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One in nine women over their lifetime will get breast cancer. The mammogram is the leading method for the detection of breast cancer in the United States. Mammograms allow detection of breast cancers at earlier stages, increasing cures and improving survival. Despite recently publicized studies to the contrary, screening mammograms have been shown in numerous large studies to save lives. 40% of cancers detected by mammography are not detectable by doctors during a physical exam. One third of cancers detected by mammography are early stage: non-invasive or small invasive cancers (less than 1 centimeter). 75-85% of patients whose invasive cancers are detected by mammography have negative axillary lymph nodes.

A good summary article in regard to the controversy of the value of screening mammography is ”Dot Size, Lead Time, Fallibility, and Impact on Survival: Continuing Controversies in Mammography” in the American Journal of Roentgenology, May, 2001 p.1123-1129 by Dr. Leonard Berlin.

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Mammogram: craniocaudad views.

The highest quality mammograms are our goal. All our sites are federally accredited through the federal Mammography Quality Standards Act of 1992 (MQSA). This ensures the equipment, monitoring, technical parameters, radiation, documentation and data collection, and ultimately, image quality, fall within strict federal standards.

In order to achieve the highest image quality, technologists apply compression to the breast. This often produces some degree of discomfort, but is crucial to produce a high quality mammogram. The compression allows a lower radiation dose, spreads superimposed breast density, and produces greater resolution with less x-ray scatter. These factors are critical in distinguishing a high quality mammogram from a substandard study.

The MQSA program mandates patients receive results of their mammogram from the breast imaging center. Therefore, you will receive a letter in the mail with the results of your mammogram.

Mammograms are not perfect tests. 10% of cancers may not be detected on a mammogram, particularly if the breasts are “dense” (dense breast glands can obscure early signs of cancer in some patients). Conversely, many non-cancerous abnormalities are detected and may eventually lead to a biopsy to determine their cause. Despite this, mammography has been proven to save lives.

Common Questions

“I’ve been called back for extra mammogram pictures. Does this mean that I probably have cancer?”

On average, 8-10% of patients getting a screening mammogram will be called back for additional mammographic views. This is obviously stressful for most women.

This means that the radiologist has identified something that needs to be examined in further detail. In an attempt to identify cancers in their earliest stages, radiologists are looking carefully for any subtle changes. This often raises the attention to areas that may be due to normal breast tissue or other non-cancerous findings. The vast majority of the time, the additional mammographic views with or without an ultrasound exam show the area to be negative or benign (such as a cyst).

After the additional pictures are taken, some patients will receive a “probably benign” diagnosis. This indicates a 1% chance the finding represents cancer. National standard of practice in this circumstance is to follow the finding in six months with another mammogram or ultasound to ensure stability.

Only a minority of patients called back go on to a recommendation for biopsy.

Once a biopsy is recommended, statistics indicate an 75% chance that the abnormality is still not cancer (benign).

So, while the call back for additional mammograms can cause anxiety, the statistics described above are encouraging for most patients.

“Does the radiation I receive during the mammogram cause cancer”

The amount of radiation received to the body during mammography is among the lowest of any test that uses radiation. The incidence of cancers caused by low level radiation is not known since there are significant statistical and ethical barriers to design studies that determine this. It is thought that there is some extremely low, but non zero chance a low level radiation exposure can cause cancer. Worst case estimates of the number of cancers/deaths caused by mammography is in the 2-3 per 10 million women screened range. To put this into perspective, the risk of death from a cancer induced by screening mammography over a women’s life is equivalent to travelling 30 miles by car or 200 miles by airplane, or smoking a fraction of a cigarette, or spending a few minutes in a smoke filled room.

Therefore, when balanced against the benefit of detecting tumors that are so prevalent in women (one in nine women get breast cancer over their lifetime), this low risk of a radiation induced cancer is insignificant relative to the lives saved by mammography.

References

For additional information and resources regarding breast imaging, the following link is a good starting point.

www.imaginis.com/breasthealth/mammography.asp

Here are some additional references in regard to the value of screening mammography:

  1. Feig, S. Decreased breast cancer mortality through mammographic screening: Results of clinical trials. Radiology 167:659, 1988
  2. Berlin, L. Dot Size, Lead Time, Fallibility, and Impact on Survival: Continuing Controversies in Mammography” AJR May, 2001 p.1123-1129

Scheduled Testing

As part of a comprehensive approach to detection which includes regular self examination and physical exam, mammograms should be obtained at regular intervals.

For patients without the highest risk factors, the American Cancer Society recommends:

Age 40 and over: Screening mammogram and a clinical breast examination (CBE) by a health care professional every year. The CBE should be scheduled close to and preferably before the scheduled mammogram.
Age 20-39: Clinical breast examination by a health professional every 3 years.
Age 20 and over: Perform breast self-examination (BSE) every month. By doing the exam regularly, you get to know how your breasts normally feel, and you can more readily detect any change.

The Federal government, through the Department of Health and Human Services, has recently concurred with the recommendation that screening studies should occur regularly at and after the age of 40:

American College of Radiology

U.S. Preventive Services Task Force

For patients with increased risk factors such as a prior history of breast cancer, first order relatives with breast cancer (sisters, mothers), or the brca1 or brca2 gene should consider annual screening in the 40 and over age group.

Patients who are considering testing for, or have tested positive for brca1 or brca2 should undergo genetic counseling to map out the options for screening which may include the additional options of breast MRI or preventive surgery.

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