Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample

Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample: Mammogram

A mammogram is a low-dose x-ray picture that allows radiologists to examine and assess the changes in breast tissue composition (CDC, 2021). Mammograms enable radiologists to detect and diagnose signs of breast cancer such as cysts or benign tumors before they can be visible or felt through palpation. According to the Centers for Medicare and Medicaid Services (n.d.), it is medically appropriate for women aged 50years and above, women whose family members have breast cancer history, or asymptomatic women aged 40 years and above to go for yearly screening mammograms.(Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample)

The Purpose

The purpose of a mammogram is to screen or make a breast cancer diagnosis. Ideally, mammography cannot prove that a particular breast abnormality is cancerous but instead presents doctors with suspicion to allow for biopsy tests. Biopsy procedures require doctors to remove tissues from the abnormal breast area using a needle or open surgical biopsy, which is then examined under a microscope to determine whether the tissues are cancerous. A screening mammogram is a radiological procedure that involves x-ray tests on the breast to discover abnormalities or changes in the breast for women with no breast cancer visible signs or symptoms since mammograms can detect tumors that cannot be felt (Johns Hopkins Medicine, n.d.). Screening mammography is vital for the early detection of cancers and includes the doctor’s interpretation of the procedural outcome. However, screening mammograms are limited to two-view exposure for each breast, i.e., the craniocaudal and medial-lateral views.(Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample)

Diagnostic mammography is a radiological procedure applicable when individuals experience unusual symptoms, including palpable lump on the breast, thickening of breast skin, breast indentation, changes in breast size or shape, nipple discharge, nipple retraction, sore nipple, or painful breast (Johns Hopkins Medicine, n.d.). A diagnostic mammogram is also used when an individual has a history of breast cancer or biopsy, i.e., a proven benign breast disease, including a doctor’s interpretation of the procedural results. Therefore, a diagnostic mammogram is crucial in evaluating the abnormalities found on a screening mammogram.(Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample)

Mammogram Procedure

The mammography process involves an individual standing in front and perpendicular to a special x-ray machine (CDC, 2021). Then, a technologist or operator supports the breast on a plastic plate and uses the other to press the breast from above firmly. The plates function to flatten the breast, helping it to position as the x-ray picture is taken. Usually, the pressing exerts pressure on the breast that can be felt and uncomfortable. However, the degree of this feeling varies with a technologist’s skill, breast size, and time took under compression. Equally, more pressure is felt for women having their period or are about to have their period. This procedure is repeated for the other breast and takes only a few minutes.  Notably, each mammogram appears different since breasts are not the same. Consequently, radiologists read and observe mammogram images for signs of breast cancer and other problems.(Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample)

Mammogram machines are designed to look only at breast tissues. The machines take low-dose x-rays since higher-dose x-rays do not go through tissues quickly. The two plates serve two functions, (a) to flatten the breast and (b) compress the breast to spread the tissue apart for better pictures to be taken and limit the amount of radiation used. The invention of three-dimensional mammograms, also known as digital breast tomosynthesis (DBT) or simply breast tomosynthesis, allow technologists to compress a breast only once and use low doses. A designated computer puts the images together into a series of thin lines, allowing the radiologists to see breast tissues more clearly (American Cancer Society, 2020). Significantly, the DBT can equally provide two-dimensional images simultaneously or reconstructed from the three-dimensional mammogram images. As such, 3D mammography is more effective, reduces chances of follow-up testing, and is helpful in women with dense breasts.(Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample)

Information Gathered

Information gathered from a mammogram is related to various representations of cancer signs and symptoms as presented in breast tissues. Screening mammograms include more than one x-ray image for each breast. The images provide information on masses, microcalcifications, and breast density that often indicate the presence of breast cancer (American Cancer Society, 2019). Masses include areas of dense tissues with shapes and edges that look different compared to other breast tissues on a mammogram. Microcalcifications are tiny calcium deposits within the breast tissue presented as white spots on a mammogram. Mammograms also show the shape and layout to help radiologists judge the likeliness of them being cancerous. Finally, breast density is presented by the degree of fibrous and glandular tissues distribution in the breast compared to the fatty composition of the breast.(Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample)

