Mammography

A mammogram is an x-ray picture of the breast. Mammograms can be used to check for breast cancer in women who have no signs or symptoms of the disease. This type of mammogram is called a screening mammogram. Screening mammograms usually involve two x-ray pictures, or images, of each breast. The x-ray images make it possible to detect tumors that cannot be felt. Screening mammograms can also find microcalcifications (tiny deposits of calcium) that sometimes indicate the presence of breast cancer. Mammograms can also be used to check for breast cancer after a lump or other sign or symptom of the disease has been found. This type of mammogram is called a diagnostic mammogram. Besides a lump, signs of breast cancer can include breast pain, thickening of the skin of the breast, nipple discharge, or a change in breast size or shape; however, these signs may also be signs of benign conditions. A diagnostic mammogram can also be used to evaluate changes found during a screening mammogram or to view breast tissue when it is difficult to obtain a screening mammogram because of special circumstances, such as the presence of breast implants

Diagnostic mammography takes longer than screening mammography because more x-rays are needed to obtain views of the breast from several angles. The technician may magnify a suspicious area to produce a detailed picture that can help the doctor make an accurate diagnosis.

The American College of Radiology (ACR) has established a uniform way for radiologists to describe mammogram findings. The system, called BI-RADS, includes seven standardized categories, or levels. Each BI-RADS category has a follow-up plan associated with it to help radiologists and other physicians appropriately manage a patient’s care. Breast Imaging Reporting and Database System (BI-RADS) Category Assessment Follow-up 0 Need additional imaging evaluation Additional imaging needed before a category can be assigned 1 Negative Continue regular screening mammograms (for women over age 40) 2 Benign (noncancerous) finding Continue regular screening mammograms (for women over age 40) 3 Probably benign Receive a 6-month follow-up mammogram 4 Suspicious abnormality May require biopsy 5 Highly suggestive of malignancy (cancer) Requires biopsy 6 Known biopsy-proven malignancy (cancer) Biopsy confirms presence of cancer before treatment begins