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Screening Mammography
1
What is a screening mammogram?
A screening mammogram is a radiographic examination of the breasts performed to detect clinically occult breast cancer in asymptomatic women.
2
When should an average woman start getting mammograms?
This is currently a topic of debate. The American College of Radiology (ACR) recommends that a woman get a baseline mammogram at age 40 and annual screening mammograms thereafter. The American Cancer Society (ACS) recommends that women with an average risk of breast cancer should undergo screening mammography starting at age 45 (annually in women of age 45-54 and either annually or biennially in women age 55 and older), although they should have the opportunity to begin annual screening between ages 40-44. The United States Preventative Services Task Force (USPSTF) recommends that women of ages 50-74 undergo biennial screening mammography, although biennial screening may be started in women of age 40-49 on an individual basis.
3
Are there instances when screening should start earlier than 40?
Women who have been treated for Hodgkin lymphoma should begin screening 10 years after chest wall/mediastinal radiation. Patients who received radiation therapy during puberty are at greatest risk for breast cancer, whereas those who received radiation therapy after age 30 have a minimally increased risk over the general population. For patients with a history of a first-degree relative with breast cancer, screening should begin 10 years before the age at which the relative was diagnosed. If the relative was diagnosed after age 50, there would be no impact on the screening recommendation. If the relative was diagnosed before age 50, the woman should begin screening before the age of 40. Women with genetic mutations also begin screening at an earlier age. These include BRCA1 and BRCA2 mutation carriers as well as women with PTEN mutations. Also included are women and their first-degree relatives with the following syndromes: Li-Fraumeni, Cowden, and Bannayan-Riley-Ruvalcaba.
4
How many views are obtained for a routine mammogram?
Four views are obtained for a routine mammogram. Mediolateral oblique (MLO) and craniocaudal (CC) views of each breast are obtained ( Figure 8-1 ). In some patients, more than four images may be needed to visualize all of the breast parenchyma adequately.
5
Which view visualizes the most breast tissue?
MLO view visualizes the most breast tissue.
6
Which portion of the breast is better visualized on the CC view than on the MLO view?
The medial breast is better visualized on the CC view.
7
What if there are comparison studies elsewhere? Do we need to get them?
If the mammogram is negative, no. Research has shown that it is not cost-effective and does not improve patient care to obtain comparison studies for examinations that are normal. If there is an abnormal finding, an attempt should be made to get the prior studies from the outside institution. If they cannot be obtained, the patient should be recalled for additional evaluation.
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