Have you had your mammogram yet?

Annual medical checkups especially to screen for cancer are very important in enabling us to take charge of our health. The check-ups also the disease is managed better should it be detected early.

One such recommended annual test for women is a screening mammogram. Here is what every woman should know about breast screening.

What is screening?

This is a test done to assess for indicators of a certain disease in the population when there are no signs or symptoms of the disease, that if found would then need confirmation.

For example, a pap smear is done for cervical cancer screening.

What is the recommended screening tool for breast cancer?

Mammography is the worldwide gold standard screening tool for the detection of early breast cancer and has been shown to result in a 40 percent reduction in death rates. It is done in women without symptoms (screening mammogram) and also in those with symptoms (diagnostic mammogram).

What is a mammogram?

It is an X-ray of the breasts that involves taking two-dimensional images of the breasts in two views. There are different types of mammogram machines, with digital mammograms providing the best image quality.

What is digital breast tomosynthesis (DBT)?

This is additional technology found only in digital mammography that allows for three-dimensional evaluation of the breasts. It allows for evaluation of the breast in thin slices resulting in increased detection of early breast cancer and reducing the number of patients that have to be recalled for additional breast imaging.

When should I start having a screening mammogram and how often should I do it?

From the age of 40 to 55 years and every two years from 56 to 74 years. If you are under the age of 40 years, you may have a breast ultrasound done. The mammogram can be normal and breast cancer develops thereafter, hence it is recommended to get screened regularly based on your age.

How do I go about getting a mammogram done?

You can walk into the radiology department and request to have it done, upon which you will be provided with a questionnaire to fill out and your mammogram will then be performed.

You may also call the Radiology Department Reception Desk to make a booking which is usually the norm during the cancer awareness months owing to the high volume of requests that hospitals receive at this time. You can also ask your doctor to request the test for you.

How should I prepare for the mammogram?

It is recommended that you wear a two-piece outfit as you would need to remove the upper body clothing to get the mammogram done. Additionally, avoid applying lotions, deodorant, or talc powder as this can interfere with the images.

If you have already applied any of these, kindly inform the technologist who will then provide you with wipes to clean. If possible it is better to perform the mammogram during the second week of your menstrual cycle when the breasts are less likely to be sore due to hormonal changes.

How long does it take to get a mammogram done?

It takes about 15 minutes.

What should I expect during the mammogram?

You will have a female technologist perform the mammogram. She will place the breasts between two paddles and apply compression before acquiring the images in two views. The compression is applied for only a few seconds and will be automatically released immediately after the images are acquired.

Can I have a screening mammogram if I am pregnant or breast-feeding?

Yes, you may have screening mammography. However, for pregnant patients, they will require lead shielding to be applied over the abdomen and pelvis to minimise radiation exposure to the foetus.

Will I need additional tests after the mammogram?

It will depend on what is seen on the screening mammogram. If your breasts are dense or an abnormality is detected, then further evaluation using breast ultrasound would be requested. The mammogram tests are reported by a radiologist with specialised training in breast imaging.

What does it mean to have dense/lumpy breasts?

Dense breasts mean that you have more glandular tissue than fat in the breasts. The images look more white which makes it difficult to pick up masses on mammography since they also appear white.

If I have dense breasts, at what age should I do a mammogram?

You should follow the same imaging guidelines as other average-risk patients and start screening at the age of 40 years. You however have to combine your mammogram with breast ultrasound imaging to assess for any small masses that may have been obscured by the dense tissue.

Do I need to bring my previous mammograms?

Yes, you will be required to bring any prior breast imaging (mammogram and ultrasound) if it was done at an external facility. The previous images assist in assessing for interval changes which can be a sign of early breast cancer and also confirms if a finding has been stable and does not require further evaluation.

If the external images are in CD format, we can upload them onto our electronic records (PACS system) for future reference and you would not have to bring them again during your next visit.

If you have had your mammogram at our hospital, there is no need to bring the prior images as they would be stored on our PACS system.

What is a biopsy?

This is a procedure performed when a suspicious finding is found on diagnostic imaging. A small tissue sample is obtained from the suspicious finding and sent to the laboratory to obtain a final diagnosis.

The procedure is performed under local anaesthesia and under image guidance to ensure accurate sampling of the area of interest.

What should I do once I have the biopsy results?

You need to discuss the biopsy results with your doctor. You can also be seen by one of our consultant breast surgeons at the breast clinic.

Dr Ndumia is a consultant breast radiologist at Aga Khan University Hospital, Nairobi