Array ( [0] => {{short description|Process of using low-energy X-rays to examine the human breast for diagnosis and screening}} [1] => {{See also|Breast cancer screening}} [2] => {{cs1 config |name-list-style=vanc}} [3] => {{Infobox medical intervention [4] => | Name = Mammography [5] => | image = Mammogram.jpg [6] => | caption = Mammography [7] => | alt = Woman undergoing mammogram on the right breast. A technologist performs breast compression. [8] => | ICD10 = BH0 [9] => | ICD9 = {{ICD9proc|87.37}} [10] => | MeshID = D008327 [11] => | MedlinePlus = 003380 [12] => | OPS301 = {{OPS301|3–10}} [13] => | Synonyms =Mastography [14] => }} [15] => '''Mammography''' (also called '''mastography''': DICOM modality = MG) is the process of using low-energy [[X-ray]]s (usually around 30 [[Peak kilovoltage|kVp]]) to examine the human [[breast]] for diagnosis and screening. The goal of mammography is the early detection of [[breast cancer]], typically through detection of characteristic masses or [[microcalcification]]s. [16] => [17] => As with all X-rays, mammograms use doses of [[ionizing radiation]] to create images. These images are then analyzed for abnormal findings. It is usual to employ lower-energy X-rays, typically Mo (K-shell X-ray energies of 17.5 and 19.6 keV) and Rh (20.2 and 22.7 keV) than those used for [[radiography]] of [[bone]]s. Mammography may be 2D or 3D ([[tomosynthesis]]), depending on the available equipment and/or purpose of the examination. [[Ultrasound]], [[ductography]], [[positron emission mammography]] (PEM), and [[magnetic resonance imaging]] (MRI) are adjuncts to mammography. Ultrasound is typically used for further evaluation of masses found on mammography or palpable masses that may or may not be seen on mammograms. Ductograms are still used in some institutions for evaluation of bloody nipple discharge when the mammogram is non-diagnostic. MRI can be useful for the screening of high-risk patients, for further evaluation of questionable findings or symptoms, as well as for pre-surgical evaluation of patients with known breast cancer, in order to detect additional lesions that might change the surgical approach (for example, from breast-conserving [[lumpectomy]] to [[mastectomy]]). [18] => [19] => In 2023, the [[United States Preventive Services Task Force|U.S. Preventive Services Task Force]] issued a draft recommendation statement that all women should receive a screening mammography every two years from age 40 to 74.{{Cite web |title=Draft Recommendation: Breast Cancer: Screening {{!}} United States Preventive Services Taskforce |url=https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/breast-cancer-screening-adults#bcei-recommendation-title-area |access-date=2024-02-01 |website=www.uspreventiveservicestaskforce.org}} The American College of Radiology and American Cancer Society recommend yearly screening mammography starting at age 40.{{cite web|title=Breast Cancer Early Detection|website=cancer.org|date=2013-09-17 |url=http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs|access-date=29 July 2014|url-status=live|archive-date=10 August 2014|archive-url=https://web.archive.org/web/20140810064747/http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs}} The Canadian Task Force on Preventive Health Care (2012) and the European Cancer Observatory (2011) recommend mammography every 2 to 3 years between ages 50 and 69.{{cite journal |vauthors=Tonelli M, Connor Gorber S, Joffres M, Dickinson J, Singh H, Lewin G, Birtwhistle R, Fitzpatrick-Lewis D, Hodgson N, Ciliska D, Gauld M, Liu YY |display-authors=6 |title=Recommendations on screening for breast cancer in average-risk women aged 40–74 years |journal=CMAJ |volume=183 |issue=17 |pages=1991–2001 |date=November 2011 |pmid=22106103 |pmc=3225421 |doi=10.1503/cmaj.110334 |collaboration=Canadian Task Force on Preventive Health Care}}{{cite web |title=Cancer screening: Breast |work=European Cancer Observatory |url=http://eu-cancer.iarc.fr/cancer-13-breast-screening.html,en |archive-url=https://web.archive.org/web/20120211011840/http://eu-cancer.iarc.fr/cancer-13-breast-screening.html%2Cen |archive-date=2012-02-11 }} These task force reports point out that in addition to unnecessary surgery and anxiety, the risks of more frequent mammograms include a small but significant increase in breast cancer induced by radiation.{{cite web|title=Final Recommendation Statement: Breast Cancer: Screening|website=US Preventive Services Task Force |url=https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening1#Pod7|access-date=31 May 2017|date=January 2016|url-status=live|archive-url=https://web.archive.org/web/20170513062922/https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening1#Pod7|archive-date=13 May 2017}}{{cite journal |vauthors=Friedenson B |title=Is mammography indicated for women with defective BRCA genes? Implications of recent scientific advances for the diagnosis, treatment, and prevention of hereditary breast cancer |journal=MedGenMed |volume=2 |issue=1 |pages=E9 |date=March 2000 |url=http://www.medscape.com/Medscape/GeneralMedicine/journal/2000/v02.n02/mgm0309.frie/mgm0309.frie-01.html |pmid=11104455 |url-status=live |archive-date=2001-11-21 |archive-url=https://web.archive.org/web/20011121141835/http://www.medscape.com/Medscape/GeneralMedicine/journal/2000/v02.n02/mgm0309.frie/mgm0309.frie-01.html}} Additionally, mammograms should not be performed with increased frequency in patients undergoing breast surgery, including breast enlargement, mastopexy, and breast reduction.{{Citation|author1=American Society of Plastic Surgeons |author1-link=American Society of Plastic Surgeons |date=24 April 2014 |title=Five Things Physicians and Patients Should Question |publisher=American Society of Plastic Surgeons |work=[[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url=http://www.choosingwisely.org/doctor-patient-lists/american-society-of-plastic-surgeons/ |access-date=25 July 2014 |url-status=dead |archive-date=19 July 2014 |archive-url=https://web.archive.org/web/20140719103909/http://www.choosingwisely.org/doctor-patient-lists/american-society-of-plastic-surgeons/}} [20] => [21] => == Types == [22] => [23] => ===Digital=== [24] => Digital mammography is a specialized form of mammography that uses digital receptors and computers instead of [[X-ray]] film to help examine [[breast]] tissue for [[breast cancer]].{{cite web |title=Digital Mammography – Mammography – Imaginis – The Women's Health & Wellness Resource Network |url=http://www.imaginis.com/breast-health/digital-mammography-2 |url-status=live |archive-url=https://web.archive.org/web/20120130191044/http://www.imaginis.com/breast-health/digital-mammography-2 |archive-date=30 January 2012 |access-date=4 May 2018 |website=www.imaginis.com}} The electrical signals can be read on computer screens, permitting more manipulation of images to allow [[radiologist]]s to view the results more clearly .{{cite web | work = Radiological Society of North America (RSNA) and American College of Radiology |title=Mammography (Mammogram) |url=http://www.radiologyinfo.org/en/info.cfm?pg=mammo |url-status=live |archive-url=https://web.archive.org/web/20180125152810/https://www.radiologyinfo.org/en/info.cfm?PG=mammo |archive-date=25 January 2018 |access-date=4 May 2018 }} Digital mammography may be "spot view", for breast [[biopsy]],{{cite web |title=How To Perform An Ultrasound-Guided Breast Biopsy |url=http://www.theradiologyblog.com/2011/10/how-to-perform-ultrasound-guided-breast.html |url-status=live |archive-url=https://web.archive.org/web/20180218210408/http://www.theradiologyblog.com/2011/10/how-to-perform-ultrasound-guided-breast.html |archive-date=18 February 2018 |access-date=4 May 2018 |website=www.theradiologyblog.com}} or "full field" (FFDM) for [[Cancer screening|screening]]. [25] => [26] => Digital mammography is also utilized in [[stereotactic biopsy]]. Breast biopsy may also be performed using a different modality, such as [[ultrasound]] or [[magnetic resonance imaging]] (MRI). [27] => [28] => While radiologists{{cite web |title=Radiology – Weill Cornell Medicine |url=https://weillcornell.org/services/radiology |url-status=live |archive-url=https://web.archive.org/web/20171222165330/https://weillcornell.org/services/radiology |archive-date=22 December 2017 |access-date=4 May 2018 |website=weillcornell.org}} had hoped for more marked improvement, the effectiveness of digital mammography was found comparable to traditional X-ray methods in 2004, though there may be reduced radiation with the technique and it may lead to fewer retests. Specifically, it performs no better than film for post-menopausal women, who represent more than three-quarters of women with breast cancer.{{cite book |url=https://archive.org/details/pinkribbonbluesh0000suli |title=Pink Ribbon Blues: How Breast Cancer Culture Undermines Women's Health |vauthors=Sulik G |publisher=Oxford University Press |year=2010 |isbn=978-0-19-974045-1 |location=New York |pages=[https://archive.org/details/pinkribbonbluesh0000suli/page/193 193–195] |oclc=535493589 |url-access=registration}} The U.S. Preventive Services Task Force concluded that there was insufficient evidence to recommend for or against digital mammography.{{Cite web |title=USPSTF recommendations on Screening for Breast Cancer |url=http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm |url-status=dead |archive-url=https://web.archive.org/web/20130102015424/http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm |archive-date=2013-01-02 |access-date=2010-09-13}} [29] => [30] => Digital mammography is a [[NASA spin-off]], utilizing technology developed for the [[Hubble Space Telescope]].{{cite web |title=NASA Spinoffs |url=http://www.nasa.gov/pdf/363454main_medical_flyer.pdf |url-status=live |archive-url=https://web.archive.org/web/20101125094242/http://www.nasa.gov/pdf/363454main_medical_flyer.pdf |archive-date=2010-11-25 |access-date=2010-12-20 |work=National Aeronautics and Space Administration}} As of 2007, about 8% of American screening centers used digital mammography. Around the globe, systems by [[Fujifilm|Fujifilm Corporation]] are the most widely used.