Mammography helps detect breast cancer at an early and more curable stage

Serena is 52. She has been asked by her gynaecologist to undergo a screening mammography. Her breast examination was normal and no abnormal lumps were found. She wants to know why she needs this test. Does she have any chance of developing breast cancer?The chances of developing breast cancer increase as we grow older. Most cases of breast cancer occur after menopause. The risk keeps increasing up to the age of 80. Breast cancer in the family, especially mother, daughter or sister can increase the risk as will the presence of certain genes (BRCA1 and BRCA2). Early onset of periods (younger than age 12) and late onset of menopause (55 years or more) also increase the chances of breast cancer. Breastfeeding and delivering babies after age 30 seem to have a protective effect. One of the contributing factors, which can be avoided, is obesity after menopause. Hormone replacement therapy for more than 5 years increases the risk slightly. What is mammography? Mammography is a process where low doses of X-rays are passed through the breasts. This test detects growths within the breast tissue even before they are large enough to be felt during a physical exam. Some growths are very small or lie deep in the breast tissue and may be hard to detect. Mammography helps detect breast cancer at an early and more curable stage. Who should have mammography? Women aged 45-49 years should have mammography done every 1-2 years. Women aged 50 and older should have it done every year. In the presence of certain risk factors, the test may be advised at a younger age. Mammography is also ordered for checking lumps that have been felt during a physical exam by a doctor or during a breast self-exam. Mammography is essential for all women, especially older women. The size of the breasts does not matter. Mammography can be done even with breast implants. Women who have had breast cancer surgery also may be asked to undergo the test to check the breast tissue that is left. What to expect? On the day of the test, using powders, lotions or deodorants should be avoided. Most of these products have substances that can show on the X-ray films and cause confusion in the diagnosis. To get ready for the test, you will be undressed from the waist up and given a gown. Two smooth, flat plastic or glass plates will be placed around one of the breasts. The plates will flatten the breast so that the most tissue can be viewed with the least radiation. After the initial X-ray, the plates may be removed so that the breast can be X-rayed from one or more angles. The test then is done on the other breast. The pressure of the plates makes this an uncomfortable test. This discomfort lasts only for a short time. It is better to avoid this test just around the time of the periods, because the breasts are more painful at that time. Women with breast implants should tell the radiologist and the X-ray technician so that extra precautions are taken. An ultrasound of the breast is usually combined with a mammogram. This is because some cancers cannot be seen on a mammogram and even lumps that can be felt may not show up. Ultrasound helps pick up these growths. Are there any risks? Mammography exposes a woman to a very low dose of X-rays because of the improved equipment and techniques. The risk from the radiation is very low, even with repeated tests. What if the test result is positive? An abnormality, which may point to the presence of early cancer, is the presence of microcalcification. Sometimes a lump may be picked up. Most lumps found in the breast are benign (not cancerous). When some abnormalities are found, one of two tests might be suggested. FNAC (fine needle aspiration cytology) is a process in which a needle is inserted into the abnormal area and a sample is drawn out for study under a microscope. Biopsy is a surgical procedure in which a small incision is made to remove the entire growth or just a small sample for study under a microscope. Combined with regular checkups and breast self-exams, mammography is a good way to detect cancer at an early and more curable stage. With a physician's guidance, yearly mammography should be a regular part of a woman's health check-up by age 50. GITA ARJUN

(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women's health issues)

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