Since breasts are relatively radiodense in younger women mammography is not usually performed in the women younger than 35 years.
However, all patients with a breast cancer, regardless of age, should have mammography before the surgery because this procedure is extremely valuable in the assessment of the extent of the disease. The modern digital technologies have offered new opportunities in image enhancement, manipulation transmission and storage.
Reading a mammogram may be quite challenging for a radiologist, because of the variations in the way the breast structures look on a mammogram. Moreover, some breast cancers may determine almost unnoticeable modifications in the mammogram. If a woman has had one or more mammograms in the past, it is extremely important for the radiologist to have either the x-ray films or digital images in order to compare them with the new images . By comparing the pictures even the small changes can be found and cancer will be detected as early as possible. Because getting the older pictures may be difficult, it would best if the woman found a health care facility she is comfortable with and plan to get her regular mammograms in that facility every year so her other pictures will be easily accessible.
In some medical facilities, the mammogram report includes a Breast Imaging Reporting and Data System classification, reflecting the radiologist’s overall impression of the mammogram. This scale goes from one to five, the higher the numbers are a higher possibility of breast cancer is indicated.
The mammogram report will mention any abnormality in breast structure. First breast symmetry, its general density and the distribution of the glandular tissue will be observed. Next densities, masses, calcifications ,structural distortions and associated findings will be sought. In case that a mass is found, its shape, density and borders will be analyzed. Malignant lesions usually have irregular, spiculated margins and have a strong tendency to have a greater density than the normal breast tissue. In benign lesions such as lipomas , oil cysts and galactoceles there may be observed areas of very low density.
The calcifications associated with malignancy are usually smaller then the benign calcifications; they have less than 0.5 mm in diameter, and for seeing them well a magnifying glass is frequently usefull. They have a strong tendency tend to have heterogeneous shape or a fine granular, a pleiomorphyc shape or branching aspect. The distribution of any calcification should be specified reffering to them such as grouped, diffuse or linear and, depending on the affected area regional or segmental.
The associated findings should also be studied and mentioned in the report. These associated findings are represented by nipple retraction, skin retraction, skin thickening ( focal or diffuse), skin lesions, axillary adenopathy and trabecular thickening.