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|ultrasound | mammography | mri|
This is simply a special type of x-ray of the breasts. It has three main indications:
The accuracy of mammography increases with age and it is not used for women under thirty-five years old unless for specific indications. In young women, the breasts are dense, due to the presence of florid glandular tissue and ducts. After forty years, the breast glands and ducts are replaced by fat, which is radiolucent and thus promotes satisfactory mammography. This means that cancers are easier to detect in fatty breasts, using mammography.
The features of breast cancer on a mammogram are:
The mammogram machine must be of excellent quality, to help the doctor make the correct assessment. The radiologist needs the best available equipment, including high quality x-ray films. It is important to look for a centre which specialises in mammography when choosing a place to go for this investigation.
Many recent reports have looked at the negative impact of mammography and questioned whether it alters survival.
There is an enormous body of consistent evidence on the relationship between tumour size, disease stage, and survival. As tumours increase in size the likelihood of nodal involvement and distant metastases increases and this is associated with a poorer prognosis. Strong evidence suggests that tumours detected on mammography are smaller in size than palpable tumours.
Poor quality of mammography can result in a decrease in identifying tumours and result in the implication that mammography misses breast cancers.
These small mammographically detected cancers may be treated with breast conserving surgery or mastectomy with immediate reconstruction.
Screening requires both a clinical examination by a physician and mammography.
In a country with limited resources like South Africa, free screening all women is not possible or cost effective. The more people who go for screening mammography, the cheaper it is to run mammogram units.
Under ideal circumstances, annual screening for all women over forty is recommended. A baseline mammogram between 35 and 40 followed by a mammogram every year or two for women is recommended.
In those women with a family history of breast cancer screening should start 10 years before the youngest relative developed a breast cancer.