Mammography for Breast Cancer Screening : Types, Procedure & BIRADS Explained

Abstract

Breast cancer remains one of the leading causes of cancer related deaths among women worldwide. It is a malignant growth that develops from the cells of the breast most commonly originating in the lining of the milk ducts (ductal carcinoma) or the lobules (lobular carcinoma). It is one of the most prevalent cancers among women worldwide and can vary in aggressiveness, ranging from slow growing tumors to highly invasive forms that spread to other parts of the body. Mammography enables clinicians to visualize internal breast structures, detect microcalcifications, masses which may indicate malignancy or benign conditions. It bridges the gap between clinical examination and histopathological confirmation, providing a non-invasive, reliable screening method. So let’s discuss this in detail.

Introduction

Mammography is a specialized medical imaging technique that uses low dose X-rays to examine the human breast. It is primarily utilized for the early detection of breast cancer and other breast abnormalities. Over the decades, mammography has become the gold standard for breast cancer screening due to its ability to identify malignancies before they become palpable or symptomatic.

Types Of Mammography

There are mainly two types of mammography:

• 2D mammography – It captures images of each breast from two different angles, usually from top to bottom and from side to side, providing a flat, two dimensional view of the breast tissue.
• 3D mammography – It is a more advanced technique where each breast is compressed once while the machine rotates in an arc to take multiple X-ray images. These images are then reconstructed by a computer into thin slices giving a three dimensional view that allows healthcare providers to examine the breast tissue layer by layer.

Clinical Types Of Mammography

There are several types of mammography each suited for specific clinical situations.

• Screening mammography – It is performed on women without any symptoms to identify early stage cancers. Typically, two standard views of each breast are taken, allowing tumors to be detected before they become palpable, which significantly improves early diagnosis and treatment outcomes.
• Diagnostic mammography – It is employed when there are symptoms such as lumps, nipple discharge, or abnormalities found on screening mammograms. This type involves more detailed imaging, including additional angles and magnified views, to carefully examine suspicious areas. It is particularly useful for confirming or ruling out malignancy and planning further procedures like biopsies.
• Digital mammography or full field digital mammography (FFDM) – In this X-ray images are captured electronically rather than on film. These digital images can be enhanced, magnified, and stored electronically for easy sharing and long-term comparison. Digital mammography is especially helpful for women with dense breast tissue, as it improves image clarity and diagnostic accuracy.
• Digital breast tomosynthesis (DBT) or 3D mammography – In this multiple X-ray slices are acquired from different angles and reconstructed into a three dimensional image. This allows radiologists to examine the breast layer by layer, improving detection of small tumors and reducing false positive results, particularly in women with dense breasts.
• Contrast enhanced mammography (CEM) – It is another specialized form that uses iodine based contrast agents to highlight areas with increased blood flow, which may indicate tumor growth. This method is useful when MRI is not feasible or contraindicated and can reveal tumors that might be missed on standard mammograms.
• Ultrasound guided mammography – This refers to the use of real time ultrasound imaging to guide procedures like biopsies or interventions following initial mammographic findings, enhancing precision for suspicious breast lesions. This technique employs high frequency sound waves to visualize masses, cysts or distortions not fully characterized by mammography alone, allowing needle placement without ionizing radiation.

Procedure

Mammography is a simple, non-invasive procedure that usually takes about 20–30 minutes. The patient is first asked to remove clothing and jewelry from the waist up and wear a hospital gown. During the imaging, each breast is placed on a flat X-ray plate, and a compression paddle gently but firmly flattens the breast to spread the tissue evenly, reduce motion and improve image clarity. The entire procedure is usually quick, though the compression may cause mild discomfort or pressure. After the images are taken, a radiologist analyzes them to detect any abnormalities and the results are shared with the patient and referring physician.

Indications For Mammography

• Routine screening in asymptomatic women
• Evaluation of breast lumps or thickening
• Nipple discharge or inversion
• Breast pain or skin changes
• Follow up of previous abnormal findings
• Surveillance in women with a personal or family history of breast cancer

For average risk women, routine screening mammography is generally recommended to begin between 40 and 50 years of age. For high risk women such as those with a strong family history of breast cancer, known genetic mutations, previous chest radiation therapy or a personal history of breast cancer, screening may begin earlier, often between 25 and 35 years of age.

BIRADS Classification System

The Breast Imaging Reporting and Data System (BIRADS) standardizes mammography reporting and helps guide clinical management:

• BIRADS 0 – Incomplete, additional imaging required
• BIRADS 1 – Negative
• BIRADS 2 – Benign findings
• BIRADS 3 – Probably benign, short term follow up advised
• BIRADS 4 – Suspicious abnormality, biopsy recommended
• BIRADS 5 – Highly suggestive of malignancy
• BIRADS 6 – Known biopsy proven malignancy

Conclusion

Mammography remains a cornerstone of breast health care and the most effective screening tool for the early detection of breast cancer. By identifying subtle abnormalities such as microcalcifications, masses and architectural distortions before clinical symptoms appear, mammography enables timely diagnosis and significantly improves treatment outcomes and survival rates. Regular screening based on age and individual risk factors along with increased awareness and adherence to established guidelines can greatly strengthen early detection efforts. Although mammography has certain limitations particularly in dense breast tissue, ongoing advancements such as digital imaging and three dimensional tomosynthesis have enhanced its diagnostic accuracy. Overall, mammography continues to play a vital role in safeguarding women’s health by emphasizing preventive screening, early intervention and informed decision making in the fight against breast cancer.

Frequently Asked Questions (FAQs)

1. Is Mammography Painful?

Mammography may cause temporary discomfort due to breast compression, but the procedure is brief and generally well tolerated.

2. Is Mammography Safe?

Yes, mammography uses a very low dose of radiation. The benefits of early cancer detection far outweigh the minimal radiation risk.

3. Can Mammography Detect All Breast Cancers?

While mammography is highly effective, it may miss some cancers, especially in women with dense breast tissue.

4. Can Women With Breast Implants Undergo Mammography?

Yes, women with breast implants can safely have mammograms. Special imaging techniques are used to ensure adequate visualization of breast tissue.

5. Why Is Mammography Considered The Gold Standard For Breast Screening?

It can detect breast cancer at an early stage, often before symptoms appear, improving treatment success and survival rates.

6. Is Mammography Suitable For Women With Dense Breasts?

Yes, although dense tissue may obscure findings; additional imaging like ultrasound or 3D mammography may be advised.

7. Is Mammography Recommended During Pregnancy?

Mammography is generally avoided during pregnancy unless absolutely necessary, due to radiation exposure.