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Aside from skin cancer, breast cancer is the most common cancer in women and represents 14% of all new cancers in the United States. Breast cancer risk increases with age and is most commonly diagnosed in women aged 55 to 64 years. This increasing risk over time offers an opportunity to catch breast cancer at earlier stages, increasing the chances that a patient may achieve a cure and also reducing the morbidity of the treatments. Breast cancer therapies continue to improve and have contributed to mortality reduction, but early diagnosis through mammographic screening has had a greater overall impact on mortality reductions. This activity describes mammography and highlights the role of the interprofessional team in managing patients who undergo mammography. Objectives: Identify the anatomy of the breast and its expected visualization in mammography. Describe the appropriate indications for screening mammography. Review the clinical significance of mammography in the early diagnosis of breast cancer and subsequent patient outcomes. Outline interprofessional team strategies for improving care coordination and communication to advance mammography and improve clinical outcomes. Access free multiple choice questions on this topic.

Breast cancer is the second most common cancer in women, after skin cancer, and represents 14% of all new cancers in the United States.[1] Breast cancer is most commonly diagnosed in women aged 55 to 64 years, and the risk increases with age.[2] Early diagnosis increases the chances that a patient may achieve a cure and also reduces the morbidity of the treatments. Breast cancer therapies continue to improve and have contributed to mortality reduction, but early diagnosis through mammographic screening has had a greater overall impact on mortality reductions.[3] The American College of Radiology recommends breast cancer screening for all average-risk women starting at the age of 40.[4] The diagnosis of breast cancer can be suggested by many different modalities, most commonly mammography, breast ultrasound, and magnetic resonance imaging (MRI). However, tissue sampling is required for a definitive diagnosis. Breast cancer screening is performed with mammography, and patients with equivocal or suggestive mammographic screening results require further imaging with a diagnostic mammogram, ultrasound, breast MRI, biopsy, or combination thereof. This article will discuss the techniques and considerations when performing screening breast mammography.

Screening mammography is well tolerated with few complications. Both immediate and subacute complications could arise from excessive breast compression. These are limited to bruising, small hematomas, and the temporary discomfort that occurs from compression. Inadequate imaging is an additional complication that can be avoided through careful positioning and technique.

Quality assurance is a significant concern within the field of mammography, and a team approach is essential for navigating the complexities of patient care. Morbidity and mortality reduction is dependent on early identification of malignant lesions on mammography. This depends not only on the chain of events from image preparation, acquisition to interpretation but also critically includes patient communication. Identifying high-risk lesions is of no clinical benefit if the patient is not promptly notified and engaged with adequate services and healthcare specialists. As such, an interprofessional team approach to breast cancer management affords the most significant benefit for clinical care. Patients with abnormal or concerning results should be promptly notified of the results and given clear direction on the necessary follow-up care. Once a lesion is identified, the patient requires additional imaging with diagnostic mammography and/or ultrasound. For patients with findings concerning for malignancy, a breast biopsy is necessary. Coordinating these steps requires a comprehensive breast imaging team. Radiologists identify the lesions initially and notify the clinical support staff of the results. These support staffs are tasked with reaching out to the patients and the referring provider with the results and suggested course of action. Once further diagnostic imaging and biopsy are performed, coordination with pathology is required, and the results must be communicated directly to the patients. Finally, if a high-risk or malignant lesion is identified, the patient is referred for surgical oncology consultation, and often the case is discussed in an interprofessional meeting that includes medical oncologists, radiologic oncologists, breast surgeons, pathologists, radiologists, genetic counselors, and nurse navigators. The cycle from identifying a concerning lesion on mammography to the diagnosis of breast cancer should take no longer than approximately three months.[25]

Interprofessional teams play a vital role in providing exceptional breast care and communicating mammographic results. At the center of the group are the radiology technologists. These professionals play a crucial role by serving as problem-solvers in obtaining not only technically adequate but optimal mammographic images. Useful diagnostic information can be obtained from the patient during mammographic image acquisition and correlated to image findings. Close-knit communication between radiology technologists and diagnostic radiologists is essential for quality assurance and contextual understanding.

Nurses and care coordinators are fundamental members of the breast imaging team, as they help ensure follow-up care for patients. As in all areas of medicine, access to care can be limited for many reasons and poses a significant threat to screening mammography. Patients with urgent or critical mammography results should be tracked, and follow-up care should not just be recommended but ensured. Care coordinators and nursing staff may communicate key results, verify follow-up appointments, and provide adequate care is received.