WHAT AND WHY WOMAN NEED MAMMOGRAPHY ..?

WHAT AND WHY WOMAN NEED MAMMOGRAPHY ..?
By : Sumarsono

Mammography is a special type of x-ray imaging used to create detailed images of the breast. Mammography is the single most important innovation in breast cancer control since the introduction of the radical mastectomy in 1898. Mammography has done more to influence the detection and management of breast cancer than any other development since that time.


Risk Versus Benefit of Mammography
In the mid 1970s a major controversy over mammography arose in which may members of the public developed the perception that radiation exposure from diagnostic x-ray would caused breast cancer than would be detected. This not the case, but fear of radiation exposure still causes some women to refuse mammography examination, and many women who undergo the examination are rightfully concern about exposure level and the resultant risk of carcinogenesis. For this reason it is necessary to understand the relationship between breast irradiation and breast cancer and to understand the ralative risk of mammography in light of natural incidence of breast cancer and the potential benefit of the examination.

Today, the average radiation dose to the breast parenchyma in mammography examination is actually much lower than 1 rad. The average mid-breast dose for a typical film-screen mammogram exposure in the BCDD was 0.04 rad. In comparison with other risk of living, the risk of having an x-ray film-scren mammogram is equivalent to the risk of smoking several cigarettes, driving 60 miles in automobile, or being a 60-year-old for 10 minutes.

Mammography uses low dose x-ray; and an x-ray system designed specifically for imaging the breasts. Successful treatment of breast cancer depends on early diagnosis. Mammography plays a major role in early detection of breast cancers. The benefits of mammography far outweigh the risks and inconvenience. Mammography can show changes in the breast well before a woman or her physician can feel them. Once a lump is discovered, mammography can be key in evaluating the lump to determine if it is cancerous. If a breast abnormality is found or confirmed with mammography, additional breast imaging tests such as ultrasound (sonography) or a breast biopsy may be performed. A biopsy involves taking a sample(s) of breast tissue and examining it under a microscope to determine whether it contains cancer cells. Many times, mammography or ultrasound is used to help the radiologist or surgeon guide the needle to the correct area in the breast during biopsy.

