Mammography: what it is, how it is performed, and from what age

Mammography is an X-ray image of the breast that helps reveal changes that cannot be detected by touch. Below: what exactly the examination shows, to whom and when it is offered, how the types of imaging differ, and where the proven benefits of the method end.

What mammography is and what it shows

Breast radiography is a non-invasive examination: the woman positions herself at the machine, each breast in turn is placed between two plates, compressed for clarity, and imaged in the craniocaudal and mediolateral oblique projections. The images are read by a radiologist. X-ray mammography remains the gold standard for detecting breast cancer: its specificity exceeds 92%.

There are two types. A screening mammogram is for women without complaints or symptoms. A diagnostic one is for those who have a lump or other manifestations; it takes longer. Reasons for it include:

• breast pain;
• thickening of the breast skin;
• nipple discharge;
• a change in the size or shape of the breast.

The same symptoms can be caused by a benign condition. Diagnostic imaging is also used with implants, when the tissues are poorly visualized. A deviation from normal is not the same as cancer: additional images, examinations, or a consultation with a breast specialist are needed before a conclusion.

Tomosynthesis (3D) mammography versus conventional: what is the difference

A conventional digital mammogram is a flat projection in which all structures overlap. With fatty involution this gives good detection rates, but with dense tissue the figures drop. Tomosynthesis (3D mammography) builds an image from thin slices at 1 mm intervals: the emitter moves, and a series of images is mathematically converted into slices, as with computed tomography.

However, the technique has not undergone sufficient clinical trials, and its effectiveness in detecting early signs of cancer remains questionable; the WHO does not include tomosynthesis in its list of recommended diagnostic procedures for this group of pathologies.

From what age mammography is performed

Screening is intended for women without signs of disease. It has been proven that regular screening mammograms reduce the number of deaths from breast cancer in women aged 40–74: the tumor is found earlier, and treatment begins earlier. The age ranges of programs differ: in developed European countries, women over 45 undergo mandatory X-ray mammography.

Screening also has a downside: false-positive results, missed findings, and radiation dose. Therefore, the timing of initiation and frequency are discussed with a doctor individually.

Safety and pain: can mammography provoke cancer

Mammography uses ionizing radiation, and this is a recognized drawback of the method. The risks and benefits of the method are discussed with a doctor individually. Other costs are more real: sometimes changes are found that are not cancer, and this leads to further examination and anxiety; sometimes cancer is not visible on the image.

The procedure itself is unpleasant: compression with the plates is needed for a clear image. Results are usually reported within a few weeks, depending on the clinic.

Alternatives: ultrasound, MRI, thermography

Ultrasound does not involve radiation and is painless, distinguishes well between fluid-filled and solid formations, and is widely used in younger women. But due to the structure of breast tissue, the capabilities of the method are limited, and it remains supplementary. MRI does not use ionizing radiation, but it is more expensive and less effective, poorly displays microcalcifications, and requires contrast.

Breast thermography as an alternative to mammography is not confirmed: the US Food and Drug Administration (FDA) states that a thermogram does not replace a mammogram.

Mammography is a planned examination; by itself it is not a reason to call an ambulance. 103/112 — if signs of a life-threatening condition appear: sudden severe chest pain with shortness of breath, loss of consciousness.

This material is for reference: it explains the method but does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer