Breast imaging

In medicine, breast imaging is the representation or reproduction of a breast's form. There are various methods of breast imaging.Mammography is the process of using low-energy X-rays (usually around 30 kVp) to examine the human breast, which is used as a diagnostic and screening tool. The goal of mammography is the early detection of breast cancer, typically through detection of characteristic masses and/or microcalcifications. For the average woman, the U.S. Preventive Services Task Force recommended (2009) mammography every two years in women between the ages of 50 and 74. The American College of Radiology and American Cancer Society recommend yearly screening mammography starting at age 40. The Canadian Task Force on Preventive Health Care (2012) and the European Cancer Observatory (2011) recommends mammography every 2–3 years between 50 and 69. These task force reports point out that in addition to unnecessary surgery and anxiety, the risks of more frequent mammograms include a small but significant increase in breast cancer induced by radiation. Additionally, mammograms should not be done with any increased frequency in people undergoing breast surgery, including breast enlargement, mastopexy, and breast reducation. The Cochrane Collaboration (2013) concluded that the trials with adequate randomisation did not find an effect of mammography screening on total cancer mortality, including breast cancer, after 10 years. The authors of systematic review write: 'If we assume that screening reduces breast cancer mortality by 15% and that overdiagnosis and overtreatment is at 30%, it means that for every 2000 women invited for screening throughout 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress including anxiety and uncertainty for years because of false positive findings.' The authors conclude that the time has come to re-assess whether universal mammography screening should be recommended for any age group. They thus state that universal screening may not be reasonable. The Nordic Cochrane Collection, which in 2012 reviews updated research to state that advances in diagnosis and treatment make mammography screening less effective today. They state screening is “no longer effective.” They conclude that “it therefore no longer seems reasonable to attend” for breast cancer screening at any age, and warn of misleading information on the internet.Breast MRI, an alternative to mammography, has shown substantial progress in the detection of breast cancer. The available literature suggests that the sensitivity of contrast-enhanced breast MRI in detection of cancer is considerably higher than that of either radiographic mammography or ultrasound and is generally reported to be in excess of 94%.Breast ultrasound is the use of medical ultrasonography to perform imaging of the breast. It can be considered either a diagnostic or a screening procedure. It may be used either with or without a mammogram.Scintimammography is a type of breast imaging test that is used to detect cancer cells in the breasts of some women who have had abnormal mammograms, or for those who have dense breast tissue, post-operative scar tissue or breast implants, but is not used for screening or in place of a mammogram. Rather, it is used when the detection of breast abnormalities is not possible or not reliable on the basis of mammography and ultrasound. In the scintimammography procedure, a woman receives an injection of a small amount of a radioactive substance called technetium 99 sestamibi. This substance is preferably taken up by cancerous tissues, making them show brightly on the images.