Did you know that about 2.3 million women around the world were diagnosed with breast cancer in 2020? And 685,000 of them could not survive. In India, as well as the rest of the world, Breast cancer is the most common type of cancer observed in women. Moreover, data suggests it to be more common in metropolitan cities. Evidently, breast cancer is a disease that needs to be taken extremely seriously.

Early detection is especially the key to fighting this problem effectively. And when it comes to diagnosis, mammography is the best screening tool at present to detect breast cancer along with a sonomammogram and a doctor’s examination. However, there are two main types available these days – conventional and digital. In conventional mammography, films are used to store and read the mammograms. And in digital mammography, a computer is used to store and read the mammograms, which makes it easier to study the data by magnifying or enhancing the same and arrive at more accurate conclusions. Naturally, digital mammography has a distinctive edge over the conventional method.

In fact, since the year 2007, digital mammography has been the most recommended tool to screen for breast cancer. This method turned out to be a technological advancement over film screen mammography as it improved the efficacy and accuracy of diagnosis quite significantly. Statistical studies also indicate that digital mammography may be better in terms of being able to predict cancers.

Moreover, it has been found that 3D digital mammography works better for younger women who are in the under-50 age group. This way, the early detection of tumours or prediction of cancer risk becomes possible, which improves treatment outcomes too. Read on to know everything about digital mammography.

Why is digital mammography recommended?

When your physician recommends that you get a mammogram, they expect to derive certain findings and eliminate certain risks. When the mammogram is being read by the radiologist, they will be on the lookout for any abnormalities that may indicate a disease or injury. Typically, the radiologist looking at your digital mammography report will be watching for:

● Calcifications: If you see white spots on your digital mammography report, they could be little deposits of calcium that have built up over time. These deposits build within your breast tissues. These could be of two kinds:

o Macrocalcification: These are relatively large deposits in the breast tissue that may arise due to the ageing of arteries or inflammation. They could also be the result of some old injuries. In general, macrocalcification spots are not investigated further because they do not indicate a cancerous condition. In women who are older, that is, above 50, these macro-calcifications are quite a common phenomenon.

o Microcalcification: These are smaller white spots that can be spotted by digital mammography specialists to screen for breast cancer. While microcalcifications do not confirm cancerous growth, they are taken more seriously than macrocalcifications. Experienced digital mammography specialists study the shape and position of these spots and their proximity to tissue masses to measure the potential risk of cancer. In specific cases, depending on the pattern or appearance of the microcalcification spots, the physician may recommend a biopsy to identify if the growth is cancerous.

● Masses: Apart from calcifications, digital mammography also enables the identification of masses, which are areas of abnormal tissue in the breast. Typically, these masses, when examined by digital mammography specialists, show features that set them apart from normal breast tissue. While masses can be just fluid filled pockets or solid tumours, they can also be cancerous, which is when digital mammography screening helps in early identification and diagnosis.

● Distortions: A tricky one to spot, distortions can arise simply from the positioning of the breast in the digital mammography machine. Such distortions also arise from some previous injuries to the breast region or from previous procedures that were done. However, this is also a possible sign of cancer, so the digital mammography screening again helps in early detection and diagnosis.

● Asymmetry: When the digital mammography screening shows up white patches that are quite unlike the surrounding healthy breast tissue, the physician may suggest further tests to eliminate cancerous growth. There are various kinds of asymmetries that may be caused by different reasons.

● Density: Digital mammography is also a measure of breast density. This is relevant because the greater the density, the higher the risk of cancer. Breast density measures the glandular/fibrous tissue in the breast relative to the fatty tissue. Higher breast density is perfectly normal, but it does place one at a slightly elevated risk of cancer, which means that more frequent checks might be necessary.

If your doctor has asked you to get digital mammography done periodically, then the reports will usually be compared with previous ones. The radiologist will try to evaluate if any changes can be seen since the last time you had a mammogram done. Their study can show up any new developments or further changes in an existing mass or spot that was evident in previous reports.

