Archive for Mammogram
There are now new guidelines regarding the frequency of mammogram screening, and yes, this debate continues to go on!
These recommendations however, are backed by most professional medical organizations. The American Cancer Society agrees, and that carries a lot of weight.
These newest recommendation apply to women of low risk, and include starting age 45 instead of 40; and having a mammogram yearly until 55 yrs of age. At this point, women are recommended to have a mammogram every other year until within 10 yrs of life expectancy (when the average woman dies); then they can stop. The new recommendations recommend against monthly self breast exams, and against your medical provider doing breast exams.
If you are at high risk, ie have a family history of breast cancer or a personal history of cancer as well as some unhealthy life style practices; you are recommended to discuss your screening with your provider.
- In other words, if you have had a sister, mother, daughter with breast cancer; you are at higher risk and need to be screened more regularly and start a little earlier.
- If you have had any other cancer, you are considered at risk for future cancers from other sites; so you are at higher risk.
- If you smoke, drink more that 10-14 alcoholic drinks a week (ie 12 oz beer, 5 oz wine, 1-1.5 oz liquor), are in the obese weight category, and are not active; you should get regular screening.
Many providers, myself included, do not agree with the lack of provider breast exams. I personally, will not give that up in my clinical practice. A lump is a lump and how are you going to know it is not cancer unless it is found and evaluated?
The reason for this shift in recommendations involve trying to minimize aggressive and fear inducing procedures and treatments for abnormalities that ultimately are benign or so slow growing they will not impact longevity. Cancer occurring in the 40′s and early 50′s are felt to be more aggressive and faster moving.
One major and important organization, the American Congress of Obstetricians and Gynecologists do not agree with these new recommendations.
They feel screening should begin at age 40 and continue yearly, no end point specified. They still approve of self breast exams and yearly provider exams.
What do I, as a provider, recommend? Somewhere in the middle.
I do agree with yearly exams in the 40′s and 50′s. As stated above, if I see a woman for a yearly female exam, she is getting a breast exam. Self breast exams are fine every other month or so. It is probably ok to skip a year here and there with mammograms if someone is low risk. If a woman has no family history or personal history of cancer, but her healthy habits are not good; I will recommend yearly mammograms. I feel it is likely safe to stop screening in the late 70′s for most healthy women who expect to live well into their 80′s.
This is my take on the new recommendations. Let me know what your experiences, questions and thoughts are!
It seems that almost weekly, there is a new study or analysis of a study questioning or extolling the virtues of breast cancer screening. Several decades ago, the medical community was repeatedly encouraging women to get breast cancer screening, all in an effort to lower the death from breast cancer. Treatments were admittedly severe with total mastectomy, radiation therapy causing severe side effects, and harsh chemotherapy.
Breast cancer treatments have come a long way since then, and many women are successfully treated for breast cancer without disfiguring surgery or devastating radiation and chemotherapy. We may be tempted to attribute this improvement of treatment with earlier detection, and that may be the case for many women.
Many advancements include identifying specific cell types and tailoring treatment towards that cell type. This is where some of the controversy has arisen. There’s one type of cancer, called DCIS (ductal carcinoma in situ) that many women have been treated for and perhaps unnecessarily so.
Specialists initially felt this cancer type was as potentially life threatening as any type of breast cancer you may think of. It turns out however that this type is unlikely to ever progress beyond a localized tumor. This has caused many studies and data crunching to evaluate whether mammograms have actually lowered the breast cancer death rate.
It is clear that the final answer is not in yet. I suspect a more stratified evaluation guideline will eventually emerge regarding when and how often to get mammograms, and how having a higher risk for this disease will change that testing algorithm. For now however we are stuck with getting yearly or bi-yearly mammograms. I cannot help but believe that in many circumstances, a mammogram can discover a cancer earlier than it otherwise would have been discovered. In so doing, treatment would theoretically be kinder and gentler than the mastectomies and blasting radiation and chemotherapy of the 70′s and 80′s.
