Mammography is a diagnostic and screening procedure involving low-energy X-rays to evaluate a lady’s breasts. Mammography can diagnose breast cancer early, even before presenting any symptoms.

Mammograms, like other X-rays, employ ionizing radiation to a picture of the breast. The pictures are then examined for any abnormalities.

 Types of Mammography

Depending upon the sign for which mammography is done, we can classify it as 

• Screening Mammography: A screening mammography is an X-ray of the breast used to identify abnormalities in the breast in healthy women. They do not have any symptoms related to breasts. Each breast is normally subjected to two X-rays. It is possible to discover a tumour that is too small to be palpated by hand.
• Diagnostic Mammography: A diagnostic mammography is a breast X-ray done for symptomatic ladies. The first investigation is done for a lady presenting atypical breast changes, including a lump, discomfort, nipple thickening or discharge, or a change in breast size or form. Diagnostic mammography may also assess abnormalities discovered during a screening mammogram. It is a fundamental medical technique that may investigate breast alterations in women, usually after 40.

How does it work?

A patient’s breast is positioned on a flat support plate and squeezed with a parallel plate called a paddle during mammography. A brief burst of x-rays is produced by an x-ray machine and passes through the breast to a detector on the other side. 

A photographic film plate, which records the x-ray picture on film, or a solid-state detector, which delivers electrical signals to a computer to create a digital image, may be used as the detector. Mammograms are the pictures that are created. 

Mammography exposes you to a very small quantity of radiation, roughly 0.2 mSV every shot. People are always scared about exposure to this radiation. To put things in perspective, the average natural background radiation is 3 mSV. By undergoing CT abdomen and pelvis you get exposed to 10 mSV. So compared to these, radiation involved in mammography is very less. 

Low-density tissues, such as fat, look transparent on film mammography (i.e., deeper shades of grey nearing black). In contrast, dense tissue appears whiter on a grey background, such as connective and glandular tissue or tumours. Normal mammography includes each breast’s top and side image, with additional views if the doctor is worried about a suspected breast region.

Mammography Views

• Craniocaudal (CC) View : During the regular screening and diagnostic mammography, the craniocaudal view is a typical view obtained from above. The whole breast parenchyma should be seen in the CC view, with the fatty tissue closest to the chest wall appearing as a dark stripe on the mammography and the pectoral muscle visible behind it. The nipple should be seen from the side.
• Mediolateral Oblique (MLO) View: The most significant projection, the mediolateral oblique view, is a conventional mammographic image obtained from an oblique or angled perspective, which is favoured above the lateral 90o projection because it permits imaging of the biggest amount of breast tissue. The pectoral muscle should be shown obliquely from above, and visible down to the position of the nipple or beyond; the muscle should expand outward as a hint that it is relaxed in the MLO perspective.

What is Sonomammography?

Sonomammography, often known as breast ultrasonography, is a non-invasive treatment that examines the health of the breasts and the blood flow to specific conditions located inside them. It’s a kind of imaging used to check for cancer and other abnormalities in the breast. The breast tissue may be seen quickly with this examination. The exam is often combined with mammography (breast tissue x-ray) to investigate a tumour or lump.

How is sonomammography done?

Nomography, unlike mammography, may be done at any point during the menstrual cycle and requires no special preparation.

It is a basic ultrasonography technique that does not need any preparation. First, the individual to be examined lays down on the examination table. Next, a radiologist administers a gel to the breast region and scans the entire chest area and armpits for any lumps or masses with a specific probe (linear, high-frequency probe).

Advantages of Sonomammography

The following are some benefits of sonomammography:

• Quick and non-invasive
• Painless
• Inexpensive
• There is no need to prepare anything beforehand.
• Suitable for monitoring breast masses
• Without even inserting a needle into a suspicious lump to aspirate fluid, it may be determined whether it is a cyst (fluid-filled sac).

Disadvantages of Sonomammography

• It is an operator-dependent test; breast abnormalities may be missed if not done by an expert.

What happens if my mammogram is abnormal?

Abnormal mammography may not necessarily indicate the presence of cancer. For standardization of reporting, mammography findings are reported with a BIRADS Score. BIRADS is an acronym for Breast Imaging and reporting database system score. It can vary from 0 – 6. Score 0 means an incomplete test due to various reasons. Score 1 – 3 indicate benign or non-cancerous lesions which may or may not need repeat mammography. A 4 -6 indicates lesions suspicious for malignancy that need further investigations and treatment.

Conclusion

Several professional groups have issued guidelines for when women should begin getting mammograms and how often they should be screened. Although patients who begin screening every year at the age of 40 save the most lives. Screening needs to start early for ladies with a family history of breast or ovarian cancer. A woman must discuss the most suitable screening plan with their healthcare professionals.