Digital mammography

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Digital mammography Performed by Hill Medical

What is digital mammography?

Digital mammography refers to x-ray examination of the breast and yields information on the interior of the breast. Digital mammography is used to detect and diagnose breast disease both in women who have breast symptoms (problems such as a lump, pain or nipple discharge) and women who are asymptomatic (no breast complaints).

When you have your mammogram performed at The Huntington-Hill Breast Center, Inc. or at Hill Imaging Center, Inc., you will be comfortable knowing that our physicians and support staff are highly experienced and trained. We perform more than 40,000 screening mammograms, and over 10,000 diagnostic evaluations of women with breast problems per year. We also provide excellent mammogram accuracy thanks to our nationally respected team of breast radiologists and our computer aided detection (CAD) program. It provides secondary interpretations of every mammogram film that our experienced team of radiologists uses as a back-up evaluation. In addition, our physicians, technologists, and state-of-the-art equipment are certified and accredited by the American College of Radiology (ACR), the FDA, and most recently the National Accreditation Program for Breast Centers (NAPBC). Huntington-Hill Breast Center, Inc. has also been awarded "The Breast Imaging Center of Excellence (BICOE) by the ACR because it has earned accreditation in all of the ACR's breast-imaging accreditation programs, in addition to the Mammography Accreditation Program.

Calcifications are tiny mineral deposits within the breast tissue, which appear as small white spots on the images. Calcifications are divided into two categories, macrocalcifications and microcalcifications. Macrocalcifications are coarse (larger) calcium deposits that are associated with benign (non-cancerous) conditions and do not require a biopsy. They most likely represent degenerative changes in the breasts, such as aging of the breast arteries, old injuries, or scarring from other causes. Macrocalcifications are found in about 50% of women over the age of 50, and in about 10% of women under the age of 50.

Microcalcifications are tiny (less than 1/50 of an inch) specks of calcium in the breast that may appear singly or in clusters. An area of microcalcification that is seen on a mammogram does not always mean that breast cancer is present. The shape and arrangement of microcalcifications help the radiologist judge the likelihood of breast cancer being present. In some cases, the microcalcifications do not even indicate a need for a breast biopsy. Instead, a doctor may advise a follow-up mammogram within 3 to 6 months. In other cases, the microcalcifications are more suspicious and a biopsy is recommended to determine if cancer is present.

A mass is an important change seen on mammograms. Masses may occur with or without associated calcifications and can be due to many things, including cysts. A cyst, which is a benign collection of fluid in the breast, cannot be diagnosed by a physical exam alone nor can it be diagnosed by digital mammography alone. To confirm that a mass is a cyst, either breast ultrasound or aspiration with a needle is required. If a mass is not a cyst, then further imaging may be obtained. As with calcifications, a mass can be caused by benign breast conditions or by breast cancer. Some masses can be monitored with periodic digital mammography and/or ultrasound, while others may require immediate or delayed breast biopsy. The size, shape, and margins (edges) of the mass help the radiologist in evaluating the likelihood of breast cancer. Breast ultrasound is often helpful. Prior mammograms may help show that a mass is unchanged for many years, indicating a benign condition and helping to avoid unnecessary breast biopsy.

Digital mammography cannot prove that an abnormal area is breast cancer. If digital mammography raises a significant suspicion of breast cancer, tissue must be removed for examination under the microscope to tell if it is cancer with certainty. This can be done with needle biopsy or open surgical biopsy.

What is screening digital mammography?

Screening digital mammography is an x-ray examination of the breast in a woman who is asymptomatic (has no breast complaints). Screening digital mammography usually involves two views (x-ray pictures) of each breast. For some patients, additional pictures may be needed at screening to include as much breast tissue as possible.

If there is a breast tissue abnormality seen on a screening mammogram, the patient will be notified to return for additional imaging. The patient may be required to have additional mammography views and/or a breast ultrasound. In some cases, a biopsy of the abnormal area may be necessary.

The goal of screening digital mammography is to detect breast cancer when it is still too small to be felt by her physician or the woman. Early detection of small breast cancers by screening digital mammography greatly improves a woman's chances for successful treatment. If you have no symptoms such as a breast lump or nipple discharge, we recommend annual screening mammograms beginning at age 40. The American Cancer Society’s breast cancer detection guidelines include yearly screening digital mammography for all women 40 years of age and older.

In the United States, one out of eight women will develop breast cancer during her life. The earlier the disease is diagnosed, the higher the chances of a complete cure. Breast cancer takes years to develop. Early in the disease, most cancers of the breast cause no symptoms. When breast cancer is detected in the localized stage without spread to lymph nodes, the five year survival rate is 98%. If the cancer has spread regionally to axillary (underarm) lymph nodes the rate drops to 76%.

Should you experience nipple discharge or notice a lump (even if you are in your early twenties), contact your personal physician immediately and he/she will recommend you to have a diagnostic evaluation. The best protection against the effects of breast disease is early detection and early treatment.

What is diagnostic digital mammography?

Diagnostic digital mammography is an x-ray examination of the breast in a woman who either has a breast complaint (for example, a breast mass, nipple discharge, etc.) or has had an abnormality found during screening digital mammography. During diagnostic digital mammography, two views (x-ray pictures) are taken of each breast. These are the same views taken for screening mammograms. For some patients, additional x-rays may be taken to carefully evaluate the breast or a breast abnormality. In some cases, special images known as cone views with magnification are used to make a small area of altered breast tissue easier to evaluate. Many other types of x-ray pictures can be obtained, depending on the type of abnormality and its location in the breast. These x-rays are tailored to the patient's needs. Clinical history and a physical examination by your physician are important information our radiologists use to properly apply digital mammography and ultrasound to your problems.

A diagnostic digital mammography work-up may show that a lesion (area of abnormal tissue) has a high likelihood of being benign (not breast cancer). For these, it is common to ask the woman to return earlier than usual for a recheck, usually in 4-6 months. On the other hand, a diagnostic mammogram may show that the abnormality is not worrisome at all and the woman can then return to routine yearly screenings.

Finally, the diagnostic work-up may suggest that a biopsy is needed to tell whether or not the lesion is breast cancer. A recommendation for biopsy does not necessarily mean that the abnormality is cancer. About 70% of all breast lesions that are evaluated with biopsy are found to be benign when evaluated under the microscope.

Three tests for breast cancer detection

Digital mammography cannot find 100% of breast cancers. The American Cancer Society recommends the use of three tests for breast cancer detection in asymptomatic women - digital mammography, clinical breast exams by a physician or other health care professional, and monthly breast self examination (BSE).

The American Cancer Society guidelines for the detection of breast cancer in asymptomatic women are:

  • Women 20 years of age and older should perform breast self-examination every month.
  • Women 20-39 should have a physical examination of the breast annually, performed by health care professional such as a physician, physician assistant, nurse or nurse practitioner.
  • Women 40 and older should have a physical examination of the breast every year, performed by a health care professional, such as a physician, physician assistant, nurse or nurse practitioner.
  • Women 40 years of age and older should have a mammogram every year.

These guidelines apply only to women at usual risk for breast cancer, who have no symptoms of breast cancer. Women with certain risk factors, such as a family history of breast cancer should discuss their risk factors with their doctor. In some cases, digital mammography may be started before age 40 and a more vigilant schedule of early detection tests may be appropriate.