However, false-negative results, i.e., normal breast tissues appearance despite the presence of breast cancer, may be diagnosed. When such happens, individuals encounter additional economic costs of diagnosis and treatment of cancer at a later stage of development. Equally, the false-negative results can lead to a false sense of security and delayed treatment. However, mammograms tend to miss only 20% of breast cancers present during screening (National Cancer Institute, 2021). The other significant concern for mammograms is radiation exposure. Mammograms require low doses of radiation, which translates to lower risks exposure. However, repeated mammography can potentially cause cancer. As such, the benefits of mammography outweighs the potential harm(Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample)

Validity and Reliability

Researchers have conducted various studies on the validity of mammograms. An update from the Breast Cancer Surveillance Consortium reports that the sensitivity of mammography stands at 87%, i.e., 87 out of 100 women are correctly screened or diagnosed with breast cancer (Lehman et al., 2017). Sensitivity refers to how well the screening mammogram tests the degree of disease possibility.  Lehman et al. (2017) found that mammography has a specificity rate of 89 percent, 0.8 false-negative rates, 4.4 positive predictive value for cancer probability with an initial assessment, 25.6 with final assessment, and 28.6 with biopsy after final assessment. Another study by Zeeshan et al. (2018) found digital mammography to be exceedingly accurate in detecting breast cancer. Zeeshan et al. (2018) found that mammograms have a sensitivity of 97% and 64.5% specificity. The study also found that digital mammography has 89% positive predictive value, 89.3% diagnostic accuracy, and 90.9% negative predictive value.(Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample)

Together, these findings demonstrate that mammograms are relatively valid and reliable, with other definitive factors constant. However, other studies have provided conflicting results on the unreliability of mammograms. For example, Hill & Robinson (2015) argued that the Perfect, Good, Moderate, and Inadequate (PGMI) criteria for mammogram image analysis are not valid or reliable considering the subjectivity of descriptors. This subjectivity makes mammograms prone to variabilities between and within operators.  Hill & Robinson (2015) also question the validity of mammograms due to the disagreement across national standards of the specific features that constitute the standard mammogram image analysis.(Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample)

References

American Cancer Society. (March 2020). Mammogram Basics. Available at: https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/mammogram-basics.html (Accessed 12 December 2021)(Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample)

American Cancer Society. (October 2019). What Does the Doctor Look for on a Mammogram? Available at: https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/what-does-the-doctor-look-for-on-a-mammogram.html (Accessed 13 December 2021)(Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample)

Centers for Medicare and Medicaid Services. (n.d.). Mammograms. Available at:  https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=186 (Accessed 16 December 2021)(Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample)

Hill, C., & Robinson, L. (2015). Mammography image assessment; validity and reliability of current scheme. Radiography, 21(4), 304-307.(Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample) https://doi.org/10.1016/j.radi.2015.07.005

Johns Hopkins Medicine. (n.d.). Mammogram Procedure. Available at: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/mammogram-procedure (Accessed 14 December 2021)(Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample)

Lehman, C. D., Arao, R. F., Sprague, B. L., Lee, J. M., Buist, D. S., Kerlikowske, K., … & Miglioretti, D. L. (2017). National performance benchmarks for modern screening digital mammography: update from the Breast Cancer Surveillance Consortium. Radiology, 283(1), 49-58. https://dx.doi.org/10.1148%2Fradiol.2016161174

National Cancer Institute (September 2021). Mammograms. Available at: https://www.cancer.gov/types/breast/mammograms-fact-sheet#r1

The Centers for Disease Control and Prevention. (September 2021). What Is a Mammogram? Available at:  https://www.cdc.gov/cancer/breast/basic_info/mammograms.htm (Accessed 16 December 2021).(Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample)

Zeeshan, M., Salam, B., Khalid, Q. S. B., Alam, S., & Sayani, R. (2018). Diagnostic accuracy of digital mammography in the detection of breast cancer. Cureus, 10(4).(Adult Assessment Tools or Diagnostic Tests Comprehensive Nursing Paper Sample) https://dx.doi.org/10.7759%2Fcureus.2448