{{citation needed|date=December 2016}} In the United States, GE's digital imaging units typically cost US$300,000 to $500,000, far more than film-based imaging systems. Costs may decline as GE begins to compete with the less expensive [[Fujifilm|Fuji]] systems. [31] => [32] => === 3D mammography === [33] => [[Three-dimensional mammography]], also known as digital breast tomosynthesis (DBT), [[tomosynthesis]], and 3D breast imaging, is a mammogram technology that creates a 3D image of the breast using X-rays. When used in addition to usual mammography, it results in more positive tests.{{cite journal |vauthors=Hodgson R, Heywang-Köbrunner SH, Harvey SC, Edwards M, Shaikh J, Arber M, Glanville J |date=June 2016 |title=Systematic review of 3D mammography for breast cancer screening |journal=Breast |volume=27 |pages=52–61 |doi=10.1016/j.breast.2016.01.002 |pmid=27212700 |doi-access=free}} Cost effectiveness is unclear as of 2016.{{cite journal |vauthors=Gilbert FJ, Tucker L, Young KC |date=February 2016 |title=Digital breast tomosynthesis (DBT): a review of the evidence for use as a screening tool |url=https://www.repository.cam.ac.uk/handle/1810/275615 |journal=Clinical Radiology |volume=71 |issue=2 |pages=141–150 |doi=10.1016/j.crad.2015.11.008 |pmid=26707815}} Another concern is that it more than doubles the radiation exposure.{{cite journal |author4-link=Diana Miglioretti |vauthors=Melnikow J, Fenton JJ, Whitlock EP, Miglioretti DL, Weyrich MS, Thompson JH, Shah K |date=February 2016 |title=Supplemental Screening for Breast Cancer in Women With Dense Breasts: A Systematic Review for the U.S. Preventive Services Task Force |journal=Annals of Internal Medicine |volume=164 |issue=4 |pages=268–278 |doi=10.7326/M15-1789 |pmc=5100826 |pmid=26757021}} [34] => [35] => === Photon counting === [36] => {{main|Photon-counting mammography}} [37] => [38] => Photon-counting mammography was introduced commercially in 2003 and was shown to reduce the X-ray dose to the patient by approximately 40% compared to conventional methods while maintaining image quality at an equal or higher level.{{cite journal |vauthors=Weigel S, Berkemeyer S, Girnus R, Sommer A, Lenzen H, Heindel W |date=May 2014 |title=Digital mammography screening with photon-counting technique: can a high diagnostic performance be realized at low mean glandular dose? |journal=Radiology |volume=271 |issue=2 |pages=345–355 |doi=10.1148/radiol.13131181 |pmid=24495234 |doi-access=}} The technology was subsequently developed to enable [[Spectral imaging (radiography)|spectral imaging]] with the possibility to further improve image quality, to distinguish between different tissue types,{{cite journal |vauthors=Fredenberg E, Willsher P, Moa E, Dance DR, Young KC, Wallis MG |date=November 2018 |title=Measurement of breast-tissue x-ray attenuation by spectral imaging: fresh and fixed normal and malignant tissue |journal=Physics in Medicine and Biology |volume=63 |issue=23 |pages=235003 |arxiv=2101.02755 |bibcode=2018PMB....63w5003F |doi=10.1088/1361-6560/aaea83 |pmid=30465547 |s2cid=53717425}} and to measure breast density.{{cite journal |vauthors=Johansson H, von Tiedemann M, Erhard K, Heese H, Ding H, Molloi S, Fredenberg E |date=July 2017 |title=Breast-density measurement using photon-counting spectral mammography |journal=Medical Physics |volume=44 |issue=7 |pages=3579–3593 |bibcode=2017MedPh..44.3579J |doi=10.1002/mp.12279 |pmc=9560776 |pmid=28421611 |doi-access=free}}{{cite journal |vauthors=Ding H, Molloi S |date=August 2012 |title=Quantification of breast density with spectral mammography based on a scanned multi-slit photon-counting detector: a feasibility study |journal=Physics in Medicine and Biology |volume=57 |issue=15 |pages=4719–4738 |bibcode=2012PMB....57.4719D |doi=10.1088/0031-9155/57/15/4719 |pmc=3478949 |pmid=22771941}} [39] => [40] => === Galactography === [41] => {{main|Galactography}} [42] => [43] => A galactography (or breast ductography) is a now infrequently used type of mammography used to visualize the milk ducts. Prior to the mammography itself, a radiopaque substance is injected into the duct system. This test is indicated when nipple discharge exists. [44] => [45] => == Medical uses == [46] => [[File:Mammo breast cancer.jpg|thumb|right|Normal (left) versus cancerous (right) mammography image]] [47] => Mammography can detect cancer early when it’s most treatable and can be treated less invasively (thereby helping to preserve quality of life). [48] => [49] => According to [[National Cancer Institute]] data, since mammography screening became widespread in the mid-1980s, the U.S. breast cancer death rate, unchanged for the previous 50 years, has dropped well over 30 percent.{{cite web |title=Cancer of the Breast (Female) - Cancer Stat Facts |url=https://seer.cancer.gov/statfacts/html/breast.html |website=National Cancer Institute: Surveillance, Epidemiology, and End Results Program}} In European countries like Denmark and Sweden, where mammography screening programs are more organized, the breast cancer death rate has been cut almost in half over the last 20 years.{{As of?|date=February 2023}} [50] => [51] => Mammography screening cuts the risk of dying from breast cancer nearly in half.[http://cebp.aacrjournals.org/content/early/2011/12/02/1055-9965.EPI-11-0476.abstract (Otto et al)] A recent study published in [[Cancer (journal)|''Cancer'']] showed that more than 70 percent of the women who died from breast cancer in their 40s at major Harvard teaching hospitals were among the 20 percent of women who were not being screened.{{cite journal | vauthors = Webb ML, Cady B, Michaelson JS, Bush DM, Calvillo KZ, Kopans DB, Smith BL | title = A failure analysis of invasive breast cancer: most deaths from disease occur in women not regularly screened | journal = Cancer | volume = 120 | issue = 18 | pages = 2839–2846 | date = September 2014 | pmid = 24018987 | doi = 10.1002/cncr.28199 | s2cid = 19236625 }}{{Unreliable medical source|sure=y|reason=outdated primary source|date=February 2024}} Some scientific studies{{citation needed|date=February 2023}} have shown that the most lives are saved by screening beginning at age 40. [52] => [53] => A recent study in the [[The BMJ|''British Medical Journal'']] shows that early detection of breast cancer – as with mammography – significantly improves breast cancer survival.{{cite journal | vauthors = Saadatmand S, Bretveld R, Siesling S, Tilanus-Linthorst MM | title = Influence of tumour stage at breast cancer detection on survival in modern times: population based study in 173,797 patients | journal = BMJ | volume = 351 | pages = h4901 | date = October 2015 | pmid = 26442924 | pmc = 4595560 | doi = 10.1136/bmj.h4901 }} [54] => [55] => The benefits of mammography screening at decreasing breast cancer mortality in randomized trials are not found in observational studies performed long after implementation of breast cancer screening programs (for instance, Bleyer et al.{{cite journal |vauthors=Bleyer A, Baines C, Miller AB |date=April 2016 |title=Impact of screening mammography on breast cancer mortality |journal=Int J Cancer |volume=138 |issue=8 |pages=2003–2012 |doi=10.1002/ijc.29925 |pmid=26562826 |s2cid=9538123 |doi-access=free}}) [56] => [57] => == When to start screening == [58] => In 2014, the Surveillance, Epidemiology, and End Results Program of the National Institutes of Health reported the occurrence rates of breast cancer based on 1000 women in different age groups.{{cite journal | vauthors = Ray KM, Joe BN, Freimanis RI, Sickles EA, Hendrick RE | title = Screening Mammography in Women 40-49 Years Old: Current Evidence | journal = AJR. American Journal of Roentgenology | volume = 210 | issue = 2 | pages = 264–270 | date = February 2018 | pmid = 29064760 | doi = 10.2214/AJR.17.18707 }} In the 40–44 age group, the incidence was 1.5 and in the 45–49 age group, the incidence was 2.3. In the older age groups, the incidence was 2.7 in the 50–54 age group and 3.2 in the 55–59 age group. [59] => [60] => While screening between ages 40 and 50 is somewhat controversial, the preponderance of the evidence indicates that there is a benefit in terms of early detection. Currently, the [[American Cancer Society]], the [[American College of Obstetricians and Gynecologists|American Congress of Obstetricians and Gynecologists (ACOG)]], the [[American College of Radiology]], and the [[American Congress of Obstetricians and Gynecologists|Society of Breast Imaging]] encourage annual mammograms beginning at age 40.{{cite web |title=American Cancer Society Guidelines for the Early Detection of Cancer |url=http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer |url-status=live |archive-url=https://web.archive.org/web/20110613085624/http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer |archive-date=2011-06-13 |access-date=2011-06-16}}{{cite journal |display-authors=6 |vauthors=Lee CH, Dershaw DD, Kopans D, Evans P, Monsees B, Monticciolo D, Brenner RJ, Bassett L, Berg W, Feig S, Hendrick E, Mendelson E, D'Orsi C, Sickles E, Burhenne LW |date=January 2010 |title=Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer |journal=Journal of the American College of Radiology |volume=7 |issue=1 |pages=18–27 |doi=10.1016/j.jacr.2009.09.022 |pmid=20129267 |s2cid=31652981}}{{cite web |title=Annual Mammograms Now Recommended for Women Beginning at Age 40 |url=http://www.acog.org/About_ACOG/News_Room/News_Releases/2011/Annual_Mammograms_Now_Recommended_for_Women_Beginning_at_Age_40 |url-status=live |archive-url=https://web.archive.org/web/20130904200650/http://www.acog.org/About_ACOG/News_Room/News_Releases/2011/Annual_Mammograms_Now_Recommended_for_Women_Beginning_at_Age_40 |archive-date=2013-09-04 |access-date=2013-09-11 |work=American Congress of Obstetricians and Gynecologists}} [61] => [62] => The [[National Cancer Institute]] encourages mammograms every one to two years for women ages 40 to 49.{{cite web |date=May 2006 |title=Screening Mammograms: Questions and Answers |url=http://www.cancer.gov/cancertopics/factsheet/Detection/screening-mammograms |archive-url=https://web.archive.org/web/20070415032727/http://www.cancer.gov/cancertopics/factsheet/Detection/screening-mammograms |archive-date=2007-04-15 |access-date=April 9, 2007 |publisher=[[National Cancer Institute]]}} In 2023, [[United States Preventive Services Task Force]] (USPSTF) revised the recommendation that women and transgender men undergo biennial mammograms starting at the age of 40, rather than the previously suggested age of 50.