Eulalee ThompsonSTRICT GUIDELINES govern the dosage of radiation given off by mammography machines during the breast X-ray, but there is always a lingering fear among women that the annual mammogram recommended by health specialists will expose them to further cancer risks. Dr. Trevor Golding, consultant radiologist, Mandeville Breast Centre, says the breasts are only exposed to low-dose radiation during the X-ray and therefore any question about overdosing is only theoretical.
"That was more applicable in 70's when the machines were not as well calibrated as they are today. Numerous studies have been done in North America and Europe as a result of this misinformation that mammograms cause breast cancer but that myth has been shot dead years ago.
"All mammography machines are produced in the First World and...in the United States every machine is inspected every year to make sure that the guidelines about the levels of radiation are followed," he said.
Up to a few years ago the recommendation was that women between 40 and 50, do mammograms every two years. However, Dr. Golding said important research coming out of a major multi-study indicates that 40 to 50-year-old women are in fact, at increased risk for breast cancer. Annual screening mammograms are therefore recommended for this group. Every woman should therefore have a baseline mammogram at 35 and then have yearly mammograms after age 40.
The mammogram is used to detect any possible breast abnormalities. Each breast is place on a flat surface that contains the X-ray plate and a compressor will be firmly pressed against the breast to allow for a better examination of the breast tissue.
The specialist would inspect the X-ray film and assess the general density of the breast. He is looking for a mass (a swelling or tumour growth) but not all masses are cancerous, some are cysts. He might also see calcifications (these appear as very white areas on the X-ray, calcifications dispersed throughout the breast are generally benign but a breast biopsy might be recommended if they are tightly clustered. Dr. Golding said that he would also review the film for architectural distortions, that is, perhaps the general arrangement of breast tissue is bizarre and asymmetrical.
Dr. Golding said he would also inspect the mass to see if it appears with spike-like edges. If is so, it has a high probability of malignancy and a biopsy would most likely be recommended. The mass might on the other hand have smooth margins and could be benign or malignant. Further diagnostic studies using ultrasound technology might be used to diagnose the mass.
Sometimes, there are false negative results from a mammogram but Dr. Golding said this might occur where there is a preponderance of glandular tissue in the breast and the X-ray procedure overlooks the cancerous tissues. If the woman felt a lump then an ultrasound would be recommended as further investigation. Depending on the appearance of the mass, a needle biopsy can be done immediately to determine if it is cancerous. The addition of the ultrasound he said, significantly lowers the prevalence of false negative results.
The mammography is an important diagnostic tool for breast cancer but Dr. Golding said it is only one of many different approaches to diagnose cancer. He said it should not be substituted for the monthly breast self-examination and the yearly examination by a physician. The care of a woman's breast is her responsibility, he said.
