Mammogram important for cancer's early detection
Published: Sunday, October 7, 2012 at 12:50 p.m.
Last Modified: Sunday, October 7, 2012 at 12:50 p.m.
For women who find mammograms painful, the excitement over digital technology turned out to be, well, a bust.
While digital mammograms are the new norm, they are obtained like film images were for years — X-rays are sent through breast tissue.
To get the best images, a technologist still must flatten and compress the breast between two plates in an imaging machine.
The resulting images are analyzed for abnormalities or changes from previous tests.
“We are not at the point where we can get past the squishing part, there is just not another good option,” said Dr. Julia Marshall, chief of breast imaging at the radiology division of the University of Florida in Gainesville.
Marshall said mammograms can pick up early signs that other tests can't, such as calcium deposits, and are more cost-effective than using imaging tests such as ultrasound, 3-D ultrasound, a 3-D mammogram also called tomosynthesis, and breast MRI.
She said using extra imaging in place of a mammogram wouldn't justify the cost because the imaging can pick up things other than cancer, which can lead to false positives.
“There is not a simple answer to diagnosing or screening for breast cancer, because there is not one perfect test. We are always looking for new ways to screen for breast cancer because even a digital mammogram isn't 100 percent effective,” Marshall said.
Dr. Megan Hodge, a diagnostic radiologist at Advanced Imaging Centers at Tealbrooke, part of the Ocala Health System, said digital mammograms became the standard in 2009 because of the accuracy and clarity seen in women with dense breasts, which are usually found in the young or those undergoing hormone therapy.
“When you have dense breasts, tissue overlaps and obscures things. The thicker the breast, the longer it takes to get a mammogram,” Hodge said. “Some may feel it is a big, painful nuisance, but it could save your life.”
Elizabeth Galvin, an Ocala Health System employee, recently received a mammogram at the center.
“Women are always taking care of everyone else first — their husbands, kids, even pets. But put yourself first. A mammogram is an easy way to do that. You can eat, you don't have to take a prep, and you're done and out in 10 minutes. It just gives you that peace of mind,” she said.
Hodge said the American Cancer Society still recommends annual mammograms starting at age 40 and continuing to age 75.
She said no one, not even insurance companies, are following the newer cost-effective guidelines by the U.S. Preventative Services Task Force, which recommend mammograms starting at age 50, with screenings every other year.
“Detection in younger people is very important because it's usually more aggressive. We could be missing breast cancer, and that is scary. Those younger women have kids at home,” she said.
Of the 39 million women in the U.S. being screened by mammogram each year, 230,000 come back as positive for breast cancer, Hodge said.
Sixty percent of those positive results were found by routine screening alone and without other symptoms, such as finding a lump.
She said many women still don't perform monthly self-exams because they are younger, have dense breasts that feel too bumpy, or think that after having a clear mammogram they don't have to worry about it until the next year.
Hodge recommends a self-exam a week after a menstrual cycle starts, and suggest women look for surface changes on skin, dimpling, discoloration, sores, inverted nipples or discharge and sudden asymmetry.
She also advises feeling up the chest area and into the armpits, where there are lymph nodes.
“If you get used to the way your breasts feel, then you will notice changes,” she said.
Marshall said the radiation dose for a digital mammogram is minimal, about 20 percent less than with film, and still much lower than flying in an airplane or getting a chest X-ray.
“There is always a theoretical risk, as with anything, but the chances are extremely low. But there is a high chance of breast cancer in just one of eight women, so the risk of getting cancer from mammogram radiation is much, much lower than the [inherited] risk of getting breast cancer,” she said.
For every 1,000 women diagnosed with breast cancer, one man is diagnosed.
Men typically are not recommended for screening unless there is a genetic indicator or they find a lump.
For those still concerned about radiation, another form of early detection is thermography, which is a holistic screening process that uses an infrared camera to take pictures of heat in the body.
Pat Reeves, a clinical thermographer at the office of Douglas C. Hall, M.D. P.A., in Ocala, said digital infrared imaging is most useful for those with a family history of breast cancer, as insurance does not cover the imaging because it is considered investigational.
She said they look for the hottest colors — red or white — to show tumors being fed by blood.
Reeves suggests a second thermogram within three months to see if anything has changed.
If there are changes, they will recommend a mammogram.
Thermograms will then be suggested once a year.
“If you wait until you have a lump then get a mammogram and ultrasound, you are already diagnosed with full-blown cancer. If you do this, you can see the change in the breast and find areas that might be suspicious,” she said.
Marshall said thermography has been around for a long time but is considered a type of alternative medicine.
She said while cancers do increase blood flow and will change the pattern seen, not all cancers will be close enough to the surface to notice.
“I do think it is an interesting concept, but it still isn't readily accepted in the general medical community as a screening tool,” she said.
Marshall said a traditional mammogram shows two views of each breast whereas a 3-D mammogram can show many views, called slices, almost like a CAT scan, and is used to determine if a mass is just overlapping tissue.
There also is a contrast-enhanced mammogram that takes images with and without intravenous contrast, but this procedure isn't as common.
Marshall said if a lump is found in a woman younger than 30, an ultrasound is often used before a mammogram because there is no radiation.
Younger breast tissue is more sensitive to radiation.
She said ultrasounds aren't as readily used for the masses as outpatient facilities would have to hire an ultrasound technician to hold a small, hand-held probe to go over the breast inch by inch, which is very time consuming.
Marshall said a faster screening is the new 3-D ultrasound, which uses a 12-inch by 12-inch automated scanner that completes the screening for both breasts in less than 10 minutes, but still requires an ultrasound technician to operate the machine and read the images.
She said a breast MRI is best for those only at high risk of developing breast cancer because, while it is the most sensitive test, it also is the most expensive.
An MRI is recommended by the American Cancer Society for those with a 20 to 25 percent chance of developing breast cancer, which is determined by a gene test or the number of relatives with breast cancer.
Marshall said that while more trials are needed, she thinks the 3-D mammogram or the 3-D ultrasound will soon become popular methods of screening.
“We are constantly looking for better technology, while asking if it will help us pick out more cancer without picking up things that aren't cancer,” she said.