{{Cite web |title=Draft Recommendation: Breast Cancer: Screening {{!}} United States Preventive Services Taskforce |url=https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/breast-cancer-screening-adults |access-date=2024-01-18 |website=www.uspreventiveservicestaskforce.org}} This adjustment is prompted by the increasing incidence of breast cancer in the 40 to 49 age group over the past decade. [63] => [64] => In contrast, the [[American College of Physicians]], a large internal medicine group, has recently encouraged individualized screening plans as opposed to wholesale biannual screening of women aged 40 to 49.{{cite journal |vauthors=Qaseem A, Snow V, Sherif K, Aronson M, Weiss KB, Owens DK |date=April 2007 |title=Screening mammography for women 40 to 49 years of age: a clinical practice guideline from the American College of Physicians |journal=Annals of Internal Medicine |volume=146 |issue=7 |pages=511–515 |doi=10.7326/0003-4819-146-7-200704030-00007 |pmid=17404353 |s2cid=9396768 |doi-access=}} The [[American Cancer Society]] recommendations for women at '''average risk''' for breast cancer is a yearly mammogram from age 45 to 54 with an optional yearly mammogram from age 40 to 44.{{Cite web |title=ACS Breast Cancer Screening Guidelines |url=https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html |access-date=2024-01-18 |website=www.cancer.org |language=en}} [65] => [66] => == Screening for high-risk population == [67] => Women who are at high risk for early-onset breast cancer have separate recommendations for screening. These include those who: [68] => [69] => * Have a known ''BRCA1'' or ''BRCA2'' gene mutation. [70] => * Have a 1st-degree relative (parent, brother, sister, or child), 2nd-degree relative (aunts, uncles, nieces, or grandparents), or 3rd-degree relative with a known ''BRCA1'' or ''BRCA2'' gene mutation. [71] => * Have a lifetime risk of breast cancer >20% according to risk assessment tools [72] => * History of radiation therapy to chest between 10 and 30 years of age [73] => * Have or has a 1st-degree relative with a genetic syndrome including Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome{{Cite web |date=2023-04-13 |title=Risk Factors for Early Breast Cancer {{!}} Bring Your Brave {{!}} CDC |url=https://www.cdc.gov/cancer/breast/young_women/bringyourbrave/breast_cancer_young_women/risk_factors.htm |access-date=2024-01-18 |website=www.cdc.gov |language=en-us}} [74] => [75] => The [[American College of Radiology]] recommends these individuals to get annual mammography starting at the age of 30. Those with a history of chest radiation therapy before age 30 should start annually at age 25 of 8 years after their latest therapy (whichever is latest).{{cite journal | vauthors = Monticciolo DL, Newell MS, Moy L, Niell B, Monsees B, Sickles EA | title = Breast Cancer Screening in Women at Higher-Than-Average Risk: Recommendations From the ACR | journal = Journal of the American College of Radiology | volume = 15 | issue = 3 Pt A | pages = 408–414 | date = March 2018 | pmid = 29371086 | doi = 10.1016/j.jacr.2017.11.034 }} The [[American Cancer Society]] also recommends women at high risk should get a mammogram and breast MRI every year beginning at age 30 or an age recommended by their healthcare provider. [76] => [77] => The [[National Comprehensive Cancer Network]] (NCCN) advocates screening for women who possess a BRCA1 or BRCA2 mutation or have a first-degree relative with such a mutation, even in the absence of the patient being tested for BRCA1/2 mutations. For women at high risk, NCCN recommends undergoing an annual mammogram and breast MRI between the ages of 25 and 40, considering the specific gene mutation type and/or the youngest age of breast cancer occurrence in the family. Additionally, NCCN suggests that high-risk women undergo clinical breast exams every 6 to 12 months starting at age 25. These individuals should also engage in discussions with healthcare providers to assess the advantages and disadvantages of 3D mammography and acquire knowledge on detecting changes in their breasts.{{cite journal | vauthors = Daly MB, Pilarski R, Yurgelun MB, Berry MP, Buys SS, Dickson P, Domchek SM, Elkhanany A, Friedman S, Garber JE, Goggins M, Hutton ML, Khan S, Klein C, Kohlmann W, Kurian AW, Laronga C, Litton JK, Mak JS, Menendez CS, Merajver SD, Norquist BS, Offit K, Pal T, Pederson HJ, Reiser G, Shannon KM, Visvanathan K, Weitzel JN, Wick MJ, Wisinski KB, Dwyer MA, Darlow SD | display-authors = 6 | title = NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 1.2020 | language = en-US | journal = Journal of the National Comprehensive Cancer Network | volume = 18 | issue = 4 | pages = 380–391 | date = April 2020 | pmid = 32259785 | doi = 10.6004/jnccn.2020.0017 }} [78] => [79] => == Adverse effects == [80] => [81] => === Radiation === [82] => The radiation exposure associated with mammography is a potential risk of screening, which appears to be greater in younger women. In scans where women receive 0.25–20 Gray (Gy) of radiation, they have more of an elevated risk of developing breast cancer.{{cite journal | vauthors = Feig SA, Hendrick RE | title = Radiation risk from screening mammography of women aged 40-49 years | journal = Journal of the National Cancer Institute. Monographs | volume = 1997 | issue = 22 | pages = 119–124 | date = 1997–2001 | pmid = 9709287 | doi = 10.1093/jncimono/1997.22.119 }} A study of radiation risk from mammography concluded that for women 40 years of age and older, the risk of radiation-induced breast cancer was minuscule, particularly compared with the potential benefit of mammographic screening, with a benefit-to-risk ratio of 48.5 lives saved for each life lost due to radiation exposure.{{cite journal | vauthors = Feig SA, Hendrick RE | title = Radiation risk from screening mammography of women aged 40-49 years | journal = Journal of the National Cancer Institute. Monographs | volume = 1997 | issue = 22 | pages = 119–124 | year = 1997 | pmid = 9709287 | doi = 10.1093/jncimono/1997.22.119 }} This also correlates to a decrease in breast cancer mortality rates by 24%. [83] => [84] => ===Pain=== [85] => The mammography procedure can be painful. Reported pain rates range from 6–76%, with 23–95% experiencing pain or discomfort.{{cite journal |vauthors=Armstrong K, Moye E, Williams S, Berlin JA, Reynolds EE |date=April 2007 |title=Screening mammography in women 40 to 49 years of age: a systematic review for the American College of Physicians |journal=Annals of Internal Medicine |volume=146 |issue=7 |pages=516–526 |doi=10.7326/0003-4819-146-7-200704030-00008 |pmid=17404354 |s2cid=35208653 |doi-access=}} Experiencing pain is a significant predictor in women not re-attending screening.{{cite journal |vauthors=Whelehan P, Evans A, Wells M, Macgillivray S |date=August 2013 |title=The effect of mammography pain on repeat participation in breast cancer screening: a systematic review |journal=Breast |volume=22 |issue=4 |pages=389–394 |doi=10.1016/j.breast.2013.03.003 |pmid=23541681}} There are few proven interventions to reduce pain in mammography, but evidence suggests that giving women information about the mammography procedure prior to it taking place may reduce the pain and discomfort experienced.{{cite journal |vauthors=Miller D, Livingstone V, Herbison P |date=January 2008 |title=Interventions for relieving the pain and discomfort of screening mammography |journal=The Cochrane Database of Systematic Reviews |volume=2009 |issue=1 |pages=CD002942 |doi=10.1002/14651858.cd002942.pub2 |pmc=8989268 |pmid=18254010}} Furthermore, research has found that standardised compression levels can help to reduce patients' pain while still allowing for optimal diagnostic images to be produced.{{cite journal |vauthors=Serwan E, Matthews D, Davies J, Chau M |date=September 2020 |title=Mammographic compression practices of force- and pressure-standardisation protocol: A scoping review |journal=Journal of Medical Radiation Sciences |volume=67 |issue=3 |pages=233–242 |doi=10.1002/jmrs.400 |pmc=7476195 |pmid=32420700 |doi-access=free}} [86] => [87] => == Procedure == [88] => [[File:Blausen 0628 Mammogram.png|thumb|Illustration of a mammogram]] [89] => [[File:BreastScreen Aotearoa.JPG|thumb|A mobile mammography unit in New Zealand]] [90] => During the procedure, the breast is compressed using a dedicated mammography unit. Parallel-plate compression evens out the thickness of breast [[biological tissue|tissue]] to increase image quality by reducing the thickness of tissue that X-rays must penetrate, decreasing the amount of scattered radiation (scatter degrades image quality), reducing the required radiation dose, and holding the breast still (preventing [[motion blur]]). In screening mammography, both head-to-foot (craniocaudal, CC) view and angled side-view (mediolateral oblique, MLO) images of the breast are taken. Diagnostic mammography may include these and other views, including geometrically magnified and spot-compressed views of the particular area of concern.