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HEATH HORIZONS : MEDICINE : A Primer in Mammography : WHAT TO EXPECT FROM MAMMOGRAMS

March 29, 1992|Kathleen Kelleher

A mammogram is an X-ray of breast tissue that shows suggestive shadows or grouped calcium deposits that appear as dense white dots--abnormalities that are read by a licensed radiologist. The radiologist may ask the woman to return for additional mammograms or for a sonogram to distinguish a benign cyst from a tumor. If a tumor is found, a biopsy is ordered for tissue analysis and if a malignancy is found, treatment follows.

Because mammograms sometimes fail to screen the periphery of the breasts, side of the breasts and armpits--those areas should be examined by a physician who checks what is found in the breast X-ray against what he feels with his hands during examination. All women should be doing self-examinations monthly.

Fear of mammograms is prevalent among many women because they may have heard that it is painful. Bassett says a mammogram should not be excruciatingly painful, but could cause discomfort. With the woman standing or sitting, a technician positions the breast between two plastic plates to compress the breast to get the best picture of it with the least amount of radiation. Squeezing of the breast may cause some discomfort, but it is not harmful.

Red flags went up in the early 1970s, when there were reports that radiation from mammograms might cause cancer. But today's X-ray technology produces sharper images with much lower radiation, and there is no evidence of health risk from radiation at these low levels, said Dr. Lawrence Bassett, director of UCLA's Iris Cantor Breast Imaging Center.

To minimize discomfort, many technicians suggest that women schedule a mammogram about a week after their period, when there is a minimum of breast sensitivity. If women have breast implants, they need to disclose this to technicians, as implants obscure abnormal images that might appear in a mammogram. Deodorant, talcum powder and lotion appear as white specks on the X-ray, none of which should be worn during the procedure.

Women should not wait for their doctors to tell them to get a mammogram.

Baseline mammograms should be taken between the ages of 35 and 39 for future comparison, according to the American Cancer Society. Women 40 to 49 should have a mammogram every year or two, and women 50 and older should have an annual mammogram. If a mother or sister has had breast cancer, a woman should have regular checkups with her doctor regardless of age.

If a woman finds a lump in her breast, a thickening or dimpling of breast skin, or bleeding from the nipples, she should consult a physician immediately. She will more than likely need a mammogram, priced anywhere from $65 to $250.

To ensure the safest and most effective mammogram, women can call referral and resource organizations to locate facilities accredited by the American College of Radiology. About 40% of U.S. facilities are accredited. However, if a woman chooses to go to a facility that is not accredited (in rural areas, facilities may be unaccredited because they cannot do the 480 mammograms a year required to qualify for accreditation), she can ensure that she is getting the highest quality mammogram by asking the following questions about the facility.

* Has the facility been accredited by the American College of Radiology or by the American Cancer Society? If not, does the facility have an application in progress? (If the facility is ACR accredited, then the rest of these questions can be disregarded).

* Is the mammography unit being tested on a monthly basis? (Tests should be conducted for sharpness and clarity of the X-ray image).

* Is the X-ray unit designed and used only to perform mammograms? Do not use a facility that uses X-ray machines that also take X-rays of bones and the chest area, both of which give off higher levels of radiation than a mammographic machine.

* What is the average dose to which the breast is exposed per view? The level of radiation used varies slightly. Exposure should not exceed 200 milliRads per projection and in some instances is less. However, the dose level should not be too low or it will not give a clear image of the breast, which increases the potential for inaccurate images.

* Is either a grid or a buckey (a piece of equipment attached to the mammography unit to ensure a sharp, clear image) used during the mammogram? The answer should be yes.

* What type of X-ray film is used? Fast speed Kodak OM-1 and Dupont are the leading brands of high-speed mammography film.

* Is the operator a radiologic technologist certified by the state Department of Health Services or the American Registry of Radiological Technologists? Certification guarantees that the technologist has received at least two years of education and training and passed a state exam. By law, certification should be posted. (The American College of Radiology suggests choosing a facility that performs at least 10 mammograms a week or 480 mammograms a year. Volume increases expertise.)

* Is the mammography unit calibrated at least once a year by a certified radiological physicist? The answer should be yes.

* Are the chemicals used to process the film tested every morning to ensure that film images are processing properly? According to Los Angeles County Department of Health Services, one of the biggest problems in mammographic quality control is in the area of film processing. * Ask how long the facility keeps the X-rays so that when you need your baseline mammogram for comparison to your second mammogram, it is available. If the facility only keeps them for a few years, you may want to take them for your own files.

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