Mammography
Mammografi

In general

Mammography is a radiological examination of the breasts with special X-ray technology that provides detailed images.

The examination is performed as preventative, aspect of a medical examination known as “screening”, or when eather you or your doctor has detected a change in your breasts.

If you are pregnant, or if your doctor suspects that there is an abscess in your breast, you should not undergo a mammogram.

Mammografi - svenska texten

Getting ready

You do not need to make any special preparations.

What happens during the examination?

The examination is most often done in a mammography unit, which could be a separate unit or connected to a hospital radiology department. Mammograms are also performed at special breast clinics and certain health care centres.

You will first have to answer a few questions from the radiology nurse about whether you have had trouble with your breasts, or if you are taking medicines that contain hormones.

Next you will undress from the waist up; the nurse will examine your breasts and note if there are any visible changes, for example larger birthmarks or scars from previous operations. These may be seen on the X-ray and can complicate the evaluation.

You will stand during the examination, and place one breast at a time on a plate containing what’s called an image detector. The breast is pressed flat between the detector and another plate. This helps make a clearer picture and keeps the radiation dose low. You can raise your arms and rest them on the machine while two or three pictures are taken. The procedure is then repeated with the other breast.

It may briefly feel unpleasant or painful while your breast is pressed flat.

How does it feel afterwards?

After the examination you will feel just the same.

Breast X-rays

During the mammogram, your breasts are X-rayed with technology that provides very detailed images.

The mammogram is either done preventively as a medical examination called a “screening”, or because eather you or your doctor has detected a new lump in your breast. Every year, more than 500,000 breast X-ray examinations are performed in Sweden.

How to detect breast cancer early

The Swedish National Board of Health and Welfare, Socialstyrelsen, recommends mammograms for women between the ages of 40 and 74. County councils offer all women aged 50 to 69 the opportunity to undergo mammograms. Most counties also offer examinations to groups between ages 40 and 74, but there are variations as to when you start being summoned and how long the examinations continue. For younger women, examinations every 18 months or so are usual. Older women are most often summoned every other year.

During these examinations a breast cancer tumour may be detected before it causes any symptoms, or before it can even be felt in your breast.

Scientific studies have shown that for women who participate in examinations with mammograms reduce breast cancer fatalities by 40%.

The risk of late detection is that the cancer has managed to spread; this would require more difficult treatments than if the tumour had been detected earlier.

Examine your breasts regularly

Women’s breasts do not have an even consistency. This is due to the fact that there are both milk glands and fatty tissues in breasts, which makes them feel uneven. From around the age 50 onwards, breasts become softer as the milk glands regress and are replaced by fatty tissue.

Your breasts are affected by the hormonal changes of your menstrual cycle and may feel completely different depending on when you examine them. The day after the final day of menstruation is a good day for self-examination, as your breasts are usually softer and thus easier to examine.

Every woman should examine her breasts herselves on a regular basis. Choosing a fixed date once a month is suitable so as to more easily compare what you’ve felt. Taking a shower is a good occasion, since it’s easier to examine when your breasts are covered with soap. You should preferably examine yourself both standing up and lying down.

Benign lumps are common

If you discover a lump or thickening of tissue you may feel alarmed, but most often it’s a benign tumour, especially in younger women. It could be a cyst – a fluid-filled sac – or a benign thickening of connective tissue.

All changes should be examined by a doctor

A change in the mammary gland could also be caused by breast cancer, which is one of the most common forms of cancer in women. Every year, approximately 7,000 women and 40 men in Sweden get breast cancer. The risk of breast cancer increases with age.

One common symptom of breast cancer is a lump in your breast or armpit. Another is the nipple, or skin on the breast, being drawn in.

Less common symptoms are an unexplained redness or swelling of your breasts, a wound that won’t heal, or fluid mixed with blood from the nipple.

All changes in your breast should be taken seriously and examined by a doctor. You can go to a health care centre, to a women’s health clinic, or a special breast clinic that can be found in a number of larger hospitals. Your doctor will carefully examine your breasts and decide whether a mammogram needs to be performed.

A special X-ray machine is needed 

Mammograms are most often done in a mammography unit, which could be a separate unit or connected to a hospital radiology department. Examinations are also performed at special breast clinics and certain health care centres.

The X-ray machine used is specially designed to yield good images of breast tissue using weak X-rays. In certain cases, tumours that are only a few millimetres in size can be detected.

What to expect

You do not need to make any special preparations. You will first have to answer a few questions and say whether you have had trouble with your breasts, or if you are taking medicines that contain hormones. You will also have to undress from the waist up; the nurse will examine your breasts and note whether there are any visible changes, for example larger birthmarks or scars from previous operations. These can may be detected on the X-ray and may be falsely diagnosed as a malignant tumour.

You’ll then step up to the X-ray machine and stand in front of it. One breast at a time will be placed on a plate that contains an image detector. Your breast is then flattened out using a transparent plate that presses down. You may raise your arms and rest them on the machine while two or three pictures are taken. It’s important to stand completely still. The procedure is then repeated with the other breast. The entire examination takes 15-30 minutes, while the pictures themselves take five to ten minutes.

How does mammography feel?

You may experience brief unpleasantness and pain while your breast is pressed flat; but it has to be done, since the picture is of better quality and the examination is more reliable. Additionally, lower doses of radiation may be used than if your breast had not been pressed flat.

You may need to come back

Most often there are two radiologists who assess the mammograms independently of each other. This increases the reliability of the assessment. If they find something that isn’t as it should be, you will be called back for a new examination. Additional mammogram images will be taken, and often you will be examined with ultrasound.

The doctor may also take a sample of the cellular change. If it’s a small cellular change that’s hard to feel, the sample may be taken in conjunction with a new mammogram, or by using ultrasound. A thin needle is inserted into the cellular change and a cell sample is drawn out. The sample will be sent away for examination under a microscope. All this is done so you can be sure whether it’s cancer or not.

If you are summoned for an examination, the results from the mammogram will be sent directly to your home within two weeks. If you have been referred for a mammogram, you will be notified of the examination results by your doctor.

Hormone treatments may complicate the assessment

A number of women receive hormone treatment during and after menopause, or are taking birth control pills. These treatments affect breast tissue, making it thicker; this makes the mammogram image harder to assess. It’s therefore important to say whether you are taking medicines that contain hormones.

The examination isn’t dangerous

The amount of radiation that you’ll be exposed to during a mammogram is so small that it is not considered to entail any risks. In addition, the technology is continually being improved so as to further reduce the doses of radiation. So you shouldn’t put off going to a mammogram when you’re called in, or if you’ve discovered a change in your breast.

You can also have a mammogram even if you have breast implants. There is no risk of the implant bursting, but since it’s not possible to press your breasts flat as with women who have no implants, an individually adapted examination may be needed. The mammogram is most often supplemented with your breasts being examined by hand and an ultrasound examination.

Who should not have a mammogram?

If you are very young, you will usually be examined with ultrasound instead of a mammogram. This is due to the fact that your breasts’ glandular tissue is so thick that mammogram images are hard to interpret. Ultrasound provides a more reliable solution.

If your doctor suspects that there is an abscess in your breast, mammograms will usually be avoided as it is painful to press your breast flat. It may instead be good to undergo an ultrasound examination to see if there’s anything that needs to be drained. When the infection has been treated, on the other hand, you should undergo a mammogram. This is especially important if you are older.

If you are pregnant, you should not undergo a health examination, or screening, with a mammogram. But if you detect a change in one of your breasts, you should always contact your health care centre to be examined promptly, even if you are pregnant. The examination usually starts with an ultrasound and is supplemented with a mammogram if needed.