{{citation needed|date=March 2022}} [[Deodorant]]{{citation needed|date=March 2022}}, [[talcum powder]]{{cite web |title=Clinical Artefacts |url=https://humanhealth.iaea.org/HHW/MedicalPhysics/DiagnosticRadiology/PerformanceTesting/Digital_Mammography_(ADDTL)/Clinical_Artefacts_(IAEA)4966739939198767940.pdf |publisher=[[International Atomic Energy Agency]] (IAEA) |access-date=8 March 2022 |archive-url=https://web.archive.org/web/20170829181231/https://humanhealth.iaea.org/HHW/MedicalPhysics/DiagnosticRadiology/PerformanceTesting/Digital_Mammography_(ADDTL)/Clinical_Artefacts_(IAEA)4966739939198767940.pdf |archive-date=29 August 2017}} or [[lotion]] may show up on the X-ray as [[calcium]] spots, so women are discouraged from applying them on the day of their exam. There are two types of mammogram studies: screening mammograms and diagnostic mammograms. Screening mammograms, consisting of four standard X-ray images, are performed yearly on patients who present with no symptoms. Diagnostic mammograms are reserved for patients with breast symptoms (such as palpable lumps, breast pain, skin changes, nipple changes, or nipple discharge), as follow-up for probably benign findings (coded BI-RADS 3), or for further evaluation of abnormal findings seen on their screening mammograms. Diagnostic mammograms may also performed on patients with personal and/or family histories of breast cancer. Patients with breast implants and other stable benign surgical histories generally do not require diagnostic mammograms. [91] => [92] => Until some years ago, mammography was typically performed with screen-film cassettes. Today, mammography is undergoing transition to digital detectors, known as [[digital mammography]] or Full Field Digital Mammography (FFDM). The first FFDM system was approved by the FDA in the U.S. in 2000. This progress is occurring some years later than in general radiology. This is due to several factors: [93] => # The higher spatial resolution demands of mammography [94] => # Significantly increased expense of the equipment [95] => # Concern by the FDA that digital mammography equipment demonstrate that it is at least as good as screen-film mammography at detecting breast cancers without increasing dose or the number of women recalled for further evaluation. [96] => [97] => As of March 1, 2010, 62% of facilities in the United States and its territories have at least one FFDM unit.{{cite web | url = https://www.fda.gov/CDRH/MAMMOGRAPHY/scorecard-statistics.html | title = Mammography Quality Scorecard | archive-url = https://web.archive.org/web/20070403172657/https://www.fda.gov/cdrh/mammography/scorecard-statistics.html | archive-date=2007-04-03 | work = U.S. [[Food and Drug Administration]] | date = March 1, 2010 | access-date = March 31, 2010 }} (The FDA includes computed radiography units in this figure.{{cite web | url = http://www.acr.org/accreditation/mammography/mammo_faq_mamac.html | title = Mammography Frequently Asked Questions | archive-url = https://web.archive.org/web/20070928202657/http://www.acr.org/accreditation/mammography/mammo_faq_mamac.html | archive-date=2007-09-28 | work = [[American College of Radiology]] | date = January 8, 2007 | access-date = April 9, 2007 }}) [98] => [99] => Tomosynthesis, otherwise known as 3D mammography, was first introduced in clinical trials in 2008 and has been Medicare-approved in the United States since 2015. As of 2023, 3D mammography has become widely available in the US and has been shown to have improved sensitivity and specificity over 2D mammography. [100] => [101] => Mammograms are either looked at by one (single reading) or two (double reading) trained professionals:{{cite journal | vauthors = Taylor P, Potts HW | title = Computer aids and human second reading as interventions in screening mammography: two systematic reviews to compare effects on cancer detection and recall rate | journal = European Journal of Cancer | volume = 44 | issue = 6 | pages = 798–807 | date = April 2008 | pmid = 18353630 | doi = 10.1016/j.ejca.2008.02.016 | url = http://discovery.ucl.ac.uk/5173/2/5173.pdf }} these film readers are generally [[radiologist]]s, but may also be [[radiographers]], [[radiotherapist]]s, or breast clinicians (non-radiologist physicians specializing in breast disease). Double reading, which is standard practice in the UK, but less common in the US, significantly improves the [[sensitivity and specificity]] of the procedure. [[Clinical decision support system]]s may be used with [[digital mammography]] (or digitized images from analogue mammography{{cite journal | vauthors = Taylor CG, Champness J, Reddy M, Taylor P, Potts HW, Given-Wilson R | title = Reproducibility of prompts in computer-aided detection (CAD) of breast cancer | journal = Clinical Radiology | volume = 58 | issue = 9 | pages = 733–738 | date = September 2003 | pmid = 12943648 | doi = 10.1016/S0009-9260(03)00231-9 }}), but studies suggest these approaches do not significantly improve performance or provide only a small improvement.{{cite journal | vauthors = Gilbert FJ, Astley SM, Gillan MG, Agbaje OF, Wallis MG, James J, Boggis CR, Duffy SW | display-authors = 6 | title = Single reading with computer-aided detection for screening mammography | journal = The New England Journal of Medicine | volume = 359 | issue = 16 | pages = 1675–1684 | date = October 2008 | pmid = 18832239 | doi = 10.1056/nejmoa0803545 | doi-access = free }} [102] => [103] => === Interpretation of results === [104] => [105] => ==== Scoring ==== [106] => Mammogram results are often expressed in terms of the [[BI-RADS]] Assessment Category, often called a "BI-RADS score". This was developed by the [[American College of Radiology]] in 1993 in order to provide referring clinicians and patients a clear, meaningful and standardized report. The findings of a mammogram are divided into five main categories: mass, asymmetry, architectural distortion, calcifications, and associated features. Each has additional subcategories to further describe findings.{{cite journal | vauthors = D'Orsi CJ, Hall FM | title = BI-RADS lexicon reemphasized | journal = AJR. American Journal of Roentgenology | volume = 187 | issue = 5 | pages = W557; discussion W558; author reply W559 | date = November 2006 | pmid = 17056895 | doi = 10.2214/AJR.06.5090 }} After providing a description of the findings, the radiologist provides a final assessment ranging from 0 to 6. [107] => [108] => * BI-RADS 0 indicates an incomplete assessment which needs additional imaging. [109] => * BI-RADS 1 & 2 indicate a negative and benign screen mammogram respectively. [110] => * BI-RADS 3 indicates probably benign.{{cite journal | vauthors = Rao AA, Feneis J, Lalonde C, Ojeda-Fournier H | title = A Pictorial Review of Changes in the BI-RADS Fifth Edition | journal = Radiographics | volume = 36 | issue = 3 | pages = 623–639 | date = May 2016 | pmid = 27082663 | doi = 10.1148/rg.2016150178 }} [111] => * BI-RADS 4 indicates suspicious for malginancy. [112] => * BI-RADS 5 indicates highly suggestive of malignancy. [113] => * BI-RADS 6 is for biopsy-proven breast cancer.{{cite book | vauthors = Magny SJ, Shikhman R, Keppke AL | chapter = Breast Imaging Reporting and Data System |date=2024 | title = StatPearls | chapter-url = http://www.ncbi.nlm.nih.gov/books/NBK459169/ |access-date=2024-01-24 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29083600 }} [114] => [115] => A BI-RADS 3, 4, 5, and 6 would require further investigation with a diagnostic mammogram. [116] => [117] => In the UK mammograms are scored on a scale from 1–5 (1 = normal, 2 = benign, 3 = indeterminate, 4 = suspicious of malignancy, 5 = malignant). Evidence suggests that accounting for genetic risk, factors improve breast cancer risk prediction.{{cite journal |display-authors=6 |vauthors=Liu J, Page D, Nassif H, Shavlik J, Peissig P, McCarty C, Onitilo AA, Burnside E |date=2013 |title=Genetic variants improve breast cancer risk prediction on mammograms |journal=AMIA ... Annual Symposium Proceedings. AMIA Symposium |volume=2013 |pages=876–885 |pmc=3900221 |pmid=24551380}} [118] => [119] => ==== "Work-up" process ==== [120] => In the past several years, the "work-up" process has become highly formalized. It generally consists of [[screening mammography]], diagnostic mammography, and [[biopsy]] when necessary, often performed via [[stereotactic biopsy|stereotactic core biopsy]] or [[ultrasound]]-guided core biopsy. After a screening mammogram, some women may have areas of concern which cannot be resolved with only the information available from the screening mammogram. They would then be called back for a "diagnostic mammogram". This phrase essentially means a problem-solving mammogram. During this session, the radiologist will be monitoring each of the additional films as they are taken by a radiographer. Depending on the nature of the finding, ultrasound may often be used as well.{{cite journal |display-authors=6 |vauthors=Lord SJ, Lei W, Craft P, Cawson JN, Morris I, Walleser S, Griffiths A, Parker S, Houssami N |date=September 2007 |title=A systematic review of the effectiveness of magnetic resonance imaging (MRI) as an addition to mammography and ultrasound in screening young women at high risk of breast cancer |journal=European Journal of Cancer |volume=43 |issue=13 |pages=1905–1917 |doi=10.1016/j.ejca.2007.06.007 |pmid=17681781}} [121] => [122] => Generally, the cause of the unusual appearance is found to be [[benign]]. If the cause cannot be determined to be benign with sufficient certainty, a biopsy may be recommended. The biopsy procedure will be used to obtain actual tissue from the site for the [[pathologist]] to examine microscopically to determine the precise cause of the abnormality. In the past, biopsies were most frequently done in surgery, under local or general [[anesthesia]]. The majority are now done with needles in conjunction with either ultrasound or mammographic guidance to be sure that the area of concern is the area that is biopsied. These core biopsies require only [[local anesthesia]], similar to what would be given during a minor dental procedure.{{cite journal |vauthors=Dahlstrom JE, Jain S, Sutton T, Sutton S |date=May 1996 |title=Diagnostic accuracy of stereotactic core biopsy in a mammographic breast cancer screening programme |journal=Histopathology |volume=28 |issue=5 |pages=421–427 |doi=10.1046/j.1365-2559.1996.332376.x |pmid=8735717 |s2cid=7707679}} [123] => [124] => ==History== [125] => As a medical procedure that induces ionizing radiation, the origin of mammography can be traced to the discovery of X-rays by [[Wilhelm Röntgen]] in 1895. [126] => [127] => In 1913, German surgeon [[Albert Salomon (surgeon)|Albert Salomon]] performed a mammography study on 3,000 [[mastectomies]], comparing X-rays of the breasts to the actual removed tissue, observing specifically [[microcalcification]]s.{{cite book |url=https://archive.org/details/mammographybeyon00comm_0 |title=Mammography and beyond: developing technologies for the early detection of breast cancer |vauthors=Nass SJ, Henderson IC |collaboration=Institute of Medicine (U.S.). Committee on Technologies for the Early Detection of Breast Cancer |publisher=National Academies Press |year=2001 |isbn=978-0-309-07283-0 |url-access=registration}}{{cite web |title=Breast Cancer Pioneer - Was the First Person to Use X-rays to Study Breast Cancer |url=http://www.scienceheroes.com/index.php?option=com_content&view=article&id=247&Itemid=223 |url-status=dead |archive-url=https://web.archive.org/web/20200215164226/http://www.scienceheroes.com/index.php?option=com_content&view=article&id=247&Itemid=223 |archive-date=February 15, 2020 |access-date=March 22, 2011 |publisher=Science Heroes |vauthors=Ingram A}} By doing so, he was able to establish the difference as seen on an [[X-ray]] image between cancerous and non-cancerous tumors in the breast. Salomon's mammographs provided substantial information about the spread of tumors and their borders.