Role of Mammography and Sonomammography in early detection of Breast Cancer

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  • There is a general anxiety about breast diseases in the women now a days. But the good news is
  • Three out of four breast lumps are benign. That means your breast soreness or lumpiness is most of the time non-cancerous.
  • With early diagnosis, 97 percent of breast cancer cases are curable. The thought of having breast cancer is frightening. But, treatments and cure rates are improving every day.

There are few simple ways for early detection:


Women 40 or older should have a mammogram and a clinical breast exam by a doctor every year and should do a breast self-examination every month.


Women under 40 should have a clinical breast exam at least every three years and do a breast self examination every month.


Early detection can aid in achieving successful breast cancer treatment. In the early stages, the tumor is still small, and the risk of it having spread throughout the body is significantly lower. There is usually a good chance of recovery. A physical breast examination performed by a doctor followed by a mammography is the most common form of screening. Today, up to 50 percent of cases can be detected this way.


What is Mammography? Mammography is a specific type of imaging that uses a low-dose x-ray system to examine breasts. It is used to aid in the early detection and diagnosis of breast diseases in women.?


Two types mammograms are:


Screening mammogram: is used to look for signs of breast disease when you do not have any breast symptoms or problems. A mammogram can detect cancer in its early stages, even before a lump can be felt, when treatment can be most successful. Screening mammograms usually take x-ray pictures of each breast from 2 different angles.


Diagnostic mammograms: These areMammograms to look at a woman?s breast if she has a breast problem or a change seen on a screening mammogram. They may include extra views (images) of the breast that are not usually done on screening mammograms.
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Mammograms can?t prove that an abnormal area is cancer, but they can give information that shows whether more testing is needed. The 2 main types of breast changes found with a mammogram are calcifications and masses.


Calcifications are tiny mineral deposits within the breast tissue, which look like small white spots on the pictures. They may or may not be caused by cancer.


A mass, which may or may not have calcifications, is another important change seen on mammograms. Masses can be many things, including cysts (non-cancerous, fluid-filled sacs) and non-cancerous solid tumors, but they could also be cancer. Any mass that is not clearly a cyst usually needs to be biopsied. (A biopsy is taking out a piece of tissue to see if cancer cells are in it.)


Having your older mammograms available for the radiologist is very important. They can help to show that a mass or calcification has not changed for a time, which would mean that it is probably not cancer and a biopsy is not needed.


During a mammography, the breast is positioned between the X-ray tube and a detector. While the image is being taken, the breast is, for a short while, carefully pushed down with a compression plate.



Mammography procedure


Many women find this a bit unpleasant and sometimes even painful. It is, however, necessary in order to get a conclusive image with the right level of quality, and it is reduced to an individually calculated minimum. Compression also lowers the exposure to radiation.
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Each breast is X-rayed at least twice ? once from top to bottom and once diagonally from the outside in. The exposure to radiation is low and below internationally specified radiation limits. In any case the benefit of breast cancer detection outweighs the risk of radiation-induced cancer caused by multiple X-ray exposures over a long time.



Mammogram


Certain deodorants, powders, and lotions contain microscopic materials which can mimic microcalicifications on your mammogram. Since microcalcifications can be an indication of breast cancer, we ask that these products not be worn on or around your breasts or under your arms the day of your appointment.


When is the best time?The best time for your mammogram is within ten days of starting your period (if you are still menstruating). There are reasons for this. First, research shows that breast tissue may appear less ?dense? during the first half of the cycle. Both dense breast tissue and tumour appear white on a mammogram, so dense areas can mask tumors and make them more difficult to detect.


Second, breasts may be less painful during the first week of your cycle. Later in the cycle, breasts often become enlarged with fluid and may be sore or tender, making it more difficult to compress them for the mammogram. Not only is it more comfortable to have a mammogram during week one, but it?s easier to compress the breasts, increasing the ability of the mammogram to detect cancer.


Thirdly, since most women ovulate 10 to 16 days after starting their period, there is a lesser chance of becoming pregnant between days 1 and 10. If you feel you may be pregnant, please inform our staff before your appointment or upon arrival for your mammogram.


Ultrasound of Breasts (SONOMAMMOGRAPHY)
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Ultrasound uses high-frequency sound waves that travel through tissue ? the reflecting echoes are computed into diagnostic image information. During an ultrasound scan, an ultrasound transducer is moved slowly over the breast and armpit while the patient lies on her back. The consultant radiologist analyzes the images displayed on the monitor.


The advantage of ultrasonography is that it is completely painless and there is no exposure to radiation. Therefore, it can be repeated as often as necessary. Ultrasound, as a supplement to mammography. It is used in cases such as a palpable mass or a suspicious finding identified on a mammogram.


While mammography remains the method of choice for breast cancer screening, ultrasound can help reveal more cancers than mammography alone. Ultrasound is especially suited for women with dense breast tissue.According to international guidelines, dense breast tissue increases a woman?s risk of breast cancer up to fivefold.



cyst seen on ultrasound


Ultrasound guided Fine Needle Aspiration Cytology(FNAC)


A FNAC is an outpatient procedure performed under local anesthesia. It involves the removal of cells or tissues with a very thin needle. This process is monitored continuously via ultrasound.Microscopic analysis of such a tissue sample is the most reliable method for determining whether a tissue change is benign or malignant. This will help the surgeon towards further management.



FNAC guided by ultrasound


The Radiology Department of Kasturba Medical College Hospital, Ambedkar Circle, is well equipped for breast imaging.? Our lady technologists haveexcellent training and experience in mammography. We have experiencedsenior lady radiologists who are specialized in mammography, sonomammography and guided FNAC/Biopsies.Thousands of women are getting the benefits every year in our department.


Early detection helps better cure.


Dr Vinaya Poornima
Assoc Prof. – Dept of Radiodiagnosis & Imaging
KMC Hospitals, Mangalore

Author: Dr Vinaya Poornima


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