October 14, 2021Breast health

Mammography: for whom, for what and how?

After breast observation, you notice a lump, redness or ulceration of the nipple. You know that you need to call your family doctor and that he or she may ask you to have a mammogram. Perhaps you also received your letter from the Quebec Breast Cancer Screening Program (PQDCS).

That’s when you start to feel anxious. You imagine your breasts being crushed like a sheet of paper by a huge metal machine!

Don’t panic! Mammography is not so scary and it is even very useful.

Why is a mammogram done?

There are two types of mammograms. The screening mammogram and the diagnostic mammogram.

The screening mammogram is the one that the Quebec Breast Cancer Screening Program (PQDCS) invites you to have every two years, from the age of 50 until 69. Why this age group specifically? Simply because women in this age group have the highest rate of breast cancer. By offering screening mammograms every two years, the presence of the disease can be detected before the first symptoms appear for early management, which can avoid more aggressive treatments. Studies have shown that this program actually saves lives through early detection of breast cancer before the first signs.

The Diagnostic mammography is done at the request of the family physician and on the basis of breast symptoms. It is not possible to have a mammogram on demand. Instead, your family doctor will do a clinical examination and ask you some questions about your risk factors to decide whether or not you should have a mammogram.

What is a mammogram?

First of all, you should know that only a medical imaging technologist certified by the Ordre des technologues en imagerie médicale, en radio-oncologie et en électrophysiologie médicale du Québec (OTIMROEPMQ), can perform this examination. Note that actually, no man performs mammography in Quebec and that is why you will always be greeted by a woman for your mammogram!

Mammography takes images of the inside of the breasts, from different angles, using low doses of x-rays. It is the most effective test for early detection of breast cancer, even at a very early stage and without any symptoms.

There is no age limit to have a mammogram, even for men! Remember that 1% of breast cancer cases affect men . However, all women between the ages of 50 and 69 are systematically invited to have a screening mammogram every two years. For all other women, a diagnostic mammogram is performed at the request of the physician and on the basis of symptoms. A woman between the ages of 50 and 69 can also have a diagnostic mammogram if she detects a symptom that worries her and that her doctor deems necessary to investigate.

How do you prepare for a mammogram?

There is no special preparation, but there are a few tips to make it as smooth as possible :

  • Avoid dresses and prioritize clothes that can be removed only from the top.
  • Before the test, it is very important not to apply deodorant, antiperspirant, cream, powder and perfume to the breasts and underarms.
  • Avoid necklaces or any other bulky jewelry.
  • If you tend to have sensitive breasts, you can ask to have the test seven to ten days after your period.

How does a mammogram work?

A mammogram is not as bad as it sounds. It’s actually a very simple exam that takes about 15 to 20 minutes.

First, a technologist will greet you and ask you to remove your top so you are shirtless. She will position you on the machine and you will remain in a standing position throughout the test.

The breasts will then be compressed successively between two compression trays. A minimum of two pictures will be taken from two different angles, horizontal and oblique (from the side) in order to locate any possible abnormalities in the breasts.

The basic examination consists of 2 images per breast. It is always important to take 2 orthogonal views in order to properly locate and situate any possible abnormalities in the breasts. And that’s all!

There is no risk of injury or damage associated with this examination, except for a slight discomfort during the compression of the breasts. But in the end, it’s 20 minutes that can save lives.

How are the results explained?

Radiologists refer to the BI-RADS (Breast Imaging-Reporting and Data System) classification to define mammography results and suggested next steps.

The classification is presented as follows:

  • BIRADS 0 : Waiting classification, when further investigations are needed
  • BIRADS 1 : Normal mammogram
  • BIRADS 2 : There are benign (i.e., not serious) abnormalities that do not require surveillance or further investigation
  • BIRADS 3 : There is a probably benign abnormality for which short-term surveillance (3 or 6 months) is advised
  • BIRADS 4 : There is an undetermined or suspicious abnormality
  • BIRADS 5 : There is an abnormality suggestive of cancer

Depending on the results of the imaging, the physician will recommend either doing nothing, close follow-up, or further investigation such as a breast ultrasound. When the imaging is classified as BI-RADS 4 or 5, a biopsy will be ordered. The biopsy is the only test that can confirm the definitive diagnosis of breast cancer.

The result of the mammogram also includes a classification of breast density . It is classified in 4 categories, from A to D:

  • A : Breasts almost entirely fatty
  • B : Breasts composed of scattered areas of fibroglandular density
  • C : Heterogeneously dense breasts, which may mask small masses
  • D : Extremely dense breasts, reducing the sensitivity of mammography

The more fatty the tissue, the better the image quality will be to see if there is a mass or lesions. On the other hand, tissue that is glandular (which secretes breast milk) or fibrous could be detrimental to image quality. When the tissue is more fibrous than fatty, it will be denser depending on the proportion of tissue.

If the breasts are too dense, this may decrease the quality of the image and prevent a mass from being seen. The doctor may then recommend further tests, such as a breast ultrasound.

Here are examples of low and high density breasts: (Photo credit : OTIMROEPMQ))

In the end, the benefits of mammography outweigh the discomfort it may cause. If you have symptoms that concern you, don’t delay in talking to your doctor and investigating, even if the exam and its results frighten you. Most of the abnormalities detected turn out to be benign, but if it is malignant, it is better too soon than too late.

You have questions or doubts? Contact us, one of our specialists will answer you confidentially and will be able to guide you.

We would like to thank OTIMROEPMQ for helping write this article.

Pink ribbon. « Breast Cancer Screening and Risk Factors | Inform Me | Pink Ribbon ». Consulté le 6 octobre 2021. https://rubanrose.org/en/inform-me/all-about-cancer/screening-and-risk-factors/.
« Breast Cancer Statistics | Inform me| Pink Ribbon | ». Consulté le 6 octobre 2021. https://rubanrose.org/en/inform-me/all-about-cancer/breast-cancer-statistics/.
Pink ribbon. « Mammography | Diagnosis & Staging | Inform Me | Pink Ribbon ». Consulté le 6 octobre 2021. https://rubanrose.org/en/inform-me/screening-and-diagnosis/mammography/.
Sickles, EA, D’Orsi CJ, Bassett LW, et al. ACR BI-RADS® Mammography. In: ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology; 2013.

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