Mammography is an X-ray examination of the breasts that can detect cysts or tumors unpalpable during a physical examination. A biopsy of an area of suspicion may be needed to confirm malignancy. Mammography may follow screening procedures, such as ultrasonography or thermography.
There are two uses of mammogram (screening and diagnostic). A screening mammogram is used to screen for unsuspected breast cancer in women with no signs or symptoms. It usually involves two x-ray images of each breast to detect tumors or small calcifications within the breast tissue. While a diagnostic mammogram is used to diagnose breast cancer in a patient with a suspicious lump or other signs such as breast pain, nipple discharge, thickening of breast skin, or sudden change in breast shape or size. It is also utilized to examine breast abnormalities found during a screening mammogram and in such cases for patients with breast implants since it provides a more detailed x-ray of the breast than using a screening mammogram.
Although mammography can detect 90-95 % of breast cancers, this test produces many false-positive results. The American College of Radiologist, American Cancer Society, and the National Cancer Institue suggests that women should begin screening mammogram at age 40 annually for women with average risk while higher-risk women should start earlier and may benefit from supplemental screening modalities.
Nurses have important responsibilities in assisting patients during mammography by providing information about breast disease and breast examination, providing emotional support, and coordinating with other healthcare specialists for further diagnostic and laboratory test.
This study guide can help nurses understand their tasks and responsibilities during mammography.
The following are the different types and advances in mammography:
- Full-field digital mammography (FFDM). Also known as digital mammography, is performed in the same manner as conventional screen-film mammography (SFM). The difference is that FFDM images are generated by digital signals rather than from the traditional x-ray film as with (SFM). The images of the breast are examined on a computer monitor or printed on a special film.
- Computer-aided detection (CAD) system. Uses software to search images from SFM or FFDM for abnormal areas of breast tissue evidenced by denseness, abnormal size, or calcifications that may indicate the presence of cancer. Abnormal areas are “marked” for further review by a radiologist.
- Three-dimensional (3-D) breast imaging or breast tomosynthesis. Uses equipment that rotates in an arc over the breast instead of the stationary system used in conventional SFM. The 3-D equipment produces thin slices of the breast from a great number of angles that generate clearer images, especially of dense breast tissue.
Mammography is generally indicated to:
- Differentiate between benign breast disease and breast cancer
- Investigate breast pain, nipple retraction, nipple discharge
- Evaluate palpable and unpalpable breast masses
- Screen for malignant breast tumors
- Monitor effectiveness of breast radiation therapy
- Evaluate opposite breast following mastectomy
These are the contraindications for the procedure:
- Pregnant women, unless the potential benefits of a procedure using radiation outweigh the risks of maternal and fetal damage
- Patients younger than age 25 or patients with very dense breast tissue
These are factors or conditions that may alter the outcome of the study
- Application of substances such as antiperspirants (deodorants), talcum powder, lotions or creams to the underarm and breast area that may interfere with the accuracy of the results
- Failure to remove metallic objects and clothing
- Previous breast surgery, active lactation, and glandular breast (common in women age 30 below), which can affect the quality of the images
- Breast implants which may prevent full visualization of the breast
- Inability to cooperate or remain still during the procedure due to age, health condition, or mental status
A mammography is performed on an outpatient basis and the step-by-step procedure is as follows:
- Prepare the patient.
The patient stands and is asked to rest one breast on a table above an X-ray cassette.
- Technician places breast onto compression plate.
The compression plate is placed on the breast and the patient is told to hold her breath. A radiograph is taken of the craniocaudal view. The machine is rotated, the breast is compressed again, and a radiograph of the lateral view is taken.
- Repeat procedure on other breast.
The procedure is repeated on the opposite breast.
- Review if films are reliable
After the films are developed, they are checked to make sure they’re reliable.
The following are the nursing interventions and nursing care considerations for a patient indicated for mammography:
Before the procedure
The following are the nursing interventions prior to mammography:
- Explain the procedure and what to expect after. Tell the patient who will perform the test and where it will take place. Inform the patient that although the test takes only about 15 minutes to perform, she may be asked to wait while the films are checked to make sure they are readable. Advise her that there’s a high rate of false-positive results.
- Allow the patient to express concerns and fears about the procedure. Assess the patient’s understanding of the procedure, answer any questions, and correct any misconceptions.
- Remove interfering factors. Instruct the patient to avoid using underarm deodorant or powder on the day of the examination.
- Schedule a senior technologist on a patient with breast implants. If the patient has breast implants, notify him/her to inform the staff when he/she schedules the mammogram so that a technologist familiar with imaging implants is on duty.
- Prepare the patient. Just before the test, give the patient a gown to wear that opens in the front, and ask her to remove all jewelry and clothing above the waist.
During the procedure
The following are the nursing interventions during mammography:
- Assist with patient positioning. Place patient in a standing or sitting position in front of the X-ray machine, which is adjusted to the level of the breast. Place the patient’s arms out of the range of the area to be imaged.
- Tell the patient that some discomfort may be felt. Pain/discomfort may be caused by the pressure required to compress the breast tissue against the X-ray plate.
- Advise the patient to cooperate completely and follow directions. Instruct patient to remain still throughout the procedure since movement produces unreliable results. Ask the patient to hold breath while the x-ray films are being taken.
After the procedure
The nurse should note of the following nursing interventions after:
- Provide information about the availability of the results. Inform the patient a report of the findings will be given to the requesting physician, who will discuss the results with the patient.
- Reinforce the information given by the patient’s HCP. Assist the patient in arranging an additional test, therapy, or referral to another HCP if an abnormality is found.
Normal findings in mammography will show:
- Normal breast tissue, with an absence of cysts, tumors, or calcification
Abnormalities in mammography will reveal:
- Breast abscesses or cysts
- Breast tumors
- Breast calcifications
- Hematoma resulting from trauma
- Mastitis (inflammation of breast tissue)
- Soft tissue masses
- Vascular calcification (small calcium deposit within breast tissue)
Images related to mammography:
Additional resources and references for mammography:
- Anne M. Van Leeuwen, Mickey Lynn Bladh. Laboratory & Diagnostic Tests with Nursing Implications: Davis’s
- Bird, R. E., Wallace, T. W., & Yankaskas, B. C. (1992). Analysis of cancers missed at screening mammography. Radiology, 184(3), 613-617.
- Kerlikowske, K., Grady, D., Rubin, S. M., Sandrock, C., & Ernster, V. L. (1995). Efficacy of screening mammography: a meta-analysis. Jama, 273(2), 149-154.
- Nyström, L., Wall, S., Rutqvist, L. E., Lindgren, A., Lindqvist, M., Ryden, S., … & Tabar, L. (1993). Breast cancer screening with mammography: overview of Swedish randomised trials. The Lancet, 341(8851), 973-978.
- Suzanne C. Smeltzer. Brunner & Suddarth’s Handbook of Laboratory and Diagnostic Tests: Lippincott Williams & Wilkins