The Marvellous Mammogram
Only a hundred years ago first attempts were made to use x-ray to supplement clinical examination to diagnose early breast cancer. The process was started by a surgeon named Albert Saloman who in 1913 reported his investigations of using x-rays on mastectomy specimens to demonstrate what are features of cancer and it’s spread. Initial attempts were disappointing and in 1927 Otto Kleinschmidt mentioned of it being tried on patients in a chapter about the breast, published in German where he credited his teacher Erwin Payr for suggesting the use of it. In 1930 Stafford Warren reported a series of 119 patients 58 of them cancer with an amazing accuracy of 93% but recognised it was a difficult test to interpret. Slowly over time expertise grew in detecting smaller cancers and 1948 Gershon-Cohen was reporting the ability to detect impalpable cancers. 1960 Egan standardised the technique which was reliable, reproducible and transferable to other practices. Use of mammography to screen for cancer was reported in 1973, it was a randomised controlled trial run by Health insurance plan of New York (Hip study) which showed a statistically significant reduction of cancer deaths in the screening group. This is considered a landmark trial.
Since then mammograms had been a valuable tool in diagnosis, screening and surveillance of breast cancer and has saved countless lives. There are very few reasons which prevents anyone from having it, we have to be careful in women with breast implants and cardiac devices like pacemaker and yes even men can have it. The radiation involved is small, a 2016 study showed 0.00016% will die of radiation induced breast cancer due to annual screening which far less than the number of lives it will save. We have to accept some cancers do not show up on mammogram and that’s why complementing with triple assessment and other modalities like ultrasound is important. Sometimes biopsies are needed for indeterminate changes which turn out to be harmless but the process can cause anxiety. Over time expertise in interpreting mammograms have improved significantly and so has the technology which in the age of digital imaging produces very clear pictures helping the clinician to diagnose at a very early stage. This early diagnosis remains the key factor in achieving better outcomes and reducing the need for some treatments like chemotherapy.
Currently it is used for assessing patients with symptoms in women above the age of 40 because younger women have dense breasts which looks like white sheet of paper because glandular tissue obscures subtle changes makes interpreting difficult reducing its value. It’s also used used as a screening tool every year for women with family history of breast cancer from the age of 40 and population based screening every 3 years from the age of 50. Patients diagnosed with cancer gets yearly follow up surveillance mammogram annually for 5 years.
The mammogram involves compressing the breast from two views, top down and at an angle from the side; this may prove painful but it’s over quickly. Occasionally further views are required if the field is not fully covered or extra compression is needed to ease out harmless density from glandular tissue. The ability to biopsy any area of concern using imaging under local anesthesia has increased the power of accurately diagnosing cancer and reducing the need of unnecessary surgery.
Let’s celebrate the centenary of this wonderful diagnostic tool which keeps on saving lives and an invaluable asset in our fight against breast cancer.
The attached picture is of an early mammogram machine and this highlights how technology has improved patient care. #breastcancer , #breastcancerawareness , #cancercure , #cancerspecialist , #breastcancerhelp
#breastcancer , #breastcancerawareness , #cancercure , #cancerspecialist , #breastcancerhelp
