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Lt Col Flemings
One of the most frequently used tests to diagnose breast diseases is a mammogram. There are two types of mammograms – screening mammograms and diagnostic mammograms. Major Spencer, will you tell us more about mammograms?

Maj Spencer
Of course, Dr. Flemings. A screening mammogram is an x-ray of the breast used to detect breast changes in women who have no signs or symptoms of breast cancer. Recommendations for when and how often to get screened vary widely, but most providers agree that early detection saves lives. Women should talk to their provider about when to start and how often to have a screening mammogram.

A screening mammogram usually involves two to three x-rays of each breast. Mammograms make it possible to detect many abnormalities or tumors that are too small to be detected during a breast exam.

If you have a questionable screening mammogram, or if a lump or other sign or symptom of breast cancer has been found, the provider may request a diagnostic mammogram. Diagnostic mammograms may also be used in special circumstances, for example, to view the breast tissue of a patient with breast implants. A diagnostic mammogram takes longer than a screening mammogram because it involves more x-rays in order to obtain views of the breast from several angles. The technician may magnify a suspicious area to produce a detailed picture that can help the provider make an accurate diagnosis.

The two main types of abnormalities providers look for on mammograms are masses and calcifications. Masses can be due to a cancer or a benign breast disease. The size, shape, and edges of the mass help providers determine whether it is likely to be a cancer. A mass that looks smooth and round and has a clear, defined edge is usually a cyst. A cancer is more likely to have a jagged outline and irregular shape.

Calcifications are tiny mineral deposits within the breast tissue that appear as small white spots on the films. Calcifications are divided into two types: macrocalcifications and microcalcifications.

Macrocalcifications are larger calcium deposits that are most likely changes in the breasts caused by things like aging of the breast arteries, past injuries, or inflammation. These deposits are associated with benign conditions and usually do not require a biopsy. Almost half of women over the age of 50 will show some macrocalcifications on their mammogram. One in ten women under the age of 50 will also show some macrocalcifications.

Microcalcifications are smaller deposits of calcium in the breast that may appear alone or in clusters. Microcalcifications are sometimes found in an area of rapidly dividing cells, which can be an indication of cancer. The shape and pattern of microcalcifications can help the provider determine the likelihood that a cancer might exist.

In some cases, a provider may suggest a follow-up mammogram in three to six months. In other cases, the microcalcifications may look more suspicious, and additional tests may be required.