DIAGNOSIS

MAMMOGRAPHY

FRED PEZZULLI, MD

This section is a guide to the mammography findings that a physician caring for women will most commonly encounter. It familiarizes clinicians with the types of mammograms that they may be reviewing during an office consultation.

Types of Mammography

Mammography is either screening or diagnostic.

SCREENING MAMMOGRAPHY

Asymptomatic women undergo screening mammography with the goal of detecting a carcinoma early. The American College of Radiology and the U.S. National Cancer Institute recommend that women have a baseline mammogram at age 35–40, and annual mammograms thereafter. Family history and other risk factors (early menarche, nulliparity, and late parity) are used to modify the recommendation. For example, if a woman's mother had breast carcinoma at age 39, the recommendation is that screening begin five years earlier – that is, no later than age 34.

DIAGNOSTIC MAMMOGRAPHY

Diagnostic mammography evaluates a specific clinical or mammographic abnormality. For example, a clinically palpable mass should be evaluated using routine views, plus additional views of the area of question (spot-magnification views, for instance). If the mammograms fail to reveal an abnormality, then the area should be evaluated using ultrasonography. An abnormality detected during routine screening mammography should be further evaluated by additional views. Those views could include spot compressions, rotation views, and exaggerated-angle views, among others.