What is full field digital mammography?

Before we get into what a full field digital mammography or FFDM is, let’s understand what a mammogram is. Simply put, a mammogram is nothing but a low dose X-ray that is interpreted by radiologists to identify any changes in the tissue in the breast region. The X- ray lets the radiologist look inside the breast. The mammography X-ray is called mammogram.

Digital mammography is also called full field digital mammography, and this is a procedure where instead of the traditional X- ray film, you have solid state detectors transposing the X- rays into electrical signals. These signals recreate images of the breast, which can be further studied on a computer screen. You can also get an image output on special film. Later, Computer Aided Design or CAD can ease the analysis of breast tissues more accurately and efficiently using the digital mammography output. The CAD system clearly outlines areas of concern for the physician to further study, thus reducing the human error factor.

3D digital mammography

Also known as Tomosynthesis, 3D digital mammography is an advancement in digital mammography that gives 2D and 3D outputs. This kind of output makes it easier to spot anomalies that may be early cancers or have the potential to turn into cancer. In a 3D digital mammography, the images of the breast are given in 1-millimetre thick segments so the radiologist can study the entire breast in detail, missing nothing out.

How to prepare for your digital mammography appointment?

● Tender breasts may make digital mammography a more uncomfortable procedure than it has to be. Choose a time of the month when your breasts are not tender and book your appointment then. Usually, this is right after your periods.

● The radiologist will ask for previous mammograms to do a comparative analysis, so take these reports and images with you.

● Do not use any kind of cream, lotion, fragrance or even talc under your arms or over your breasts when you go for your appointment. Avoid deodorants and anti- perspirants too. These can distort the mammogram.

● You will be asked to remove any jewellery you are wearing above your waist, such as chains, so, if you can, leave them at home.

● You will be given a gown at the testing facility that you need to wear instead of the clothing that covers your upper half.

● The technician will ask you to position yourself before the digital mammography machine in such a way that your breasts can be placed on the given platform one at a time.

● A plastic plate that is fixed above is pressed down upon your breast to flatten it against the platform so the tissues are spread out and can be captured clearly by the digital mammography machine. This can cause discomfort or even pain. If it is too painful, tell the technician.

● The digital mammography machine moves from side to side to get images from all sides. To facilitate the imaging, you will be asked to hold your breath for a few moments and keep completely still.

● The process may be repeated until images have been taken from all directions and then the same is done for the other breast.

Typically, digital mammography takes around 20 minutes to complete. Inform the technician if you have breast implants or if you are breastfeeding. If you can’t stand still for more than a few minutes, do let the technician know beforehand so they can arrange for a cane or some other support for the duration.

Digital mammography cost in India

Digital mammography test prices can vary quite substantially in India depending on the location and the lab where you get it done. It is important for you to find a reputed lab that has good facilities and expert technicians, so that you can improve the accuracy of the imaging and reduce the risk of being called back for a second try.

Costs vary from city to city and it may range from Rs 3000 to Rs 8000 and upwards depending on where you live and which lab you use. There are options for single breast mammography as well, which will halve your digital mammography cost, but may not comprehensively rule out breast cancer risk.

It is a good idea to check with your physician about what you need and ask about reliable labs where the imaging can be done quickly and accurately with as little discomfort as possible. If you have medical insurance, check with the insurer beforehand if this procedure is covered and if they have specific labs allocated for it.

Statistics reveal that breast cancer is a major health concern in India, especially in metro cities. The National Cancer Registry Programme (NCRP) estimates that we may see 15.7 lakh cancer cases by the year 2025. The good news is that about a third of these cancers can be prevented by taking simple precautions. There are, however, causes of cancer that are not quite in your hands. The best thing is for you to periodically consult with your physician and follow their advice on getting digital mammography done on a regular basis, so that you can ensure early detection and receive treatment for good outcomes.