{{cite book |title=Classic papers in modern diagnostic radiology |vauthors=Thomas A |publisher=Springer |year=2005 |isbn=3-540-21927-7 |location=Berlin |pages=540}} [128] => [129] => In 1930, American physician and radiologist [[Stafford L. Warren]] published "A Roentgenologic Study of the Breast",{{cite journal |vauthors=Warren SL |year=1930 |title=A Roentgenologic Study of the Breast |journal=The American Journal of Roentgenology and Radium Therapy |volume=24 |pages=113–124}} a study where he produced [[stereoscopic]] X-rays images to track changes in breast tissue as a result of [[pregnancy]] and [[mastitis]].{{cite book | vauthors = Gold RH |title=Diagnosis of Diseases of the Breast |publisher=Saunders |year=2005 |isbn=978-0-7216-9563-1 | veditors = Bassett LW, Jackson VP, Fu KL, Fu YS |location=Philadelphia, Pennsylvania |page=3 |contribution=History of Breast Imaging |oclc=488959603 }}{{cite web |title=History of Cancer Detection 1851–1995 |url=http://www.cancerquest.org/history-cancer-detection |access-date=March 12, 2011 |publisher=[[Emory University]]}} In 119 women who subsequently underwent surgery, he correctly found breast cancer in 54 out of 58 cases. [130] => [131] => As early as 1937, [[Jacob Gershon-Cohen]] developed a form a mammography for a diagnostic of breast cancer at earlier stages to improve survival rates.Gardner, Kirsten E. Early Detection: Women, Cancer, and Awareness Campaigns in the Twentieth-Century United States. U of North Carolina P, 2006. p.179 In 1949, Raul Leborgne sparked renewed enthusiasm for mammography by emphasizing the importance of technical proficiency in patient positioning and the adoption of specific radiological parameters. He played a pioneering role in elevating imaging quality while placing particular emphasis on distinguishing between benign and malignant calcifications.{{Cite journal | vauthors = Kalaf JM |date=Jul–Aug 2014 |title=Mamografia: uma história de sucesso e de entusiasmo científico |journal=Radiologia Brasileira |language=pt |volume=47 |issue=4 |pages=VII–VIII |doi=10.1590/0100-3984.2014.47.4e2 |issn=1678-7099 |pmc=4337127 |pmid=25741098}} In the early 1950s, Uruguayan radiologist Raul Leborgne developed the breast compression technique to produce better quality images, and described the differences between benign and malign microcalcifications.{{cite journal |vauthors=Gold RH, Bassett LW, Widoff BE |date=November 1990 |title=Highlights from the history of mammography |journal=Radiographics |volume=10 |issue=6 |pages=1111–1131 |doi=10.1148/radiographics.10.6.2259767 |pmid=2259767 |doi-access=}} [132] => [133] => In 1956, Gershon-Cohen conducted clinical trails on over 1,000 asymptomatic women at the [[Albert Einstein Medical Center]] on his screening technique, and the same year, Robert Egan at the [[University of Texas M.D. Anderson Cancer Center]] combined a technique of low kVp with high mA and single emulsion films developed by [[Kodak]] to devise a method of screening mammography. He published these results in 1959 in a paper, subsequently vulgarized in a 1964 book called ''Mammography''.Medich DC, Martel C. ''Medical Health Physics''. Health Physics Society 2006 Summer School. Medical Physics Publishing. {{ISBN|1930524315}} pp.25 The "Egan technique", as it became known, enabled physicians to detect calcification in breast tissue;{{cite journal |vauthors=Skloot R |date=April 2001 |title=Taboo Organ |url=https://www.pittmed.health.pitt.edu/apr_2001/taboo_organ.pdf |url-status=live |journal=University of Pittsburgh School of Medicine |volume=3 |issue=2 |archive-url=https://web.archive.org/web/20160303235918/http://pittmed.health.pitt.edu/apr_2001/taboo_organ.pdf |archive-date=2016-03-03}} of the 245 breast cancers that were confirmed by biopsy among 1,000 patients, Egan and his colleagues at M.D. Anderson were able to identify 238 cases by using his method, 19 of which were in patients whose physical examinations had revealed no breast pathology. [134] => [135] => Use of mammography as a screening technique spread clinically after a 1966 study demonstrating the impact of mammograms on mortality and treatment led by [[Philip Strax]]. This study, based in New York, was the first large-scale randomized controlled trial of mammography screening.{{cite journal |vauthors=Lerner BH |year=2003 |title="To see today with the eyes of tomorrow": A history of screening mammography |journal=Canadian Bulletin of Medical History |volume=20 |issue=2 |pages=299–321 |doi=10.3138/cbmh.20.2.299 |pmid=14723235 |s2cid=2080082 |doi-access=free}}{{cite journal |vauthors=Shapiro S, Strax P, Venet L |date=February 1966 |title=Evaluation of periodic breast cancer screening with mammography. Methodology and early observations |journal=JAMA |volume=195 |issue=9 |pages=731–738 |doi=10.1001/jama.1966.03100090065016 |pmid=5951878}} [136] => [137] => In 1985, [https://www.intechopen.com/profiles/82190 László Tabár] and colleagues documented findings from mammographic screening involving 134,867 women aged 40 to 79. Using a single mediolateral oblique image, they reported a 31% reduction in mortality. Dr. Tabár has since written many publications promoting mammography in the areas of epidemiology, screening, early diagnosis, and clinical-radiological-pathological correlation. [138] => [139] => == Arguments against screening mammography == [140] => The use of mammography as a screening tool for the detection of early breast cancer in otherwise healthy women without symptoms is seen by some as controversial.{{cite journal |vauthors=Biller-Andorno N, Jüni P |date=May 2014 |title=Abolishing mammography screening programs? A view from the Swiss Medical Board |url=https://boris.unibe.ch/51602/7/Biller-Andorno%20NEnglJMed%202014.pdf |journal=The New England Journal of Medicine |volume=370 |issue=21 |pages=1965–1967 |doi=10.1056/NEJMp1401875 |pmid=24738641}}{{cite news |date=11 February 2014 |title=Vast Study Casts Doubts on Value of Mammograms |url=https://www.nytimes.com/2014/02/12/health/study-adds-new-doubts-about-value-of-mammograms.html |url-status=live |archive-url=https://web.archive.org/web/20140530014419/http://www.nytimes.com/2014/02/12/health/study-adds-new-doubts-about-value-of-mammograms.html?_r=0 |archive-date=30 May 2014 |access-date=28 May 2014 |newspaper=[[The New York Times]] |vauthors=Kolata G}}{{cite journal |vauthors=Pace LE, Keating NL |date=April 2014 |title=A systematic assessment of benefits and risks to guide breast cancer screening decisions |journal=JAMA |volume=311 |issue=13 |pages=1327–1335 |doi=10.1001/jama.2014.1398 |pmid=24691608 |doi-access=}} [141] => [142] => Keen and Keen indicated that repeated mammography starting at age fifty saves about 1.8 lives over 15 years for every 1,000 women screened.{{Cite journal |vauthors=Mulcahy N |date=April 2, 2009 |title=Screening Mammography Benefits and Harms in Spotlight Again |url=http://www.medscape.com/viewarticle/590535 |url-status=live |journal=Medscape |archive-url=https://web.archive.org/web/20150413020916/http://www.medscape.com/viewarticle/590535 |archive-date=April 13, 2015}} This result has to be seen against the adverse effects of errors in diagnosis, [[overtreatment|over-treatment]], and radiation exposure. [143] => [144] => The Cochrane analysis of screening indicates that it is "not clear whether screening does more good than harm". According to their analysis, 1 in 2,000 women will have her life prolonged by 10 years of screening, while 10 healthy women will undergo unnecessary breast cancer treatment. Additionally, 200 women will experience significant psychological stress due to false positive results.{{cite journal |vauthors=Gøtzsche PC, Jørgensen KJ |date=June 2013 |title=Screening for breast cancer with mammography |journal=The Cochrane Database of Systematic Reviews |volume=2013 |issue=6 |pages=CD001877 |doi=10.1002/14651858.CD001877.pub5 |pmc=6464778 |pmid=23737396}} [145] => [146] => The [[Cochrane Collaboration]] (2013) concluded after ten years that trials with adequate randomization did not find an effect of mammography screening on total cancer mortality, including breast cancer. The authors of this Cochrane review write: "If we assume that screening reduces breast cancer mortality by 15% and that overdiagnosis and over-treatment is at 30%, it means that for every 2,000 women invited for screening throughout 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress including anxiety and uncertainty for years because of false positive findings." The authors conclude that the time has come to re-assess whether universal mammography screening should be recommended for any age group. They state that universal screening may not be reasonable.{{cite web |title=Mammography-leaflet; Screening for breast cancer with mammography |url=http://www.cochrane.dk/screening/mammography-leaflet.pdf |url-status=dead |archive-url=https://web.archive.org/web/20120905132426/http://www.cochrane.dk/screening/mammography-leaflet.pdf |archive-date=2012-09-05 |access-date=2012-06-24}} The Nordic Cochrane Collection updated research in 2012 and stated that advances in diagnosis and treatment make mammography screening less effective today, rendering it "no longer effective". They conclude that "it therefore no longer seems reasonable to attend" for breast cancer screening at any age, and warn of misleading information on the internet. [147] => [148] => Newman posits that screening mammography does not reduce death overall, but causes significant harm by inflicting cancer scare and unnecessary surgical interventions.