expect at a Mammogram

When you have a mammogram, your breasts will be placed on a flat x-ray plate one at a time. A compressor will press down on your breasts to flatten out the breast tissue. Then a technician will take a series of x-rays of each breast from several angles.

One concern many women have about having a mammogram is the potential for breast pain during the exam. Women who have sensitive breasts do experience discomfort during the compression portion of a mammogram. For women with sensitive breasts, it is best to schedule a mammogram at a time when your breasts are least sensitive.

The level of radiation you receive from mammography is quite low. Any radiation exposure risk from mammography is very low. If you need to have a mammogram and you have radiation concerns, or if you are pregnant, a lead apron will protect the abdominal area.

If you have had breast implants and are requesting a routine mammogram, be sure the x-ray technicians are experienced in the use of the special techniques required. Ultrasound examinations may be of benefit.

Most Women Report Little Pain
While routine screening has been shown to reduce breast cancer mortality, patients and physicians report that pain experienced during mammography is one reason why more women do not get annual screening breast exams. However, the results of a study published in the April 14, 2003 issue of Archives of Internal Medicine, indicate that for the vast majority of women (72 percent), the pain during mammography is less than that of a mild headache (rating less than 4 out of 10, with 10 being excruciatingly painful). More importantly, however, of the 200 women who participated in the study, 94 percent said they were "very likely or somewhat likely to get a mammogram next year."

When to Have a Mammogram

There is some disagreement about how often a woman should get a mammogram. The American Cancer Society recommends a mammogram every year for all women age 40 and older. The National Cancer Institute recommends a mammogram every 1 to 2 years for women age 40 and older.

Annual or every other year, both of these are general recommendations for mammography. It is important to discuss and assess your personal risk with your doctor to make a decision about how often to receive breast exams and mammography. Your doctor's recommendation may be different based on your family's history or your personal risk factors.

In addition, if at any time you notice any of the following warning signs of breast cancer, you should report them to your doctor immediately:

change in the shape of the breast
change in the size of the breast
new dimple in the skin
change in breast or nipple color
nipple that becomes inverted (pulled in)
discharge from the nipple
new lump in the breast.

Resources

Akron Children's Hospital. (2004, July). Menstruation and breast exam.Tips to Grow By [KT409].

American Cancer Society. (2003, September 30). Mammograms and other breast imaging procedures.

National Library of Medicine. (2004). Mammography. MedlinePlus Medical Encyclopedia.

Quinn, K. (2004). Women in their 40s should get a mammogram every year. St. Louis Post-Dispatch, Inc.

Radiological Society of North America, Inc. (2004, August 6). Mammography. RSNA Handout.

Sharp, P.C., Michielutte, R., Freimanis, R., Cunningham, L., Spangler, J. & Burnette, V. (2003, April 14). Reported pain following mammography screening. Archives of Internal Medicine, 163(7), 833-836.

White, E., Miglioretti, D.L., Yankaskas, B.C., Geller, B.M., Rosenberg, R.D., Kerlikowske, K., Saba, L., et al. (2004, December 15). Biennial versus annual mammography and the risk of late-stage breast cancer. Journal of the National Cancer Institute 96(24), 1832-1839.