October is breast cancer awareness month, and we have done a Q&A with radiologist Susan Chick – who specialises in breast imaging.
Q: What is a mammogram, and why are mammograms so important?
A: A mammogram is an X-ray image of one’s breasts. Two images are taken of each breast under different compression directions. Mammograms are vitally important and remain the gold standard for screening for breast cancer worldwide, as they are the only form of imaging which can easily detect microcalcifications. These can indicate early breast cancer or preinvasive breast cancer (Carcinoma in situ). They can also detect asymmetry, architectural distortions, and mass lesions before they become palpable. This early detection results in a decreased mortality and morbidity in breast cancer.
Q: Tell us briefly about the mammogram procedure, to put women who are afraid at ease.
A: Mammograms use very low dose radiation (similar to what you would get on an overseas flight) and the compression is for mere seconds. The machines used today have automatic release, so war stories of being stuck in the machine… this can’t possibly happen in our current machines. Most of our patients can’t believe how “easy, quick and painless” the procedure is.
Q: What are the benefits of the 3D mammogram procedure? Is it safe?
A: 3D mammography uses tomosynthesis (multiple low dose images are taken and stacked together to make a 3D image). Our computers can then reconstruct a 2D image from the data. Our 3D imaging hence has an even lower radiation dose than the traditional 2D images from the past. The benefit of 3D imaging is enormous. I wouldn’t want to work without it! You can scroll through the breast tissue and see the difference between overlapping breast structures and something that shouldn’t be there.
Q: Why may an ultrasound also be needed after your mammogram?
A: In patients with dense breast tissue (usually younger patients, but this can also be genetic), the mammogram is less sensitive (breast glandular tissue is white on a mammogram and so is a cancer, so it can “hide”.) In these cases, an ultrasound is used to double check for cancer. It can also be used to assess something seen on the mammogram like a round density and tell us if it’s a cyst (which we can leave alone) or something solid which we may need to biopsy.
Q: Can you give us a step-by-step guide on how to do a breast self-exam?
A: Step 1: Stand in front of a mirror, look carefully for changes to any part of your breasts – like the shape, size or any discharge.
Step 2: Place arm behind head. Using the opposite hand, gently move your fingertips in a circular motion. Feel for lumps, thickening or changes. Be thorough. Also check armpits. Repeat for the other side.
Step 3: Feel your breasts while lying down using your right hand to feel the left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads (not your fingertips) of your hand, keeping the fingers flat and together in a circular motion.