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Mammogram

  • Author: Muhammad Neaman Siddique, MBBS; Chief Editor: Eugene C Lin, MD  more...
 
Updated: Dec 12, 2014
 

Background

Although various radiographic modalities are readily available to identify lesions that are suspicious for breast cancer, mammography remains the mainstay of breast cancer screening. Role of breast sonogram is confined mainly to the diagnostic follow-up of a mammographic abnormality because it may help clarify features of a potential lesion. The role of magnetic resonance imaging (MRI) for breast cancer screening is still evolving; currently MRI screening, in combination with mammography, is reserved to the screening of high-risk patients only.

Breast cancer is the most frequently diagnosed female cancer in the world and is the leading cause of cancer-related mortality in women.[1] In the United States, it is the second most common cause of cancer death in women across all age groups and is the main cause of death in women aged 40-59.

The lifetime probability of developing breast cancer is 1 in 6 overall (1 in 8 for invasive disease).[2] Due to the magnitude of the disease, its psychosocial impact, and associated morbidity and mortality, screening for early diagnosis forms a pivotal part of the struggle against this cancer. Breast cancer mortality has shown a decline since 1975,[3] which may be attributable to both early diagnosis by virtue of screening mammograms and improvements in adjuvant therapies.[4]

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Indications

In studies, mammography has clearly been shown to increase the detection of breast cancer at an earlier stage.[5] Based upon consistent data from multiple randomized trials, a strong consensus has been developed in favor of routine screening mammography for all women aged 50-69. Consensus, however, is not as strong in favor of routine screening among women aged 40-49 or women over the age of 70, and in terms of how frequently these patient populations should be screened.

Based upon pooled data form 8 trials, the United States Preventive Services Task Force (USPSTF) has given an estimate that 1904 women aged 39-49 (credible interval, CrI 929 to 6378 women) would need to be screened to prevent one death from breast cancer after at least 11 years of observation, compared to 1339 women in their 50s (CrI 322-7455) and 377 women in their 60s (CrI 230-1050).[6] Moreover, false-positive readings are more common in younger women, both because the tests are less specific and because breast cancer occurs less commonly in that population.[7, 8]

The American Medical Association, the American Cancer Society, the American College of Radiology, the American College of Obstetrics and Gynecology, the National Cancer Institute, and the National Comprehensive Cancer Network (NCCN) recommend starting routine screening at the age of 40. The American Academy of Family Physicians recommends screening mammography every 1-2 years for women aged 40 and older.

On the other hand, the USPSTF, the American College of Physicians, and the Canadian Task Force on the Periodic Health Examination recommend beginning routine screening at age 50. Most of the groups do not clearly state the age when breast cancer screening should stop. The USPSTF recommends mammography screening until age 74. The American College of Radiology recommends continuing screening until life expectancy becomes 5-7 years, on the basis of age and/or comorbidities.

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Contributor Information and Disclosures
Author

Muhammad Neaman Siddique, MBBS Resident Physician, Department of Medicine, Staten Island University Hospital

Muhammad Neaman Siddique, MBBS is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Seema N Varma, MD Attending Physician, Division of Hematology and Oncology, Department of Medicine, Sanford R Nalitt Institute for Cancer and Blood Related Diseases, North Shore-Long Island Jewish Health System/Staten Island University Hospital; Hospice Medical Director, University Hospice, Staten Island University Hospital

Seema N Varma, MD is a member of the following medical societies: American College of Physicians, American Society of Hematology, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Najum Us Saher, MBBS 

Disclosure: Nothing to disclose.

Naila Saleem, MBBS 

Disclosure: Nothing to disclose.

Nimrah Siddique King Edward Medical College, Pakistan

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Eugene C Lin, MD Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency Program, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine

Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, Society of Nuclear Medicine and Molecular Imaging

Disclosure: Nothing to disclose.

References
  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011 Mar-Apr. 61(2):69-90. [Medline].

  2. National Cancer Institute. SEER Cancer Statistics Review, 1975-2000. [Full Text].

  3. Kohler BA, Ward E, McCarthy BJ, Schymura MJ, Ries LA, Eheman C. Annual report to the nation on the status of cancer, 1975-2007, featuring tumors of the brain and other nervous system. J Natl Cancer Inst. 2011 May 4. 103(9):714-36. [Medline].

  4. Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005 Oct 27. 353(17):1784-92. [Medline].

  5. Weaver DL, Rosenberg RD, Barlow WE, Ichikawa L, Carney PA, Kerlikowske K. Pathologic findings from the Breast Cancer Surveillance Consortium: population-based outcomes in women undergoing biopsy after screening mammography. Cancer. 2006 Feb 15. 106(4):732-42. [Medline].

  6. Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009 Nov 17. 151(10):727-37, W237-42. [Medline].

  7. Kerlikowske K, Grady D, Barclay J, Sickles EA, Eaton A, Ernster V. Positive predictive value of screening mammography by age and family history of breast cancer. JAMA. 1993 Nov 24. 270(20):2444-50. [Medline].

  8. Lidbrink E, Elfving J, Frisell J, Jonsson E. Neglected aspects of false positive findings of mammography in breast cancer screening: analysis of false positive cases from the Stockholm trial. BMJ. 1996 Feb 3. 312(7026):273-6. [Medline].

  9. Kerlikowske K, Ichikawa L, Miglioretti DL, Buist DS, Vacek PM, Smith-Bindman R. Longitudinal measurement of clinical mammographic breast density to improve estimation of breast cancer risk. J Natl Cancer Inst. 2007 Mar 7. 99(5):386-95. [Medline].

  10. Pisano ED, Hendrick RE, Yaffe MJ, Baum JK, Acharyya S, Cormack JB. Diagnostic accuracy of digital versus film mammography: exploratory analysis of selected population subgroups in DMIST. Radiology. 2008 Feb. 246(2):376-83. [Medline]. [Full Text].

  11. Pisano ED, Gatsonis C, Hendrick E, Yaffe M, Baum JK, Acharyya S. Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med. 2005 Oct 27. 353(17):1773-83. [Medline].

  12. Hofvind S, Geller BM, Rosenberg RD, Skaane P. Screening-detected breast cancers: discordant independent double reading in a population-based screening program. Radiology. 2009 Dec. 253(3):652-60. [Medline].

  13. Taylor P, Potts HW. Computer aids and human second reading as interventions in screening mammography: two systematic reviews to compare effects on cancer detection and recall rate. Eur J Cancer. 2008 Apr. 44(6):798-807. [Medline].

  14. Morel JC, Iqbal A, Wasan RK, Peacock C, Evans DR, Rahim R, et al. The accuracy of digital breast tomosynthesis compared with coned compression magnification mammography in the assessment of abnormalities found on mammography. Clin Radiol. 2014 Nov. 69(11):1112-6. [Medline].

 
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Normal mammograms in a 40-year-old woman show dense breast parenchyma.
Screening mammogram depicts malignant ductal-type microcalcifications.
Image shows a malignant-type lesion: an invasive ductal carcinoma. This stellate (spiculated) lesion has ductal-type microcalcifications.
Image shows a benign lesion: a fibroadenoma with well-defined edges and a halo sign.
Benign microcalcifications: cystic hyperplasia.
Breast cancer, mammography. Bilateral mammogram shows diffuse inflammatory carcinoma of the left breast.
 
 
 
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