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MammographyMammography

Breast cancer kills 15,000 women every year in the UK. But it's been estimated that more than 2,000 lives could be saved each year if all women invited to have a mammogram took up the offer.

One in 12 women in the UK will develop breast cancer in their lifetime, which makes it, after lung cancer, our biggest female cancer killer. The UK is not unique in this. Statistics show that our incidence of breast cancer is similar to that of most other developed countries.

TROUBLE STARTING

Breast cancer begins to develop when something goes wrong in one of the cells in the breast. As a result, the cell starts to multiply in an uncontrolled way.

If the immune system fails to recognize that something is wrong and does not destroy the changed cell, it will go on multiplying until it forms a tumour, or lump.

At this point, a cancerous tumour is not usually dangerous. But if it is left untreated, the cancerous cells can break away and spread through the blood circulation and lymph system to other parts of the body. They may lodge in vital organs such as the liver and brain, where they will start to form new tumours. This spreading process is known as metastasis.

If breast cancer is diagnosed and treated early, before metastasis has taken place, the chances of a cure are very good. But once the cancer has spread it then becomes much harder to treat.

BENEFIT OF SCREENING

Mammography is a special type of X-ray which is designed to detect abnormalities like cancer in the soft tissue of the breasts. It can help to pinpoint suspicious changes well before you or your doctor might be able to find a lump by physical examination or notice other signs.

This early detection is vital, as detecting breast cancer at an early stage increases the chance of a cure. It also means that you might be treated more conservatively. This means you may only need to have the cancerous lump removed rather than the entire breast.

Breast cancer becomes much more prevalent from the age of 50 onwards. This is why in the UK all women between the ages of 50 and 64 should receive invitations every three years or so to have a free mammogram. It's been estimated that if every woman invited to have a mammogram accepted the offer, more than 2,000 lives could be saved in Britain every year.

Women aged 65 and over are no longer sent special invitations, but they are still entitled to free mammograms. They should still have a mammogram at least once every three years, as the risk of developing the disease is still present. These women can arranged to be screened either directly with their breast screening unit (listed in your local telephone directory), or through their doctor.

After the age of 64, it's a good idea to keep a note of when your next mammogram is due, as after this age you will not be getting an invitation or reminder.

DURING THE PROCEDURE

When you first attend the breast screening unit, a specialist breast cancer doctor will take the details of your medical history.

You will then be asked to remove all the clothing from the top half of your body. they doctor will then carry out a thorough manual, physical examination of your breasts. Mammography is always combined with a physical breast examination. Although it can pick up very minor changes that can indicate abnormalities, in about five per cent of cases it can miss lumps that can be felt by a physical examination.

This will be followed by the mammogram itself. You will be asked to place each breast in turn on an X-ray plate. The breast is then compressed by a transparent plate while the X-ray is taken.

BEST RESULTS

Although many women say the compression is uncomfortable and even painful, it only lasts a few seconds. You are then free to go, and should be notified of the results within about two weeks.

The more fatty tissue and the larger the breast, the better the quality of the X-ray picture will be as any abnormalities or lesions will show up vividly against fatty breast tissue. Mammography is less effective on women with very small breasts containing little fat.

The mammogram is read by a doctor who is skilled in examining this specific type of X-ray. In most cases this will be a consultant radiologist, a specialist trained in using imaging techniques such as X-rays and ultrasound scanning to diagnose disease.

READING THE X-RAY

When investigating breast X-rays, the doctor will be checking the mammogram very carefully. He will be looking for three things - white areas which may be an indication of abnormal lumps, any distortion of the breast tissue, and calcification or chalky deposits, which in some instances are linked with breast cancer.

If the mammogram looks in any way suspicious, it will usually be sent off to another specialist in the field for a second opinion. If he agrees that it does look suspicious, the woman concerned will be called back for reassessment.

This usually means a further clinical examination and more detailed X-rays of the suspect area. These may be magnified views or views taken from different angles.

If you are recalled, do not immediately assume that you have breast cancer. It simply means you may have an abnormality that will require further investigation.

Most of these results turn out to be what are called 'false positives'. This means that although the initial mammogram came up positive, on further checking it is negative. It could be that the mammogram was misleading because it was difficult to read, or that you have some other benign breast condition such as a cyst or fibroadenoma, lumps caused by the overdevelopment of the fibrous tissue of the breast.

BEING RECALLED

About six in every 100 women are recalled after screening but only one in 10 of these turn out to have cancer. At this point you will be put in contact with a nurse counsellor to give information and support at this inevitably worrying time. You will most likely undergo further X-rays and examinations. Sometimes you will also have an ultrasound scan to find out more information about a lump, for instance whether it is solid or filled with fluid.

If there is still doubt about the lump a biopsy may be performed. During this procedure a small needle will be used to draw off either fluid or cells from the breast for examination in the laboratory. This is usually no more painful than having a blood test. You will then be called back to get the results.

CATCHING CANCER EARLY

Overall only six out of every 1,000 women invited for screening turn out to have breast cancer.

And even if breast cancer is diagnosed, it may be a type of easily treatable cancer known as carcinoma in situ, which in half of cases is not life threatening.

Currently in the United States, experts recommend that women start having regular mammograms from the age of about 40 onwards. However this remains controversial in both the UK and other western countries for a number of reasons.

First, breast cancer is far less common in women under 50, and mammography may not be very effective at picking up early cancers in younger women.

In addition, because breast tissue in younger women is much more glandular and less fatty, they need to be given a higher dose of radiation for the mammogram to be effective. Even then, it still remains more difficult to detect breast cancer in this age group from mammography, as the X-rays can be difficult to interpret correctly.

In addition, there has been no firm evidence to show that giving mammograms to women under 50 reduces their chances of dying from breast cancer. But more research is under way to evaluate the effectiveness of the procedure in women in their forties.

Because of these difficulties, scientists are experimenting to see if computers can help them enhance and interpret the mammograms of younger women. Digital mammography, as it's called, should be safer too, as it gives even lower doses of radiation than conventional breast X-rays.

RADIATION WORRY

Like any X-ray, mammography involves subjecting the body to very small doses of radiation -- a substance which is well known to cause cancer itself.

However, the amount of radiation that you will receive during a mammogram is equivalent to what you would get from general background radiation during a flight from the UK to Australia.

This means that the increased risk of cancer is very small. In fact, having a mammogram has been likened to the equivalent cancer risk of smoking only one-third of a cigarette once a year.

     
     

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