{{Cite book |title=Hippocrates' Shadow |vauthors=Newman DH |publisher=Scibner |year=2008 |isbn=978-1-4165-5153-9 |page=193}} The Nordic Cochrane Collection notes that advances in diagnosis and treatment of breast cancer may make breast cancer screening no longer effective in decreasing death from breast cancer, and therefore no longer recommend routine screening for healthy women as the risks might outweigh the benefits. [149] => [150] => Of every 1,000 U.S. women who are screened, about 7% will be called back for a diagnostic session (although some studies estimate the number to be closer to 10% to 15%).{{cite web |date=4 May 2018 |title=Wrap-Up Session |url=https://www.ncbi.nlm.nih.gov/books/NBK83865/ |url-status=live |archive-url=https://web.archive.org/web/20180504022034/https://www.ncbi.nlm.nih.gov/books/NBK83865/ |archive-date=4 May 2018 |access-date=4 May 2018 |publisher=National Academies Press (US) |via=www.ncbi.nlm.nih.gov |collaboration=Institute of Medicine (US) Committee on New Approaches to Early Detection and Diagnosis of Breast Cancer |vauthors=Herdman R, Norton L}} About 10% of those who are called back will be referred for a biopsy. Of the 10% referred for biopsy, about 3.5% will have cancer and 6.5% will not. Of the 3.5% who have cancer, about 2 will have an early stage cancer that will be cured after treatment. [151] => [152] => Mammography may also produce false negatives. Estimates of the numbers of cancers missed by mammography are usually around 20%.{{cite web |title=Mammograms |url=http://www.cancer.gov/cancertopics/factsheet/detection/mammograms |archive-url=https://web.archive.org/web/20141217005145/http://www.cancer.gov/cancertopics/factsheet/Detection/mammograms |archive-date=2014-12-17 |work=National Cancer Institute}} Reasons for not seeing the cancer include observer error, but more frequently it is because the cancer is hidden by other dense tissue in the breast, and even after retrospective review of the mammogram the cancer cannot be seen. Furthermore, one form of breast cancer, lobular cancer, has a growth pattern that produces shadows on the mammogram that are indistinguishable from normal breast tissue. [153] => [154] => === Mortality === [155] => The [[Cochrane Collaboration]] states that the best quality evidence does not demonstrate a reduction in mortality or a reduction in mortality from all types of cancer from screening mammography. [156] => [157] => The Canadian Task Force found that for women ages 50 to 69, screening 720 women once every 2 to 3 years for 11 years would prevent one death from breast cancer. For women ages 40 to 49, 2,100 women would need to be screened at the same frequency and period to prevent a single death from breast cancer. [158] => [159] => Women whose breast cancer was detected by screening mammography before the appearance of a lump or other symptoms commonly assume that the mammogram "saved their lives".{{cite journal |vauthors=Welch HG, Frankel BA |date=December 12, 2011 |title=Likelihood that a woman with screen-detected breast cancer has had her "life saved" by that screening |journal=Archives of Internal Medicine |volume=171 |issue=22 |pages=2043–2046 |doi=10.1001/archinternmed.2011.476 |pmid=22025097}}
{{*}}Lay summary: {{cite web | vauthors = Parker-Pope T |date=October 24, 2011 |title=Mammogram's Role as Savior Is Tested |url=http://well.blogs.nytimes.com/2011/10/24/mammograms-role-as-savior-is-tested/?ref=health |url-status=live |archive-url=https://web.archive.org/web/20111027211045/http://well.blogs.nytimes.com/2011/10/24/mammograms-role-as-savior-is-tested/ |archive-date=2011-10-27 |access-date=2011-10-28 |work=The New York Times (blog)}} In practice, the vast majority of these women received no practical benefit from the mammogram. There are four categories of cancers found by mammography: [160] => # Cancers that are so easily treated that a later detection would have produced the same rate of cure (women would have lived even without mammography). [161] => # Cancers so aggressive that even early detection is too late to benefit the patient (women who die despite detection by mammography). [162] => # Cancers that would have receded on their own or are so slow-growing that the woman would die of other causes before the cancer produced symptoms (mammography results in [[overdiagnosis|over-diagnosis]] and [[overtreatment|over-treatment]] of this class). [163] => # A small number of breast cancers that are detected by screening mammography and whose treatment outcome improves as a result of earlier detection. [164] => [165] => Only 3% to 13% of breast cancers detected by screening mammography will fall into this last category. Clinical trial data suggests that 1 woman per 1,000 healthy women screened over 10 years falls into this category. Screening mammography produces no benefit to any of the remaining 87% to 97% of women. The probability of a woman falling into any of the above four categories varies with age.{{cite book |title=Proceedings of the ACM international conference on Health informatics - IHI '10 |vauthors=Nassif H, Page D, Ayvaci M, Shavlik J, Burnside ES |year=2010 |isbn=978-1-4503-0030-8 |pages=76–82 |chapter=Uncovering age-specific invasive and DCIS breast cancer rules using inductive logic programming |doi=10.1145/1882992.1883005 |s2cid=2112731}}{{cite journal |display-authors=6 |vauthors=Ayvaci MU, Alagoz O, Chhatwal J, Munoz del Rio A, Sickles EA, Nassif H, Kerlikowske K, Burnside ES |date=August 2014 |title=Predicting invasive breast cancer versus DCIS in different age groups |journal=BMC Cancer |volume=14 |issue=1 |pages=584 |doi=10.1186/1471-2407-14-584 |pmc=4138370 |pmid=25112586 |doi-access=free}} [166] => [167] => A 2016 review for the [[United States Preventive Services Task Force]] found that mammography was associated with an 8%-33% decrease in breast cancer mortality in different age groups, but that this decrease was not [[statistically significant]] at the age groups of 39–49 and 70–74. The same review found that mammography significantly decreased the risk of advanced cancer among women aged 50 and older by 38%, but among those aged 39 to 49 the risk reduction was a non-significant 2%.{{cite journal |vauthors=Nelson HD, Fu R, Cantor A, Pappas M, Daeges M, Humphrey L |date=February 2016 |title=Effectiveness of Breast Cancer Screening: Systematic Review and Meta-analysis to Update the 2009 U.S. Preventive Services Task Force Recommendation |journal=Annals of Internal Medicine |volume=164 |issue=4 |pages=244–255 |doi=10.7326/M15-0969 |pmid=26756588 |doi-access=free}} The USPSTF made their review based on data from randomized controlled trials (RCT) studying breast cancer in women between the ages of 40-49. [168] => [169] => === False positives === [170] => The goal of any screening procedure is to examine a large population of patients and find the small number most likely to have a serious condition. These patients are then referred for further, usually more invasive, testing. Thus a screening exam is not intended to be definitive; rather it is intended to have sufficient sensitivity to detect a useful proportion of cancers. The cost of higher sensitivity is a larger number of results that would be regarded as suspicious in patients without disease. This is true of mammography. The patients without disease who are called back for further testing from a screening session (about 7%) are sometimes referred to as "[[False positives and false negatives|false positives]]". There is a trade-off between the number of patients with disease found and the much larger number of patients without disease that must be re-screened.{{citation needed|date=May 2019}} [171] => [172] => Research shows{{cite journal |vauthors=Brewer NT, Salz T, Lillie SE |date=April 2007 |title=Systematic review: the long-term effects of false-positive mammograms |journal=Annals of Internal Medicine |volume=146 |issue=7 |pages=502–510 |doi=10.7326/0003-4819-146-7-200704030-00006 |pmid=17404352 |s2cid=22260624}} that false-positive mammograms may affect women's well-being and behavior. Some women who receive false-positive results may be more likely to return for routine screening or perform breast self-examinations more frequently. However, some women who receive false-positive results become anxious, worried, and distressed about the possibility of having breast cancer, feelings that can last for many years.{{citation needed|date=July 2021}} [173] => [174] => False positives also mean greater expense, both for the individual and for the screening program. Since follow-up screening is typically much more expensive than initial screening, more false positives (that must receive follow-up) means that fewer women may be screened for a given amount of money. Thus as sensitivity increases, a screening program will cost more or be confined to screening a smaller number of women.{{citation needed|date=May 2019}} [175] => [176] => === Overdiagnosis === [177] => The central harm of mammographic breast cancer screening is [[overdiagnosis]]: the detection of abnormalities that meet the pathologic definition of cancer but will never progress to cause symptoms or death. Dr. [[H. Gilbert Welch]], a researcher at Dartmouth College, states that "screen-detected breast and prostate cancer survivors are more likely to have been over-diagnosed than actually helped by the test." Estimates of overdiagnosis associated with mammography have ranged from 1% to 54%.{{cite journal |vauthors=de Gelder R, Heijnsdijk EA, van Ravesteyn NT, Fracheboud J, Draisma G, de Koning HJ |date=27 June 2011 |title=Interpreting overdiagnosis estimates in population-based mammography screening |journal=Epidemiologic Reviews |volume=33 |issue=1 |pages=111–121 |doi=10.1093/epirev/mxr009 |pmc=3132806 |pmid=21709144}} In 2009, [[Peter C. Gotzsche]] and Karsten Juhl Jørgensen reviewed the literature and found that 1 in 3 cases of breast cancer detected in a population offered mammographic screening is over-diagnosed.{{cite journal |vauthors=Jørgensen KJ, Gøtzsche PC |date=July 2009 |title=Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends |journal=BMJ |volume=339 |pages=b2587 |doi=10.1136/bmj.b2587 |pmc=2714679 |pmid=19589821}} In contrast, a 2012 panel convened by the national cancer director for England and [[Cancer Research UK]] concluded that 1 in 5 cases of breast cancer diagnosed among women who have undergone breast cancer screening are over-diagnosed. This means an over-diagnosis rate of 129 women per 10,000 invited to screening.