Mammogram: Diagnosis of Breast Pathologies

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Table of Contents

Introduction
Purpose
Process
Information Gathered
Validity and Reliability
Conclusion
References

Introduction

A mammogram is a procedure for radiographic diagnosis of breast pathologies. It is widely used for screening during preventive examinations of women. The informative nature of the mammography method makes it possible to determine tumor-like formations of a benign or malignant nature in the early stages. This makes it possible to determine the accumulation of microcalcinates — the main sign of the probable development of breast cancer.

Purpose

Mammography is an X-ray method of examining mammary glands, based on the ability of various types of living tissues to transmit X-rays to varying degrees. At the same time, normal and pathologically altered breast tissues give a different image on an X-ray (in our case, it is called a mammogram), which allows the doctor to detect various diseases (Demb et al., 2020). Mammography can be diagnostic and performed to confirm an already established diagnosis to assess, for example, the size of the tumor node, its growth rate compared to previously performed images, and preventive screening (Haas et al., 2017). Mammograms for diagnostic purposes are made for women and men regardless of age; the main thing is the presence of objective indications, for example, palpable formation in the mammary gland.

Preventive mammography is necessary for all women starting from the age of 40. This is because, during this period, a change in the hormonal balance begins, associated with involutive processes in the ovaries. In addition, after 40 years, the informative value of breast X-rays is much higher since the fibroglandular tissue in older women is less developed (Haas et al., 2017). Consequently, bulky formations are not masked by connective tissue, as a result of which they are better visible on X-ray images.

Process

A mammographic examination is performed using a special device – a mammograph. The patient visits the mammary gland on a certain table under the X-ray tube. After that, the laboratory assistant gives current; the tube generates X-rays that pass through the tissues and illuminate the X-ray film or affect digital detectors in more modern devices (Demb et al., 2020). Then the image is either digitized and displayed on a computer screen or printed out in “analog” form on film. These images are analyzed by a radiologist, and a conclusion is issued on them in the future. Adipose tissue delays X-rays to a much lesser extent compared to connective tissue, and liquid (water) is impervious to X-rays to an even greater extent. It should be noted that calcinates are impervious to X-rays by almost 100% (Demb et al., 2020). Thus, mammograms can show cysts, tumors, and calcifications in the structure of the breast – in scientific terms, to evaluate its architectonics.

Information Gathered

The informative nature of the mammography method makes it possible to determine tumor-like formations of a benign or malignant nature in the early stages. With the help of mammographic examination, in more than 86% of cases, it is possible to determine tumor neoplasms (Demb et al., 2020). Nevertheless, the most crucial advantage of this method is the detection of more than half of cancer cases in the early stages, when the mammologist is unable to detect the tumor on palpation and the woman does not feel any changes (Qin et al., 2018). However, in 14% of cases, a mammographic examination cannot detect signs of tumors, and then the mammologist prescribes an additional study through pneumocystography or ductography (Qin et al., 2018). In addition to malignant neoplasms, mammography reveals several benign tumors, including:

mastopathy;
calcinates;
fibroadenomas;
cysts.

Validity and Reliability

Undoubtedly, mammography is an effective way to examine mammary glands, but it also has some limitations. Thus, the method’s reliability decreases with small breast size and if the woman is young (up to 30 years old) (Giampietro et al., 2020). In addition, a mammographic examination is not performed if a woman has undergone aesthetic breast augmentation surgery using implants. To conduct a study, no special training is required, but the pain that accompanies mammography cannot be called just discomfort (Giampietro et al., 2020). The procedure is certainly a little painful since the mammary glands are compressed between the plates, but this allows identifying malignant neoplasms and benign tumors.

One of the criteria for the reliability of the method is sensitivity and specificity. The sensitivity of mammography (the ability to identify people with the disease) depends on the density of the mammary parenchyma. According to some studies in adipose tissue, sensitivity is close to 100%, when examining women with dense mammary glands, mammography from 10 to 40% does not exclude cases of X-ray negative cancer (Giampietro et al., 2020). These results are consistent with the indicators of foreign randomized studies proving that mammography determines about 75% of breast cancer cases in women aged 40-50 years and up to 90% of breast cancer cases in women aged 50-70 years (Haas et al., 2017). The specificity of the method, which consists of the ability to identify persons who do not suffer from the disease, reaches 95-97% (Haas et al., 2017). Thus, it should be noted that this is a fairly reliable method.

Conclusion

In general, mammography refers to studies accompanied by a low radiation load – unlike computer tomography and other X-ray diagnostic methods. Therefore, there can be only one answer to the question of how many times a mammogram can be done — as many as it takes to make an accurate diagnosis (Haas et al., 2017). At the same time, the doctor prescribing the study should, if possible, strive to avoid additional radiation exposure (Qin et al., 2018). In the case of similar informativeness, they prefer other, non-ionizing diagnostic methods (ultrasound, magnetic resonance tomography of the mammary glands).

References

Demb, J., Abraham, L., Miglioretti, D. L., Sprague, B. L., O’Meara, E. S., Advani, S., Henderson, L. M., Onega, T., Buist, D., Schousboe, J. T., Walter, L. C., Kerlikowske, K., Braithwaite, D., & Breast Cancer Surveillance Consortium (2020). Screening mammography outcomes: Risk of breast cancer and mortality by comorbidity score and age. Journal of the National Cancer Institute, 112(6), 599–606. Web.

Giampietro, R. R., Cabral, M., Lima, S., Weber, S., & Dos Santos Nunes-Nogueira, V. (2020). Accuracy and effectiveness of mammography versus mammography and tomosynthesis for population-based breast cancer screening: A systematic review and meta-analysis. Scientific reports, 10(1), 7991. Web.

Haas, J. S., Barlow, W. E., Schapira, M. M., MacLean, C. D., Klabunde, C. N., Sprague, B. L., Beaber, E. F., Chen, J. S., Bitton, A., Onega, T., Harris, K., Tosteson, A. (2017). Primary care providers’ beliefs and recommendations and use of screening mammography by their patients. Journal of General Internal Medicine, 32(4), 449–457. Web.

Qin, J., White, M. C., Sabatino, S. A., & Febo-Vázquez, I. (2018). Mammography use among women aged 18-39 years in the United States. Breast Cancer Research and Treatment, 168(3), 687–693. Web.

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