MammographyEdit
Mammography is the leading imaging test used to detect breast cancer at an early, more treatable stage. It uses low-dose X-ray technology to create images of the breast tissue, typically examining each breast from two angles. In routine practice, women scheduled for screening receive two views per breast, usually craniocaudal (CC) and mediolateral oblique (MLO). The goal is to identify cancers before they become palpable, increasing the chance of successful treatment with less aggressive procedures. For more on the imaging modality itself, see X-ray and radiography as foundational concepts, and digital breast tomosynthesis for newer, three-dimensional approaches.
While many health systems rely on population-wide screening programs, the benefits of mammography come with tradeoffs. Proponents emphasize mortality reduction and the opportunity for earlier intervention, while critics point to harms such as false positives, unnecessary biopsies, anxiety, and the potential for overdiagnosis. The net effect varies by age, risk profile, and how screening is organized and delivered. See screening and overdiagnosis (medicine) for discussions of benefits and harms, and radiation protection guidelines for information on cumulative exposure.
In the policy realm, guidelines reflect competing priorities: maximizing early detection, preserving access, and limiting unnecessary procedures or costs. Different countries and professional bodies have endorsed varying starting ages and screening intervals, with some favoring more personalized, risk-based approaches over one-size-fits-all mandates. The debate often centers on balancing population health gains with individual burden, cost considerations, and the prudence of medical intervention when the evidence is nuanced. See health policy and preventive medicine for related context.
Techniques and practice
- Two-view screening: CC and MLO views per breast are standard, though supplemental views or targeted imaging may be used as needed. See mammogram and breast imaging for related terms.
- Digital approaches: Digital mammography improves image storage and retrieval, and digital breast tomosynthesis (3D mammography) can reduce the rate of callbacks and improve cancer detection in some groups. See digital mammography and digital breast tomosynthesis.
- Diagnostic follow-up: If something suspicious is found or if symptoms develop, additional imaging or biopsy is common. See biopsy, ultrasound in breast imaging, and MRI (medical imaging) as a supplemental tool.
Benefits, risks, and evidence
- Mortality impact: Large studies indicate a reduction in breast cancer mortality in screened populations, particularly among certain age groups. The magnitude of benefit depends on age, tumor biology, and screening quality. See breast cancer and population-based screening for broader context.
- Harms: False positives lead to additional testing and emotional distress; false negatives can occur; cumulative radiation exposure is a consideration, though the dose per screening is small. Overdiagnosis—detecting cancers that would not have become clinically significant in a person’s lifetime—remains a point of contention among researchers and policymakers. See false positive and overdiagnosis (medicine) for definitions and debates.
- Risk-based thinking: Some advocates argue for risk-stratified screening that accounts for family history, prior results, and other factors, rather than universal, age-based protocols alone. See risk assessment and health economics for related concepts.
Technology, innovation, and practice evolution
- Imaging quality and interpretation continue to improve, with standardized reading protocols and quality assurance programs shaping outcomes. See quality assurance and radiology.
- AI and decision support tools are being explored to aid radiologists, improve consistency, and help triage cases for diagnostic workups. See artificial intelligence in radiology and clinical decision support.
- Access and efficiency: Innovations aim to streamline scheduling, reporting, and follow-up, reducing delays and patient burden while maintaining diagnostic accuracy. See healthcare administration and health systems.
Access, equity, and public health considerations
- Availability and affordability of screening services influence participation and outcomes. In many settings, private insurance coverage, public programs, and regional health infrastructure shape who gets screened and how often. See health insurance and public health.
- Population groups may experience different levels of benefit or harm due to factors like breast density, technology access, and healthcare literacy. See breast density and health disparities for related topics.