{{cite journal |author1=Independent UK Panel on Breast Cancer Screening |date=November 2012 |title=The benefits and harms of breast cancer screening: an independent review |journal=Lancet |volume=380 |issue=9855 |pages=1778–1786 |doi=10.1016/S0140-6736(12)61611-0 |pmid=23117178 |s2cid=6857671 |hdl-access=free |hdl=20.500.11820/ed6e2e58-5cfa-4fee-8dc8-641ab03effb8}} A recent systematic review of 30 studies found that screening mammography for breast cancer among women aged 40 years and older was 12.6%.{{cite journal | vauthors = Flemban AF | title = Overdiagnosis Due to Screening Mammography for Breast Cancer among Women Aged 40 Years and Over: A Systematic Review and Meta-Analysis | journal = Journal of Personalized Medicine | volume = 13 | issue = 3 | pages = 523 | date = March 2023 | pmid = 36983705 | pmc = 10051653 | doi = 10.3390/jpm13030523 | doi-access = free }} [178] => [179] => === False negatives === [180] => Mammograms also have a rate of missed tumors, or "false negatives". Accurate data regarding the number of false negatives are very difficult to obtain because [[mastectomy|mastectomies]] cannot be performed on every woman who has had a mammogram to determine the false negative rate. Estimates of the false negative rate depend on close follow-up of a large number of patients for many years. This is difficult in practice because many women do not return for regular mammography making it impossible to know if they ever developed a cancer. In his book ''The Politics of Cancer'', Dr. Samuel S. Epstein claims that in women ages 40 to 49, one in four cancers are missed at each mammography. Researchers have found that breast tissue is denser among younger women, making it difficult to detect tumors. For this reason, false negatives are twice as likely to occur in pre-menopausal mammograms (Prate). This is why the screening program in the UK does not start calling women for screening mammograms until age 50.{{Cite book |last=Epstein |first=Samuel S. |title=The politics of cancer |date=1979 |publisher=Anchor Pr |isbn=978-0-385-15167-2 |edition=rev. and expand. |series=A Doubleday Anchor book |location=Garden City, NY}} [181] => [182] => The importance of these missed cancers is not clear, particularly if the woman is getting yearly mammograms. Research on a closely related situation has shown that small cancers that are not acted upon immediately, but are observed over periods of several years, will have good outcomes. A group of 3,184 women had mammograms that were formally classified as "probably benign". This classification is for patients who are not clearly normal but have some area of minor concern. This results not in the patient being biopsied, but rather in having early follow up mammography every six months for three years to determine whether there has been any change in status. Of these 3,184 women, 17 (0.5%) did have cancers. Most importantly, when the diagnosis was finally made, they were all still stage 0 or 1, the earliest stages. Five years after treatment, none of these 17 women had evidence of re-occurrence. Thus, small early cancers, even though not acted on immediately, were still reliably curable.{{cite journal |vauthors=Sickles EA |date=May 1991 |title=Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases |journal=Radiology |volume=179 |issue=2 |pages=463–468 |doi=10.1148/radiology.179.2.2014293 |pmid=2014293}} [183] => [184] => === Cost-effectiveness === [185] => Breast cancer imposes a significant economic strain on communities, with the expense of treating stages three and four in the United States in 2017 amounting to approximately $127,000.{{cite journal | vauthors = Allaire BT, Ekwueme DU, Poehler D, Thomas CC, Guy GP, Subramanian S, Trogdon JG | title = Breast cancer treatment costs in younger, privately insured women | journal = Breast Cancer Research and Treatment | volume = 164 | issue = 2 | pages = 429–436 | date = July 2017 | pmid = 28432514 | pmc = 6083444 | doi = 10.1007/s10549-017-4249-x }} While early diagnosis and screening methods are important in reducing the death rates, the cost-benefit of breast cancer screening using mammography has been unclear. A recent systematic review of three studies held in Spain, Denmark, and the United States from 2000-2019 found that digital mammography is not cost-beneficial for the healthcare system when compared to other screening methods. Therefore, increasing its frequency may cause higher costs on the healthcare system. While there may be a lack of evidence, it is suggested that digital mammography be performed every two years for ages over 50.{{cite journal | vauthors = Ghorbani S, Rezapour A, Eisavi M, Barahman M, Bagheri Faradonbeh S | title = Cost-benefit Analysis of Breast Cancer Screening with Digital Mammography: A Systematic Review | journal = Medical Journal of the Islamic Republic of Iran | volume = 37 | issue = 1 | pages = 89 | date = 2023-02-10 | pmid = 37750094 | pmc = 10518066 | doi = 10.47176/mjiri.37.89 }} [186] => [187] => === Arguments against the USPSTF recommendations === [188] => As the [[United States Preventive Services Task Force|USPSTF]] recommendations are so influential, changing mammography screenings from 50 to 40 years of age has significant implications to public health. The major concerns regarding this update is whether breast cancer mortality has truly been increasing and if there is new evidence that the benefits of mammography are increasing.{{cite journal | vauthors = Woloshin S, Jørgensen KJ, Hwang S, Welch HG | title = The New USPSTF Mammography Recommendations - A Dissenting View | journal = The New England Journal of Medicine | volume = 389 | issue = 12 | pages = 1061–1064 | date = September 2023 | pmid = 37721382 | doi = 10.1056/NEJMp2307229 | s2cid = 262035301 }} [189] => [190] => According to [[National Vital Statistics System]], mortality from breast cancer has been steadily decreasing in the United States from 2018 to 2021. There have also been no new randomized trials of screening mammography for women in their 40s since the previous USPSTF recommendation was made. In addition, the 8 most recent randomized trials for this age group revealed no significant effect.{{cite journal | vauthors = Gøtzsche PC, Jørgensen KJ | title = Screening for breast cancer with mammography | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 6 | pages = CD001877 | date = June 2013 | pmid = 23737396 | pmc = 6464778 | doi = 10.1002/14651858.CD001877.pub5 | collaboration = Cochrane Breast Cancer Group }} Instead, the [[United States Preventive Services Task Force|USPSTF]] used statistical models to estimate what would happen if the starting age were lowered, assuming that screening mammography reduces breast cancer mortality by 25%. This found that screening 1,000 women from 40–74 years of age, instead of 50-74, would cause 1-2 fewer breast cancer deaths per 1,000 women screened over a lifetime.{{Cite journal | vauthors = Trentham-Dietz A, Chapman CH, Jayasekera J |date=May 2023 |title=Breast Cancer Screening With Mammography: An Updated Decision Analysis for the U.S. Preventive Services Task Force |url=https://uspreventiveservicestaskforce.org/home/getfilebytoken/uRwAnYAnc4HCNY3j3h5v_z |journal=AHRQ Publication |number=23-05303-EF-2}} [191] => [192] => Approximately 75 percent of women diagnosed with breast cancer have no family history of breast cancer or other factors that put them at high risk for developing the disease (so screening only high-risk women misses majority of cancers). An analysis by Hendrick and Helvie,{{cite journal | vauthors = Hendrick RE, Helvie MA | title = United States Preventive Services Task Force screening mammography recommendations: science ignored | journal = AJR. American Journal of Roentgenology | volume = 196 | issue = 2 | pages = W112–W116 | date = February 2011 | pmid = 21257850 | doi = 10.2214/AJR.10.5609 }} published in the ''[[American Journal of Roentgenology]]'', showed that if USPSTF breast cancer screening guidelines were followed, approximately 6,500 additional women each year in the U.S. would die from breast cancer. [193] => [194] => The largest (Hellquist et al){{cite journal | vauthors = Hellquist BN, Duffy SW, Abdsaleh S, Björneld L, Bordás P, Tabár L, Viták B, Zackrisson S, Nyström L, Jonsson H | display-authors = 6 | title = Effectiveness of population-based service screening with mammography for women ages 40 to 49 years: evaluation of the Swedish Mammography Screening in Young Women (SCRY) cohort | journal = Cancer | volume = 117 | issue = 4 | pages = 714–722 | date = February 2011 | pmid = 20882563 | doi = 10.1002/cncr.25650 | s2cid = 42253031 }} and longest running (Tabar et al){{Cite journal |title=Tabar et al |url=http://radiology.rsna.org/content/early/2011/06/15/radiol.11110469.full |journal=Radiology}} breast cancer screening studies in history re-confirmed that regular mammography screening cut breast cancer deaths by roughly a third in all women ages 40 and over (including women ages 40–49). This renders the USPSTF calculations off by half. They used a 15% mortality reduction to calculate how many women needed to be invited to be screened to save a life. With the now re-confirmed 29% (or up) figure, the number to be screened using the USPSTF formula is half of their estimate and well within what they considered acceptable by their formula. [195] => [196] => == Society and Culture == [197] => [198] => === Attendance === [199] => Many factors affect how many people attend breast cancer screenings. For example, people from minority [[Ethnic group|ethnic communities]] are also less likely to attend cancer screening. In the UK, women of [[South Asians in the United Kingdom|South Asian heritage]] are the least likely to attend breast cancer screening. Research is still needed to identify specific barriers for the different South Asian communities. For example, a study showed that [[British Pakistanis|British-Pakistani]] women faced cultural and [[language barrier]]s and were not aware that breast screening takes place in a female-only environment.