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Mammograms...Still the Best Choice for Early Detection of Breast Cancer
Mammograms...Still the Best Choice for Early Detection of Breast Cancer The bottom line for women is to pay attention to getting a screening mammogram on the recommended schedule.

Mammograms, MRIs, ultrasounds….with such a dizzying array of tests for breast disease from which to choose, how do we know what is best for early detection of breast cancer? That’s the $64,000 question. The short answer is that mammography remains the most effective breast-screening tool in our medical arsenal. But there are some situations that women should know about that might make additional testing appropriate for their particular situation.

In addition to the mammogram, a breast examination by a healthcare provider (clinical breast exam) has traditionally been part of the well woman’s annual exam along with breast self-exam. Recent reports from the US Preventive Services Task Force (USPTF) on breast cancer screening have suggested that breast self-exam and clinical breast exam are not adding any breast cancer detection benefits, and this task force has released new screening mammogram guidelines as of November 2009.

The American College of Obstetricians and Gynecologists has stated that they will continue to recommend the screening mammography every one to two years for women forty to forty-nine and annually after that.
Magnetic resonance imaging (MRI) has come into more common use in detecting breast disease, but it is still not recommended for the average woman as a routine screening test. It has issues of false positive results as well as the potential to miss an early lesion that a mammogram would otherwise pick up. MRI can be used in some cases as an adjunct to regular mammogram particularly in women who have already had breast cancer in one breast, women with breast implants, and women with very high risk of breast cancer based on their history.

MRI can be used to look more closely at a suspicious area that has already been identified by other means; however, it is not a substitute for breast biopsy. This technology can be used to guide a biopsy more accurately and to check the rest of the breast for the possibility that spread has already occurred. The overall role of MRI for detecting and treating breast cancer has not yet been fully determined by medical science, but studies are in progress.

Mammography has likewise evolved over time, and the new digital enhancement has taken what was previously a regular x-ray on film to another level. The digital images can be increased in size such that the radiologist can focus on areas of concern more readily without the need to bring the patient back in for more views. The digital method works well for women with dense breast tissue because the relative lack of fatty tissue background made traditional mammogram interpretation more challenging. Finding micro-calcifications in the breasts has always been the goal for detecting tiny tumors, but this new technology is so sensitive that doctors are not certain if all the lesions they discover are of any significance as far as leading to future invasive breast cancer. This is another topic of current study in the war on breast cancer.

The technique for mammography has changed little over the years, and most women know the drill of putting their breast on a hard surface while the top is compressed from above to get the x-ray image. It’s certainly not comfortable, and some women have intense pain with traditional mammography techniques. Discuss with your healthcare provider how you might minimize your discomfort during the exam including use of a soft pad beneath the breast and scheduling the test during the first fourteen days of the menstrual cycle.

Ultrasound is generally more comfortable than a mammogram, but it is not a substitute because of the issue of detecting micro-calcifications, which are a potential indicator of the presence of cancer cells. Ultrasound is a helpful tool when the physician feels a lump during the clinical exam.
The previously recommended mammogram testing interval was yearly or at least every other year for women aged forty to forty-nine and yearly at age fifty and beyond. The US Preventive Services Task Force (USPSTF) now recommends against any routine screening for women aged forty to forty-nine and then only every other year starting at age fifty. This timeline is based on the USPSTF’s statistical analyses, but these new recommendations have not been universally accepted among physician organizations. They also feel that breast self examination has potential benefit along with annual clinical breast examinations starting at age nineteen. When to initiate mammogram screening and how often should be a topic of discussion between a woman and her healthcare provider based on that woman’s individual risk factors and desires for testing.

Ultrasound technology can be used in conjunction with mammograms for further evaluating areas of concern. This technique uses sound waves to determine cystic (fluid-filled) versus solid tumors. Needle biopsy of the solid tissue or sucking out the cyst fluid can then be performed using the guidance of the ultrasound image.

Even better than early detection would be prevention of breast cancer, and there are clearly steps that women can take to lower their overall risk. Studies have shown that overweight women, women who consume two or more alcoholic beverages a day, and those with diets containing a high amount of animal fat have a substantial increase in the baseline risk of breast cancer. This risk relates to increased circulating estrogen in the blood. Even after the ovaries have ceased to produce much estrogen beyond menopause, the fatty tissues continue to convert precursors to a weak form of estrogen that can definitely add up. In overweight women who can decrease their weight by twenty or more pounds (and keep it off), there is a forty percent risk reduction for breast cancer…so go for it!

The bottom line for women is to pay attention to getting a screening mammogram on the recommended schedule. While there is no proof that it changes outcomes for women who are later diagnosed with breast cancer, breast self-exam still offers a window of opportunity for women to find their own disease and seek immediate attention regardless of the normalcy of their latest mammogram.

Not long ago, I lost one of my cherished friends to breast cancer. I watched her go through chemo regimens and even bone marrow transplant only to ultimately have the disease claim her life. It was heartbreaking for her family and friends, and her light in this world is sorely missed. As I remember her life and her friendship, I am inspired to remind all women to be proactive in their pursuit of breast health.

The most common risk factors:

Having one or two of these risk factors doesn’t mean a woman will develop breast cancer. But knowing her personal risk factor profile and understanding what it means will help her and her doctor plan a course of action that may reduce her chances of developing the disease or, at least, to detect it in its earliest, most treatable stages.
  • Sex. The highest risk factor for breast cancer is being female; the disease is about 100 times more common among women.
  • Age. The risk of breast cancer increases as a woman grows older. The risk is especially high for women age 60 and older. Breast cancer is uncommon in women younger than age 35, although it does occur. There is some evidence to suggest young African American women are at greater risk for breast cancer than young Caucasian women.
  • Personal History. Women who have had breast cancer and women with a history of breast disease (not cancer, but a condition that may predispose them to cancer) may develop it again.
  • Family History. The risk of developing breast cancer increases for a woman whose mother, sister, daughter, or two or more close relatives have had the disease. It is important to know how old they were at the time they were diagnosed.
  • The Breast Cancer Genes. Some individuals, both women and men, may be born with an “alteration” (or change) in one of two genes that are important for regulating breast cell growth. Individuals who inherit an alteration in the BRCA1 or BRCA2 gene are at an “inherited” higher risk for breast cancer. They also may pass this alteration on to their children. It is very rare. Scientists estimate that only about 5-10 percent of all breast cancers are due to genetic changes. One out of two women with these changes are likely to develop breast cancer. Women with a family history of breast cancer are encouraged to speak to a genetics counselor to determine the pros and cons of genetic testing.
Provided by National Breast Cancer Awareness

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"Mammograms...Still the Best Choice for Early Detection of Breast Cancer"
   authored by:
Dr. Jacqueline Thompson is a Board Certified Obstetrician and Gynecologist and Fellow of the American College of Obstetricians and Gynecologists. Formerly an active duty Army doctor, she is now a full time civil service staff physician at Womack Army...

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