Can Mammograms Detect Cancer? Breast Cancer Screening

• Screening
  • Looks for early signs of breast cancer and is a routine screening procedure in women without any symptoms
  • X-rays are taken from two different angles
  • Reveals microcalcifications (small calcium deposits)
• Diagnosis
  • Takes more detailed images of the breast in women presenting with symptoms (lumps, breast pain, discharge from the nipples, change in size and shape of breasts)
  • Done to screen women with a previous history of breast cancer
  • Done when a routine screening mammogram shows abnormalities

A mammogram is done by using an X-ray machine that uses low-dose radiation. The machine has two plates that flatten the breast to spread the tissues apart so that the X-rays can pass through them easily.

The technician will place the breast on a plastic plate, another plate will press the breast firmly from above (flattens the breast) and an X-ray is taken. The same steps are repeated to take an X-ray from a side view and for another breast. The technician will check all four X-rays to make sure they are clear and readable.

A radiologist will read the mammogram and look for early signs of breast cancer or other problems.

For many women, a mammogram can be uncomfortable because the X-ray plates tightly squeeze the breast tissue. Discomfort typically lasts for just a few minutes, although this depends on factors such as breast size and the experience of the technician.

Mammograms are generally safe because they expose the breast tissue to a very low dose of radiation. The total dose for a mammogram with two views of each breast is about 0.4 mSv.

However, there are potential drawbacks to screening mammography:

• False-positive result: False-positive results occur when abnormally dense but normal tissue is misdiagnosed as cancer. False-positive results may occur in younger women with dense breasts, previous breast biopsies and a family history of breast cancer, and who are on estrogen (menopausal hormone therapy). This could lead to an unnecessary biopsy.
• False-negative result: False-negative results occur when the mammogram appears normal even though cancer is present. Fibroglandular tissue and tumors have a similar density (both appear as white areas); tumors are harder to detect in women with dense breasts. False-negative results can delay treatment.
• Overdiagnosis: Sometimes, small cancers that are not life-threatening may be diagnosed, resulting in overtreatment or unneeded treatment.
• Radiation exposure: Though mammograms use only small doses of radiation, repeated X-rays are potentially harmful.

The American College of Radiology (ACR) has established a uniform way for radiologists to evaluate mammogram findings through a system called breast imaging reporting and database system (BI-RADS), which includes 7 categories.

Breasts are made up of both glandular and connective tissues, together called fibroglandular and fatty tissues. Breast density reflects the amount of fibrous and glandular tissue compared to the amount of fatty tissue in the breasts. BI-RADS also includes four categories of breast density: 

1. Almost entirely fatty
2. Scattered areas of fibroglandular density
3. Even density throughout, excess areas of fibroglandular density
4. Extremely dense, making it difficult to visualize tumors

The first two categories are considered low-density breasts, whereas the last two categories are considered high-density breasts.

Women with dense breasts have a higher risk of getting breast cancer.

Breasts are made up of three parts.

• Lobules: Milk-producing glands
• Ducts: Tubes that carry milk to the nipple
• Connective tissue (fibrous and fatty tissues): Surrounds other structures

Most often, breast cancer begins in the lobules or ducts and may metastasize (spreads to other organs) through blood and lymph vessels.

• Invasive ductal carcinoma: Cancer begins in the ducts and spreads to other breast tissues and parts of the body.
• Invasive lobular carcinoma: Cancer cells begin in the lobules and spread to other breast tissues and parts of the body.

Ductal carcinoma in situ is a condition preceding breast cancer, wherein the cancer cells are present only in the duct lining and have not spread to the other tissues.