II. Indications
III. Background
- Mammogram visualizes glandular tissue
- Lucent Areas
- Fat appears as dark, hazy gray areas
- White areas
- Parenchymal cells and ducts
- Breast tissue abnormalities
IV. Protocol: Mammographic Views
- Preparation
- Breast compressed to 6 cm
- Skin taut
- More compression
- Uses less radiation
- Results in better image
- Breast compressed to 6 cm
- Standard Views
- Cranial caudal (C-C)
- Head to toe view
- Shows medial tissue with centered nipple
- Medial-Lateral Oblique (MLO)
- Side view including axilla
- Images more of Breast than C-C view
- Cranial caudal (C-C)
- Additional Views
- Cone down compression
- Indicated for Nodules
- Magnification
- Indicated for micro-calcifications
- Eklund View (Implant Displacement View)
- Indicated for Breast Implants
- Pushes Breast Implant out of image
- Compresses Breast to 3.5 cm
- Very umcomfortable for patient
- Cone down compression
V. Protocol: Technological enhancement
- Digital Mammography
- Overall diagnostic accuracy similar to XRay film
- Test Sensitivity better in specific cohorts
- Women younger than 50 and premenopausal women
- Radiographically dense Breasts
- Pisano (2005) N Engl J Med 353:1773-83 [PubMed]
- Computer-aided detection
- Test Sensitivity decreases with use
- Higher False Positive Rate
- No change in overall Breast Cancer detection rates
- Fenton (2007) N Engl J Med 356:1399-409 [PubMed]
VI. Timing
- Perform during Follicular Phase (Days 1-14)
- Less Breast engorgement
- Age 40-49 years
- ACOG and AMA recommend every 1-2 years
- USPSTF Strength of Recommendation: C
- New data recommends every 18 month Mammograms
- Reference
- Age 50 years and older
- Annual Mammogram
- USPSTF Strength of Recommendation: A
- Continue screening indefinitely as long as benefit
VII. Efficacy
- Early detection of Breast Cancer
- Detects Breast Cancer 1.7 years before Breast Exam
- Detects lesions as small as 12 mm
- Benefits outweigh risks for women ages 50 to 74 years
- Reference
- Sox (1998)
-
Test Sensitivity: 60 to 95%
- False Negative Rate: 15%
- Less effective in:
- Dense Breasts
- Women younger than age 50 years
- Hormone Replacement
- References
-
Test Specificity: 94-97%
- False Positive Rate: 3-6%
- Higher rate of False Positives under age 60 years
- 24% of U.S women have at least 1 False Positive/10 yr
- 49% cummulative False Positive risk with 10 Mammogram
- Reference
- Elmore (1998) N Engl J Med 338:1089-96
- Consensus Double Reading
- Two radiologists independently review Mammograms
- Identified 80 Breast Cancers per 10,000 reading
- Only 71 Breast Cancers found by a single reader
- Saved $7300 over cost of a single reader
- Reference
VIII. Risks
- Radiation exposure with Mammogram is NOT significant
- Two view Mammogram delivers less than 0.5 Centigray
- 200 Mammograms would be needed to raise cancer risk