What is mammography?
The mammography debate!
Mammography is a procedure involving special x-rays of the breast. It is a simple procedure, which can detect breast cancer before it can be felt. In a typical mammogram, two views of the breast are taken by compressing the breast between two plates in two different directions. With careful compression, this is not a painful procedure. Adequate compression is necessary to ensure good quality x-rays of the breasts. The idea is to flatten the breast as much as possible, thereby spreading the tissue out making any abnormal details easier to spot with a minimum of radiation.
Currently this is the single most effective method to detect breast changes that may be cancer, long before physical symptoms can be seen or felt.
In Malaysia, mammograms are performed by a trained female radiographer in mammography facilities licensed by the Ministry of Health. No medical test is always 100% accurate and mammography is no exception. The main drawback of mammography is that its ability to pick up lesions is limited by the density of the breast tissue; hence it is not so useful in most young women where the breast is dense. In older women, especially above 50 years, the dense breast tissue is replaced by fat, and therefore mammography can easily detect any abnormalities.
However, every patient is asked a set of questions and the mammographer examines the breasts as well or the referring doctor may write the relevant physical findings and a radiologist normally would correlate the findings. A lump is never ignored just because it does not show on the mammogram. There will be always be further assessment. After a mammogram, sometimes, the radiologist will perform an ultrasound of the breast on the patient. One of the reasons is to review a patient with dense breasts and therefore, dense mammograms. Not all young patients have dense breasts and not all older ladies have fatty replaced breasts.
Another disadvantage is that a mammography facility is relatively expensive, requires trained mammographers, requires a trained and experienced radiologist to interpret the results and requires dedicated mammography machines that are well maintained and regularly calibrated to ensure high quality mammograms are produced. Therefore, the availability of mammography facilities will also determine women’s access to this early detection procedure. 
In Malaysia, mammography services are now available in almost all the larger government hospitals in each state. Steps are being taken to ensure all main hospitals will be equipped. Quality assurance is a must in all facilities, private centres included.
