Mammography

Mammography is the taking of the detailed image of the breast on the film with the help of a special low-dose x-ray (X-Ray). Low-dose X-ray, high-contrast and high-density films and specially designed X-ray devices are used in mammography. Early diagnosis is very important in the success of breast cancer treatment. Mammography plays the most important role in early breast cancer diagnosis. The United States Food and Drug Administration estimates that 85% to 90% of masses found in women over the age of 50 can be detected by mammography 2 years before they reach detectable size. The benefits of mammography far outweigh the potential risks and discomfort.

Mammography can display changes in the breast even when they are not felt by the woman herself or her doctor. After the mass is found, mammography can be used to determine whether it is cancer. For this purpose, biopsy can be performed with the help of mammography. Biopsy is the process of taking suspicious tissue and determining whether there is cancer under laboratory conditions. If an abnormality is found, a biopsy with the help of a special type of Mammography (Stereotactic Mammography) or ultrasound can be used to confirm the diagnosis.

Types of Mammography

Mammography can be divided into two as control and diagnostic purposes;

- Control mammography is used to detect possible breast cancers at an early stage in women who have no complaints. Control mammography increases the possibility of early diagnosis and significantly increases the chance of success of treatment when done regularly. It is recommended that every woman over the age of 40 should have a control mammogram once a year. Women, who are assumed to have a relatively higher risk, can start this practice at an earlier age with the recommendation of a doctor.

- Tanı amaçlı Mamografi kitle bulunması ya da meme akıntısı gibi meme ile ilgili şikayeti olan kadınlar ile kontrol amaçlı mammografisinde normal olmayan oluşumlar bulunan kadınlar için uygulanan bir yöntemdir. Tanı amaçlı Mamografi daha detaylı bir işlemdir ve bu nedenle kontrol amaçlı mammografiden daha uzun zaman alır. Tanı amaçlı Mamografi kuşkulu dokunun tam yerini, boyutunu belirlemek ve çevre dokuyla lenf bezlerini görüntülemek amacı ile yapılır. Daha önceden meme kanseri geçirmiş kadınlar ve memelerinde protez bulunan (Silikon vb.) kadınlar tanı mammografisi yaptırırken daha fazla açıdan görüntülenebilirler.

How Is Mammography Done?

While mammography is being taken, the specialist moves the patient to the required position and views each breast separately. In the shot of each nozzle, the nozzle is carefully placed on the film carrier plates and gently pressed between the two sheets. These sheets are usually made of clear fiberglass or other clear plastics. This compression causes the breast to flatten, which makes more successful imaging and examination of tissue possible. The amount of radiation received by the tissue also decreases.

In some mammography centers, specialists may place adhesive locators on the breast skin prior to mammography. The purpose of this marking may be to identify formations that are not related to cancer, such as wounds, but may lead to incorrect evaluations, or it may also be to mark potential areas such as a found mass that causes mammography. In some mammography centers, a marker is always placed on the nipple, and radiologists use this marker to locate their findings.

During mammography, an X-ray source is turned on and the resulting X-rays pass through the compressed breast and reach the film cassette under the breast. A special phosphor layer in the film cassette creates light photons at the rate of X-rays falling on it, and these light photons are recorded by the X-ray film and darkening occurs on the film. Since X-rays pass through tissues of different densities and types at different rates, the internal structure of the breast is visualized. This two-stage imaging method produces a very detailed image of the breast with the least amount of radiation possible, as it is made using high-sensitivity X-ray films and low-energy X-rays. Processed mammography films are evaluated by radiologists. Radiologists compare mammograms of both breasts with each other and new mammograms with old ones in their evaluations. In the evaluation, radiologists look at the shadows and the distribution of breast tissue density.

Mammography is like a fingerprint, it varies a lot from woman to woman, in fact, no mammogram is like any other mammogram. For this reason, it is of great importance to take not only the reports of the previous controls, but also the mammography films taken during these controls when going to the controls. Small differences between previously taken mammography films and newly made films can enable cancer to be diagnosed at an early stage.

Breasts are made up of fat, connective tissue and glands. Breast masses, including benign and cancerous lesions, appear as white areas on mammography film. Fat appears black on mammography film. Everything else (secretory glands, connective tissue, tumors, other significant abnormalities such as microcalcification) appears as varying degrees of white on the mammography film.

Compressing the breast during a mammogram

During mammography, the breast is slightly compressed so that the maximum amount of tissue can be visualized. Although the compression of the breast may cause some discomfort, this will only subside in the short time required for the mammogram to be taken. You may feel a firm compression and pressure during the mammogram, but this should not be painful. If you experience pain, you should notify the mammography technician. Causes of compression of the breast during mammography;

1- When the breast is compressed, the breast tissue spreads over a wider area, overlaps are minimal, and therefore the anatomy of the breast and possible abnormalities can be better visualized. For example, insufficient compression leads to poor visualization of microcalcifications, microcalcifications are tiny deposits of calcium and are often an early sign of breast cancer.

2- Shadows of normal structures are less likely to overlap, creating a suspicious image.

3- Because a thinner tissue will be examined, less X-ray is needed.

4- By preventing the nozzle from moving, blurring of images is prevented.

5- X-ray is prevented from dispersing in the thick tissue, reducing the image quality.