{{Cite journal |date=2020-09-15 |title=Cultural and language barriers need to be addressed for British-Pakistani women to benefit fully from breast screening |url=https://evidence.nihr.ac.uk/alert/cultural-and-language-barriers-need-to-be-addressed-for-british-pakistani-women-to-benefit-fully-from-breast-screening/ |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research |doi=10.3310/alert_41135 |s2cid=241324844}}{{cite journal | vauthors = Woof VG, Ruane H, Ulph F, French DP, Qureshi N, Khan N, Evans DG, Donnelly LS | display-authors = 6 | title = Engagement barriers and service inequities in the NHS Breast Screening Programme: Views from British-Pakistani women | journal = Journal of Medical Screening | volume = 27 | issue = 3 | pages = 130–137 | date = September 2020 | pmid = 31791172 | pmc = 7645618 | doi = 10.1177/0969141319887405 }}{{cite journal | vauthors = Woof VG, Ruane H, French DP, Ulph F, Qureshi N, Khan N, Evans DG, Donnelly LS | display-authors = 6 | title = The introduction of risk stratified screening into the NHS breast screening Programme: views from British-Pakistani women | journal = BMC Cancer | volume = 20 | issue = 1 | pages = 452 | date = May 2020 | pmid = 32434564 | pmc = 7240981 | doi = 10.1186/s12885-020-06959-2 | doi-access = free }} [200] => [201] => People with [[Mental disorder|mental illnesses]] are also less likely to attend cancer screening appointments.{{Cite journal |date=2020-05-19 |title=Cancer screening across the world is failing people with mental illness |url=https://evidence.nihr.ac.uk/alert/cancer-screening-across-the-world-is-failing-people-with-mental-illness/ |journal=NIHR Evidence |type=Plain English summary |language=en |publisher=National Institute for Health and Care Research |doi=10.3310/alert_40317 |s2cid=243581455}}{{cite journal | vauthors = Solmi M, Firth J, Miola A, Fornaro M, Frison E, Fusar-Poli P, Dragioti E, Shin JI, Carvalho AF, Stubbs B, Koyanagi A, Kisely S, Correll CU | display-authors = 6 | title = Disparities in cancer screening in people with mental illness across the world versus the general population: prevalence and comparative meta-analysis including 4 717 839 people | journal = The Lancet. Psychiatry | volume = 7 | issue = 1 | pages = 52–63 | date = January 2020 | pmid = 31787585 | doi = 10.1016/S2215-0366(19)30414-6 | hdl-access = free | s2cid = 208535709 | hdl = 11577/3383784 | url = https://kclpure.kcl.ac.uk/portal/en/publications/320aacc4-3ffa-434b-a114-de060c42f5fd }} In Northern Ireland women with mental health problems were shown to be less likely to attend [[Breast cancer screening|screening for breast cancer]], than women without. The lower attendance numbers remained the same even when marital status and [[social deprivation]] were taken into account.{{Cite journal |date=2021-06-21 |title=Breast cancer screening: women with poor mental health are less likely to attend appointments |url=https://evidence.nihr.ac.uk/alert/breast-screening-poor-mental-health-linked-to-non-attendance/ |journal=NIHR Evidence |type=Plain English summary |language=en |publisher=National Institute for Health and Care Research |doi=10.3310/alert_46400 |s2cid=241919707}}{{cite journal | vauthors = Ross E, Maguire A, Donnelly M, Mairs A, Hall C, O'Reilly D | title = Does poor mental health explain socio-demographic gradients in breast cancer screening uptake? A population-based study | journal = European Journal of Public Health | volume = 30 | issue = 3 | pages = 396–401 | date = June 2020 | pmid = 31834366 | doi = 10.1093/eurpub/ckz220 | doi-access = free }} [202] => [203] => ==Regulation== [204] => Mammography facilities in the United States and its territories (including military bases) are subject to the [[Mammography Quality Standards Act]] (MQSA). The act requires annual inspections and accreditation every three years through an FDA-approved body. Facilities found deficient during the inspection or accreditation process can be barred from performing mammograms until corrective action has been verified or, in extreme cases, can be required to notify past patients that their exams were sub-standard and should not be relied upon.{{Cite web |author=Center for Devices and Radiological Health |title=Facility Certification and Inspection (MQSA) – Mammography Safety Notifications |url=https://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/FacilityCertificationandInspection/ucm246568.htm |access-date=2019-04-18 |website=www.fda.gov}} [205] => [206] => At this time,{{When|date=December 2023}} MQSA applies only to traditional mammography and not to related scans, such as [[breast ultrasound]], stereotactic breast biopsy, or breast MRI. [207] => [208] => As of September 10, 2024, the MQSA requires that all patients be notified of their breast density ("dense" or "not dense") in their mammogram reports.{{Cite web |date=March 8, 2023 |title=Breast Density and Your Mammogram Report |url=https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/mammograms/breast-density-and-your-mammogram-report.html |access-date=December 13, 2023 |website=[[American Cancer Society]]}}{{Cite web |date=December 1, 2023 |title=Mammography Quality Standards Act and Program |url=https://www.fda.gov/radiation-emitting-products/mammography-quality-standards-act-and-program |access-date=December 13, 2023 |website=FDA}} [209] => [210] => == Research == [211] => [212] => === Artificial intelligence (AI) algorithms === [213] => Recently, [[artificial intelligence (AI)]] programs have been developed to utilize features from screening mammography images to predict breast cancer risk. A systematic review of 16 retrospective study designs comparing median maximum [[Area under the curve (receiver operating characteristic)|AUC]] found that artificial intelligence had a comparable or better accuracy (AUC = 0.72) of predicting breast cancer than clinical risk factors alone (AUC = 0.61), suggesting a transition from clinical risk factor-based to AI image-based risk models may lead to more accurate and personalized risk-based screening approaches.{{cite journal | vauthors = Schopf CM, Ramwala OA, Lowry KP, Hofvind S, Marinovich ML, Houssami N, Elmore JG, Dontchos BN, Lee JM, Lee CI | display-authors = 6 | title = Artificial Intelligence-Driven Mammography-Based Future Breast Cancer Risk Prediction: A Systematic Review | journal = Journal of the American College of Radiology | date = November 2023 | pmid = 37949155 | doi = 10.1016/j.jacr.2023.10.018 | s2cid = 265107884 }} [214] => [215] => Another study of 32 published papers involving 23,804 mammograms and various machine learning methods ([[Convolutional neural network|CNN]], [[Artificial neural network|ANN]], and [[Support vector machine|SVM]]) found promising results in the ability to assist clinicians in large-scale population-based breast cancer screening programs.{{cite journal | vauthors = Liu J, Lei J, Ou Y, Zhao Y, Tuo X, Zhang B, Shen M | title = Mammography diagnosis of breast cancer screening through machine learning: a systematic review and meta-analysis | journal = Clinical and Experimental Medicine | volume = 23 | issue = 6 | pages = 2341–2356 | date = October 2023 | pmid = 36242643 | doi = 10.1007/s10238-022-00895-0 | s2cid = 252904455 }} [216] => [217] => == Alternative examination methods == [218] => For patients who do not want to undergo mammography, MRI and also breast computed tomography (also called breast CT) offer a painless alternative. Whether the respective method is suitable depends on the clinical picture; it is decided by the physician.{{Citation needed|date=January 2023}} [219] => [220] => == See also == [221] => * [[Computed tomography laser mammography]] [222] => * [[Molecular breast imaging (disambiguation)|Molecular breast imaging]] [223] => * [[Xeromammography]] [224] => [225] => == References == [226] => {{Reflist|30em}} [227] => [228] => == Further reading == [229] => {{refbegin}} [230] => * {{cite book | vauthors = Reynolds H |title = The Big Squeeze: A Social and Political History of the Controversial Mammogram |date=2012 |location=Ithaca | publisher = ILR Press/Cornell University Press |isbn=978-0-8014-5093-8 | pages = 128 }} [231] => {{refend}} [232] => [233] => == External links == [234] => {{Commons category}} [235] => {{Library resources box [236] => |by=no [237] => |onlinebooks=no [238] => |others=no [239] => |about=yes [240] => |label=Mammography}} [241] => * [http://www.mammoimage.org/ Mammographic Image Analysis Homepage] [242] => * [https://www.cancer.gov/types/breast/mammograms-fact-sheet Screening Mammograms: Questions and Answers], from the [[National Cancer Institute]] [243] => * [https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection.html American Cancer Society: Mammograms and Other Breast Imaging Procedures] [244] => * [https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening U.S. Preventive Task Force recommendations on screening mammography] [245] => [246] => {{Medical imaging}} [247] => {{Breast procedures}} [248] => [249] => {{Authority control}} [250] => [251] => [[Category:Breast imaging]] [252] => [[Category:Cancer screening]] [253] => [[Category:Diagnostic radiology]] [254] => [[Category:Projectional radiography]] [] => )
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Mammography

Mammography is a medical imaging technique that uses low-dose X-rays to create detailed images of the breast for the early detection and diagnosis of breast cancer. This Wikipedia page provides a comprehensive overview of mammography, covering its history, procedure, indications, and interpretation of results.

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This Wikipedia page provides a comprehensive overview of mammography, covering its history, procedure, indications, and interpretation of results. It also discusses the different types of mammography, such as digital mammography and 3D mammography, and explains their advantages and limitations. The page also delves into the controversies surrounding mammography, including the debate on overdiagnosis and false positives, and discusses alternative screening methods. Additionally, it provides information on the role of mammography in breast cancer screening programs, guidelines for screening frequency and age, and the effectiveness of mammography in reducing breast cancer mortality. Overall, this Wikipedia page serves as a valuable resource for anyone seeking to understand the various aspects of mammography and its significance in breast cancer detection.

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