Mammography is a specific type of imaging that uses a low-dose x-ray system to detect early breast cancer in women who experience no symptoms. It also detects and diagnoses breast disease in women who experience symptoms such as lumps,. pain or nipple discharge. Mammography plays a central part in early detection of breast cancers because it can show changes in the breast up to two years before a patient or physiian can feel them. Breast cancer is the most common cancer among women in Singapore, with one in 20 women at risk.

The BreastScreen Singapore programme recommends breast screening for women aged 40 and above. Research has shown that annual mammograms lead to early detection of breast cancers, when they are most curable and when breast-conservation therapies are available.

While mammography is the best available screening tool for breast cancer today, it does not detect all breast cancers. Also, a small portion of mammograms indicate that cancer is present when it is not (called a false-positive result).

Film Screen Mammography
Film screen mammography involves minimal radiation exposure. A skilled technologist positions and compresses the breast between two plates. Then a highly specialised x-ray equipment takes two pictures of each breast from two directions.

Mildly uncomfortable for most women, mammography can be painful for some. However, compression of the breast is necessary to flatten and reduce the thickness of the breast, so that the x-ray beam penetrates as few layers of overlapping tissues as possible.

Digital Mammography
Digital mammography uses the same technique as film screen mammography, except that the image is recorded directly into a computer. The image can then be enlarged or highlighted. If there is a suspicious area, your doctors can use the computer to take a closer look.

The Health Promotion Board in Singapore recommends that women aged 40 to 49 years have regular mammograms ever year; and women above 50 years of age, every two years.

Women who are at higher risk of developing breast cancer should see a doctor for advice. You may need to go for screening earlier and more frequently.

The technologist will stand behind a glass shield during the x-ray exposure. You will be asked to change positions slightly between images. The routine views are a top-to-bottom view and an oblique side view. The process will be repeated for the other breast.

The examination process should take about half an hour. When the mammography is completed, you will be asked to wait until the radiographer examines the images to determine if more are needed.

The Mammotome Breast Biopsy System is a technological advancement that assists physicians in obtaining the right amount of breast tissue for a definitive diagnosis without surgery. The Mammotome's ability to sample tiny abnormalities called microcalcifications - which can be the earliest or only sign of cancer-makes early detection and accurate diagnosis easier. You can be confident in your biopsy results because the Mammotome Breast Biopsy System is designed to accurately diagnose breast cancer at its earliest stages, when it is most treatable.

You will feel at ease during the procedure because a Mammotome biopsy causes little pain, requires no sutures, and can be performed quickly. Stereotactic (X-rays from two angles) or ultrasound (sound waves) images guide the Mammotome probe into the abnormal area and multiple tissue samples are removed.

Core Needle

Biopsy An earlier form of nonsurgical biopsy, called a core needle biopsy, is guided by stereotactic images and withdraws tissue through a spring-loaded device fired into the breast. A single sample is obtained each time the device is fired, so multiple insertions are needed to obtain sufficient breast tissue. Usually, 10 to 20 samples are taken.

Open Surgical Biopsy

Until the last few years, most biopsies were open surgical biopsies. First, a radiologist places a wire into the breast via mammography, locating the suspicious site. Then the surgeon, using the wire as a guide, makes an incision in the breast and removes a large section of tissue (about the size of a golf ball) for examination. Removal of such a large piece of tissue can permanently disfigure the breast. The surgery usually requires 1 day of recuperation at home.

Under stereotactic or ultrasound guidance, the Mammotome probe is positioned in the breast, aligning the sample chamber with the lesion.

1. Once in position, the vacuum system draws tissue into the sample chamber.
2. The rotating cutting device is advanced, capturing a tissue sample. The sample is then carried through the probe to the tissue collection area.
3. The physician rotates the probe, moving the sample chamber to the next position. The sequence is repeated until all desired areas have been sampled. The probe is removed, pressure will be applied to the biopsy site and an adhesive bandage applied to the skin nick.

Physicians have studied the Mammotome to document its effectiveness in the diagnosis of breast cancer. Key findings include:

A 100 percent correlation exists between Mammotome biopsies and surgical biopsies in the diagnosis of two early-stage conditions: a typical ductal hyperplasia (ADH), a benign condition that can sometimes become cancerous, and ductal carcinoma in situ (DCIS), a cancer that has not spread.

A Mammotome biopsy is 3 times more accurate than a core needle biopsy in diagnosing conditions associated with early stage breast cancer.

The Mammotome is better at retrieving tiny abnormalities called microcalcifications than the core needle method.

A change in your breast, such as abnormality detected by a mammogram or a lump found by you or your doctor, may or may not be cancerous. In order to determine whether an area of concern is malignant (cancerous) or benign (not cancerous), a physician must perform a biopsy.

A breast biopsy is the removal of a sample of breast tissue for examination and is the only definitive way to determine if an abnormality is cancerous or not.

Fortunately, 80 percent of biopsies result in a benign diagnosis. However, if cancer is present, it is crucial that you know the type and stage of the disease as early as possible. Through early detection and accurate diagnosis, more treatment options are available and a complete recovery is more likely.

BREAST IMAGING

Mammogram
Mammogram with Ultrasound
Breast Lesion Localisation
Mammotome Biopsy
Ductogram

Mammogram/Ductogram

Please bring along all of your previous x-rays for comparison.

Appointments are necessary. Please call the location where service is available directly.

As the developing embryo is much more sensitive to x-radiation exposure, patients must inform the radiographer or physician, prior to any x-ray examination if there is any possibility of pregnancy.

It is an advantage if separates (e.g., blouse and pants or skirt) are worn instead of a one-piece attire. Do not apply any talcum or any such similar powder on the breast.

The following questions will be asked prior to the examination for a complete history of the patient:

	Any lumps. If so, its location
	Any discharge from the nipple
	Any history of mastectomy
	Any previous biopsy or aspiration
	Any previous history of lumpectomy
	Any silicon implant
	No. of children and if they were breast-fed
	Age of first menstrual period
	Last menstrual period
	If the menses is regular/irregular or if menopausal
	Any history of hysterectomy
	Any history of taking birth control pill/oestrogen/progesterone/ cortisone. If so, for how many years
	Any family history of cancer. If so, relationship to patient and type of lesion

Breast Lesion Localisation/Mammotome Biopsy

Appointments are necessary. Please call the location where service is available directly.

As the developing embryo is much more sensitive to x-radiation exposure, patients must inform the radiographer or physician, prior to any x-ray examination if there is any possibility of pregnancy.

Procedure is done as a day-case. Patient has to be admitted into Mount Elizabeth Hospital and in most cases be discharged later in the day. Documents (e.g., Identity card, admission letter, previous x-rays) must accompany the patient for admission process.

Breast Profile