Mammography (Mammogram) - Nursing Responsibilities

There are two uses. A screening mammogram looks for unsuspected breast cancer in women with no signs or symptoms, usually two x-ray images of each breast to catch tumors or small calcifications. A diagnostic mammogram works up a suspicious lump or symptoms such as breast pain, nipple discharge, skin thickening, or a sudden change in breast shape or size. It also evaluates abnormalities found on screening and gives a more detailed image for patients with breast implants.

Mammography finds most breast cancers but also produces false-positive results, and sensitivity drops in dense breast tissue. Screening guidance now varies by organization. In its 2024 update, the US Preventive Services Task Force recommends biennial (every other year) screening mammography for average-risk women ages 40 to 74 (USPSTF). The American Cancer Society gives women the option to start annual screening at 40 to 44, recommends annual screening at 45 to 54, and switching to every other year at 55 with the option to continue yearly (American Cancer Society). The American College of Radiology recommends annual screening beginning at age 40. Higher-risk women should start earlier and may benefit from supplemental screening such as breast MRI.

Your role is information, emotional support, and coordinating followup. Patients need teaching about breast disease and breast examination, and many are anxious about results.

Types

• Full-field digital mammography (FFDM). Also called digital mammography. Performed the same way as conventional screen-film mammography (SFM), but images are generated from digital signals rather than x-ray film. Images are read on a monitor or printed on special film.
• Computer-aided detection (CAD). Software scans SFM or FFDM images for abnormal tissue (denseness, abnormal size, calcifications) and marks suspicious areas for radiologist review.
• Three-dimensional (3-D) breast imaging (breast tomosynthesis). Equipment rotates in an arc over the breast rather than staying stationary, producing thin slices from many angles for clearer images, especially of dense tissue.

Indications

• Differentiate benign breast disease from breast cancer
• Investigate breast pain, nipple retraction, nipple discharge
• Evaluate palpable and unpalpable breast masses
• Screen for malignant breast tumors
• Monitor response to breast radiation therapy
• Evaluate the opposite breast after mastectomy

Contraindications

• Pregnancy, unless the benefit outweighs the risk of maternal and fetal damage
• Patients younger than age 25 or with very dense breast tissue

Interfering Factors

• Antiperspirants, talcum powder, lotions, or creams on the underarm or breast
• Failure to remove metallic objects and clothing
• Previous breast surgery, active lactation, and glandular breast tissue (common in women age 30 and below)
• Breast implants blocking full visualization
• Inability to cooperate or hold still due to age, health, or mental status

Procedure

Mammography is done on an outpatient basis.

1. Prepare the patient. The patient stands and rests one breast on a table above an x-ray cassette.
2. Compress the breast. The technician lowers the compression plate, the patient holds her breath, and a craniocaudal view is taken. The machine rotates, the breast is compressed again, and a lateral view is taken.
3. Repeat on the other breast.
4. Check the films. After developing, the films are reviewed for reliability.

Nursing Responsibilities

Before the procedure

• Explain the procedure. Tell the patient who performs it and where. The test itself takes about 15 minutes, but she may wait while films are checked. Warn her about the high rate of false-positive results.
• Address concerns. Let the patient voice fears, assess her understanding, answer questions, and correct misconceptions.
• Remove interfering factors. No underarm deodorant or powder on the day of the exam.
• Schedule for implants. If the patient has breast implants, have her tell the staff at scheduling so a technologist experienced with implants is on duty.
• Prepare the patient. Give a front-opening gown and have her remove all jewelry and clothing above the waist.

During the procedure

• Assist with positioning. Place the patient standing or sitting at the machine, adjusted to breast level, with arms out of the imaging field.
• Warn about discomfort. The compression needed against the x-ray plate can cause pain.
• Coach cooperation. The patient stays still (movement gives unreliable results) and holds her breath while films are taken.

After the procedure

• Explain result timing. A report goes to the requesting physician, who reviews it with the patient.
• Reinforce provider teaching. Help arrange any additional testing, therapy, or referral if an abnormality is found.

Normal Results

• Normal breast tissue with no cysts, tumors, or calcification

Abnormal Results

• Breast abscesses or cysts
• Breast tumors
• Breast calcifications
• Hematoma from trauma
• Mastitis (inflammation of breast tissue)
• Soft tissue masses
• Vascular calcification (small calcium deposit in breast tissue)

Frequently Asked Questions

At what age should women start screening mammograms?

It depends on the guideline. The 2024 USPSTF recommends starting biennial screening at age 40 and continuing through 74 (USPSTF). The American Cancer Society offers the option to start annual screening at 40, recommends annual screening from 45 to 54, then every other year from 55 (American Cancer Society). The American College of Radiology recommends annual screening from 40. Higher-risk women may start earlier.

What is the difference between a screening and a diagnostic mammogram?

A screening mammogram checks for unsuspected cancer in women without symptoms, typically two views of each breast. A diagnostic mammogram works up a known problem such as a lump, pain, nipple discharge, or an abnormality found on screening, and it takes additional, more detailed images.

Why should the patient avoid deodorant or powder on the day of the exam?

Antiperspirant, talcum powder, lotions, and creams on the underarm or breast can appear as specks on the images that mimic calcifications, leading to false readings. Patients are told to skip these products until after the exam.

Does a mammogram hurt?

The breast is compressed against the x-ray plate, which can be uncomfortable or briefly painful but is necessary for clear images and to lower the radiation dose. The compression lasts only seconds per view, and the whole exam takes about 15 minutes.

What is breast tomosynthesis (3-D mammography)?

Tomosynthesis moves the x-ray equipment in an arc over the breast and reconstructs thin slices from many angles. This gives clearer images, particularly in dense breast tissue, and can improve cancer detection while reducing callbacks compared with standard 2-D imaging.

Does a positive or abnormal mammogram mean cancer?

No. Mammography has a high rate of false-positive findings, and many abnormalities turn out to be cysts, benign calcifications, or normal dense tissue. An abnormal result leads to additional imaging or a biopsy, which is what confirms or rules out malignancy.