II. Indications

III. Background

  1. Mammogram visualizes glandular tissue
  2. Lucent Areas
    1. Fat appears as dark, hazy gray areas
  3. White areas
    1. Parenchymal cells and ducts
    2. Breast tissue abnormalities

IV. Protocol: Mammographic Views

  1. Preparation
    1. Breast compressed to 6 cm
      1. Skin taut
      2. More compression
        1. Uses less radiation
        2. Results in better image
  2. Standard Views
    1. Cranial caudal (C-C)
      1. Head to toe view
      2. Shows medial tissue with centered nipple
    2. Medial-Lateral Oblique (MLO)
      1. Side view including axilla
      2. Images more of Breast than C-C view
  3. Additional Views
    1. Cone down compression
      1. Indicated for Nodules
    2. Magnification
      1. Indicated for micro-calcifications
    3. Eklund View (Implant Displacement View)
      1. Indicated for Breast Implants
      2. Pushes Breast Implant out of image
      3. Compresses Breast to 3.5 cm
      4. Very umcomfortable for patient

V. Protocol: Technological enhancement

  1. Digital Mammography
    1. Overall diagnostic accuracy similar to XRay film
    2. Test Sensitivity better in specific cohorts
      1. Women younger than 50 and premenopausal women
      2. Radiographically dense Breasts
      3. Pisano (2005) N Engl J Med 353:1773-83 [PubMed]
  2. Computer-aided detection
    1. Test Sensitivity decreases with use
    2. Higher False Positive Rate
    3. No change in overall Breast Cancer detection rates
    4. Fenton (2007) N Engl J Med 356:1399-409 [PubMed]

VI. Timing

  1. Perform during Follicular Phase (Days 1-14)
    1. Less Breast engorgement
  2. Age 40-49 years
    1. ACOG and AMA recommend every 1-2 years
    2. USPSTF Strength of Recommendation: C
    3. New data recommends every 18 month Mammograms
    4. Reference
      1. Bjurstam (1997) Cancer 80: 2091-9 [PubMed]
  3. Age 50 years and older
    1. Annual Mammogram
    2. USPSTF Strength of Recommendation: A
    3. Continue screening indefinitely as long as benefit

VII. Efficacy

  1. Early detection of Breast Cancer
    1. Detects Breast Cancer 1.7 years before Breast Exam
    2. Detects lesions as small as 12 mm
    3. Benefits outweigh risks for women ages 50 to 74 years
    4. Reference
      1. Sox (1998)
  2. Test Sensitivity: 60 to 95%
    1. False Negative Rate: 15%
    2. Less effective in:
      1. Dense Breasts
      2. Women younger than age 50 years
      3. Hormone Replacement
    3. References
      1. Mushlin (1998) Am J Prev Med 14:143-53 [PubMed]
  3. Test Specificity: 94-97%
    1. False Positive Rate: 3-6%
    2. Higher rate of False Positives under age 60 years
    3. 24% of U.S women have at least 1 False Positive/10 yr
    4. 49% cummulative False Positive risk with 10 Mammogram
    5. Reference
      1. Elmore (1998) N Engl J Med 338:1089-96
  4. Consensus Double Reading
    1. Two radiologists independently review Mammograms
    2. Identified 80 Breast Cancers per 10,000 reading
      1. Only 71 Breast Cancers found by a single reader
      2. Saved $7300 over cost of a single reader
    3. Reference
      1. Brown (1996) BMJ 312:809-12 [PubMed]

VIII. Risks

  1. Radiation exposure with Mammogram is NOT significant
    1. Two view Mammogram delivers less than 0.5 Centigray
    2. 200 Mammograms would be needed to raise cancer risk

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Ontology: Mammography (C0024671)

Definition (MEDLINEPLUS)

A mammogram is an x-ray picture of the breast. It can be used to check for breast cancer in women who have no signs or symptoms of the disease. It can also be used if you have a lump or other sign of breast cancer.

Screening mammography is the type of mammogram that checks you when you have no symptoms. It can help reduce the number of deaths from breast cancer among women ages 40 to 70. But it can also have drawbacks. Mammograms can sometimes find something that looks abnormal but isn't cancer. This leads to further testing and can cause you anxiety. Sometimes mammograms can miss cancer when it is there. It also exposes you to radiation. The National Cancer Institute recommends that women age 40 or older have screening mammograms every 1 to 2 years.

Mammograms are also recommended for younger women who have symptoms of breast cancer or who have a high risk of the disease.

When you have a mammogram, you stand in front of an x-ray machine. The person who takes the x-rays places your breast between two plastic plates. The plates press your breast and make it flat. This may be uncomfortable, but it helps get a clear picture. You should get a written report of your mammogram results within 30 days.

NIH: National Cancer Institute

Definition (NCI_CDISC) A type of radiography used specifically to examine breast tissue. The procedure utilizes a low-dose of x-rays or radiation to generate an image.
Definition (NCI) A low voltage X-ray photograph of the breast generally done to detect breast cancer. This method is also valuable in diagnosis of benign abnormal conditions of the breast such as fibroadenoma, mastitis, abscess, and cysts.
Definition (NCI_NCI-GLOSS) The use of film or a computer to create a picture of the breast.
Definition (NCI_NCI-GLOSS) An x-ray of the breast.
Definition (NCI) A type of radiography used specifically to examine breast tissue. The procedure utilizes a low-dose of x-rays or radiation to generate an image. A mammography exam or mammogram, is used as a screening tool to detect early breast cancer in women experiencing no symptoms and to detect and diagnose breast disease.
Definition (MSH) Radiographic examination of the breast.
Definition (CSP) radiography of the mammary gland.
Concepts Diagnostic Procedure (T060)
MSH D008327
ICD10 1973
SnomedCT 145894002, 71651007
CPT 1014840
LNC LP32234-4, LA16046-7
English Mammographies, MAMMOGR, mammogram (procedure), mammogram, Mam, Radiography of breast, mammography procedures, mammograms, mammography procedure, Mammogram (procedure), MAMMOGRAPHY, Mammogram, Mammography (procedure), Radiographic examination of breast, mammography, Mammography, NOS, Radiographic examination of breast, NOS, Mammogram, NOS, Mammography
Italian Mammogramma, Mammografia
Japanese 乳房撮影, ニュウボウサツエイ
Swedish Mammografi
Czech mamografie, Mamogram
Finnish Mammografia
Polish Mammografia
Hungarian Mammogram
Norwegian Mammografi
Spanish examen radiográfico de la mama, mamografía (procedimiento), mamografía, Mamografía
Dutch mammogram, Mammografie
German Mammogramm, Mammographie
French Mammographie
Portuguese Mamografia