Women's Breast Health
● By Sandy Kauten
The American Cancer Society advocates a simple program of regular breast self exams for women, combined with annual mammograms for women 40 and older. That is still the best way for women to protect themselves against breast cancer.
In the last 30 years, annual screenings are credited with discovering 50% of all new, small breast cancers. Combined with better treatments, often conducted earlier, the survival rate for women diagnosed with breast cancer is significantly higher. “Mammograms are a really important part of the survival equation,” says Dr. Chicola. “And risk begins to climb at 40. There is no reason to wait a full decade before beginning screenings.”
About one in ten screenings will prompt a “call back” for additional mammogram views or the use of ultrasound to get a better look at a possible abnormality shown in the imaging. “The call back can be stressful for women, and critics of mammograms cite that as unnecessary, given that many of the abnormalities turn out to be just that: variations that are not harmful,” Dr. Chicola explains. “But we believe the short-term worry is a tolerable risk given the greater danger of undiagnosed cancer.”
To minimize stress, Oregon Imaging Centers provides a ‘patient navigator’ who is available to all patients, but specifically supports those patients who have been recommended for biopsy. She educates and guides each woman through the procedure and is available for emotional support and to answer questions.
Mammograms alone are not enough. “Know yourself,” counsels Dr. Chicola. “Be familiar with your breasts and give yourself credit to know if something’s different.” If it is, call your doctor.
Many women postpone a mammogram because of rumors of pain and because they think they don’t have the time. Yet new technology has vastly improved the experience. “We use pads in our machines, and that minimizes discomfort,” says technologist Jennifer Cantu. “And it only takes 15 to 20 minutes to get a screening mammogram.”
As for the dueling age recommendations, Dr. Jonathan Sims of OIC is emphatic. “Absolutely start your mammograms at 40. It’s really a decision you make for your whole family.” He joins his colleagues and the American College of Radiology and Society for Breast Imaging in refuting an often-cited Canadian study that claimed mammograms don't save lives. Among the study’s many flaws, the results from poor quality film-screen mammograms were read by doctors who were not trained to interpret the mammograms, and the technologists were not board-accredited and specifically trained licensed mammographers, which is required in the United States.
If you have a family history of breast cancer, or if you notice a change in your breasts not related to your menstrual cycle, you should contact your doctor to determine the best time for you to begin screenings. Otherwise, screenings for women 40 and older do not require a referral, and they are covered by private and public insurance.
What You May Not Know
Mammography, which has been in use since 1969, is simply a specialized x-ray of the breast done in such a way that it can reveal small lumps or calcium deposits that might be cancerous.
Mammograms give women and their physicians a detailed look at breast tissue, making it possible to detect small abnormalities that wouldn't be felt by self exams. You want to learn about these early because breast cancer responds very well to early treatment, and is best treated before you notice any symptoms at all.
Although it uses x-rays, the amount of radiation you're exposed to in a digital screening mammogram is quite small. “The risk from radiation is tiny compared to the benefits of early screening,” Dr. Sims says.
When you have a mammogram, a female radiologic technologist will take two different views of each breast while they are briefly compressed between two flat plates. While this squeezing may be uncomfortable, it lasts for only a few seconds, and it's necessary to get a good, detailed image.
You may be told after your mammogram that you have “dense breast tissue”. This is fairly common and means it can be more difficult to detect a small cancer using mammography. In that case, your doctor may want to use another scanning method, such as ultrasound or an MRI to examine your breasts.
insurance companies are required to pay for an annual screening mammogram for
women 40 and older, so cost should not be an issue.