Types of Mammography Examination
There are two types of mammography exams, screening and diagnostic:
1. Screening mammography is an x-ray examination of the breasts in a woman who is asymptomatic (has no complaints or symptoms of breast cancer). The goal of screening mammography is to detect cancer when it is still too small to be felt by a woman or her physician. Early detection of small breast cancers by screening mammography greatly improves a woman's chances for successful treatment. Screening mammography is recommended every one to two years for women once they reach 40 years of age and every year once they reach 50 years of age. In some instances, physicians may recommend beginning screening mammography before age 40 (i.e. if the woman has a strong family history of breast cancer). Screening mammography is available at a number of clinics and locations.
2. Diagnostic mammography is an x-ray examination of the breast in a woman who either has a breast complaint (for example, a breast lump or nipple discharge is found during self-exam) or has had an abnormality found during screening mammography. Diagnostic mammography is more involved and time-consuming than screening mammography and is used to determine exact size and location of breast abnormalities and to image the surrounding tissue and lymph nodes. Typically, several additional views of the breast are imaged and interpreted during diagnostic mammography. Thus, diagnostic mammography is more expensive than screening mammography. Women with breast implants or a personal history of breast cancer will usually require the additional views used in diagnostic mammography.
Method of Mammography Examination
The patient should be dressed is an openfront gown. The Breast must be bared for the examination because the mammogram will record the slightest wrinkle in any cloth covering. Before the breast is radiographed, a careful physical examination is performed, and all biopsy scars, pappable masses, suspicious thickening, skin abnormalities, and nipple alteration are noted.
For screening mammography each breast is imaged separately:
• typically from above (cranial-caudal view, CC) : The directional X-ray is linear from above the breast (patient’s head) to below (foot’s patient).
• from an oblique or angled view (mediolateral-oblique, MLO)
For diagnostic mammography, each breast is imaged separately:
• from above (cranial-caudal view, CC)
• from an oblique or angled view (mediolateral-oblique, MLO) and
• supplemental views tailored to the specific problem are often performed. These can include views from each side (lateromedial, LM: from the outside towards the center and mediolateral view, ML: from the center of the chest out), exaggerated cranial-caudal, magnification views, spot compression, and others.
• if screening mammography has been performed first and the resulting CC and MLO views are of sufficient quality, they may not need to be repeated if diagnostic mammography is required.
A cleavage view (also called "valley view") is a mammogram view that images the most medial (central) portions of the breasts. This is the portion of breast tissue "in the valley" between the two breasts. When one breast is imaged and the other breast is left out of the compression field, some of the breast being imaged may get pulled or left out too. To get as much medial tissue as possible, the mammogram technologist will place both breasts on the plate at the same time to image the medial half of both breasts.
A cleavage view may be performed when there is a questionable density on the medial edge of the mammogram film and the radiologist needs to see more of this density (if possible). A cleavage view may also be performed if the radiologist sees something suspicious in the mediolateral-oblique (MLO) mammogram view and cannot find the area on the cranial-caudal view (CC) view.
Breast compression is necessary to flatten the breast so that the maximum amount of tissue can be imaged and examined. Breast compression may cause some discomfort, but it only lasts for a brief time during the mammography procedure. Patients should feel firm pressure due to compression but no significant pain. If you feel pain, please inform the technologist. During the mammography examination, breast compression should only be applied two to four times per breast for a few seconds each time (see below for description of views taken during screening and diagnostic mammography).
Breast compression is necessary during mammography in order to:
• Flatten the breast so there is less tissue overlap for better visualization of anatomy and potential abnormalities. For example, inadequate compression can lead to poor imaging of microcalcifications, tiny calcium deposits that are often an early sign of breast cancer.
• Reduce overlapping normal shadows, which can appear as suspicious regions on the film.
• Allow the use of a lower x-ray dose since a thinner amount of breast tissue is being imaged
• Immobilize the breast in order to eliminate image blurring caused by motion
• Reduce x-ray scatter which also leads to image degradation
Some mammography facilities will allow the patient to control the breast compression herself during mammography. See the section below on Minimizing Pain and Discomfort During Mammography for more information.
Minimizing Pain and Discomfort During Mammography
The benefit of mammography in helping to detect breast cancer early clearly outweighs the temporary discomfort of the exam. However, some women do find mammograms to be uncomfortable and sometimes painful. Several studies over the last 10 years have isolated a number of factors that influence a woman's comfort level during mammography. These factors include:
• Breast compression
• Friendliness and sensitivity of the mammography technologist(s)
• Facility atmosphere and procedures
By surveying women about their experiences with mammograms, researchers offer suggestions on how to minimize discomfort during mammography.
To alleviate much of the pain associated with mammography, patients may wish to:
• Find a "friendly" mammography facility with knowledgeable mammography technologists
• Control the breast compression themselves during mammography
• Change mammography facilities when dissatisfied with care/service
• Use calming self-statements and learn distraction techniques to use during mammography
Some mammography facilities will allow the patient to control the breast compression herself during mammography. This can greatly reduce anxiety, making the woman feel more comfortable during the procedure, both physically and emotionally. Women should feel free to ask the technologist about controlling breast compression themselves when scheduling the exam or before the exam begins.
Researchers have found that a woman often feels more comfortable during a mammogram with a courteous technologist who can provide thoughtful answers to her questions. Knowledgeable technologists can also help women with distraction techniques to take their minds off the exam. In a study published in the February 2000 issue of the journal Radiology, researchers found that factors associated with mammogram discomfort included the facility itself, satisfaction with care, and the patient's perception of the technologist's "roughness."
If women are not satisfied with the quality of care they receive at one facility, they should feel free to change facilities. However, it is important that a patient obtain her original mammogram films if she changes facilities so that future films may be compared to them.

References
1. Ballinger Philip W; Merril Atlas of Radiographic Positioning and Radiologic Prosedures,Vol Three, eighted ed,CV Mosby Co,St.Louis.Toronto
2. General Information on Mammography ; www.imaginis . Com
3. Prise SA dan Wilson LM; Patofisiologi, Konsep Klinis Proses-Proses Penyakit, Alih bahasa oleh Peter Anugrah,EGC, Jakarta,1994