An interesting new study has introduced the use of a modality that is still somewhat controversial within the conventional medical community. It has been considered an alternative testing strategy, but this study raises its value.link to study***
Thermoscans have been around for a while and utilize the heat of blood flow to look for areas of growth within breast tissue. It does not use radiation, but an infrared technology. A growing cancer requires a blood supply that is otherwise not present to that degree in normal breast tissue. There for, an increased heat signal could indicate a growth. This will hopefully become a more accepted screening method within the medical community as it may give different information from standard mammograms.
Regardless of your personal feeling regarding breast cancer screening, it is wise to speak with your provider about your risk factors and determine a schedule and modality that is safe and effective for you.
Mammograms are part of most women’s health screening if they are over 40. Mammograms are never enjoyed, often feared for the information they may give forth; but usually endured on a regular basis. Woman are often relieved, if not happy; when they get their letter stating everything is fine for another year at least. Until now, most women were not routinely told if their breast tissue was dense and may limit the sensitivity of mammogram screening.
Mammograms detect a cancer by evaluating the density of normal breast tissue, and looking for an area of higher density which may represent an area of growth. Normal breast tissue is usually not all that dense by the time we are menopausal, and this is a normal changing associated with age. Any area that appears more dense than most the surrounding tissue is then felt to be abnormal, perhaps suspicious for a cancer. This is one reason that mammograms in younger women are usually not very good at picking up a cancer, as the breast tissue in younger women is usually fairly dense.
There are some women that do maintain density in the breast tissue as they age. Estrogen is one of the causes of breast tissue density, so it stands to reason that late onset menopause can cause breast tissue to remain dense because of prolonged amounts of estrogen in the system. For the same reason taking HRT can also cause breast tissue density. This, in and of itself is not a problem; except for the fact that screening accuracy can be affected.
If you have dense breast tissue, and you are at increased risk for breast cancer; you may want to talk to your provider about different forms of breast cancer screening such as MRI or ultrasound of a specific lump or mass. It is now required in some states that a patient be informed if her breast tissue is dense enough to limit sensitivity of screening.
Mammograms continue to be a useful and sensitive screening tool for detection of breast cancer. Like anything though, it has its’ limitations. They may be painful and a dreaded event; and many specialist would point out the amount of over diagnosis that a false positive mammogram causes. It is up to you and your provider what you do for screening and how often this screening occurs.
What are you doing about mammograms? Is your doctor recommending you get one yearly, every few years, or how often? Does he or she believe in the recent guidelines or do they think you should be screened more often? Anne weighs in with some advice for women in menopause.
What do you think? How should it be done for you? Join in our conversation here. You can find Mammogram guidelines at the National Cancer Institute, and the USPSTF
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There are many ways to evaluate breast tissue for cancer.
Which modality is used in which situations when screening for breast cancer or evaluating a breast lump? Thank goodness we have ways of evaluating for breast cancer. Many women are concerned about the amount of radiation involved in mammograms.
When an area of concern is found,
- what type of study is appropriate to fully evaluate this area?
- d0 we need to do anything at all?
For decades we have had conventional mammography which utilizes X-rays (radiation) to look for areas of increased density within breast tissue. This is how many breast cancers will appear, as an area of increased density within the less dense breast tissue.
Because their breast tissue is already very dense, mammograms are not as useful in young women who find a mass in their breast. It is more difficult to detect a difference in densities. This is one situation where ultrasound is useful.
Ultrasound utilizes sound waves to penetrate breast tissue. These sound waves bounce against different structures and give a characteristic “signal” which can help to determine if a lump or mass is solid or fluid filled. Fluid filled is usually benign, solid CAN be a cancer but may also be a fibroadenoma (a benign problem). Ultrasound is also used in menopausal and post menopausal women to further evaluate a mass, in addition to mammograms.
Digital mammogram is a newer technology with utilizes X-rays as in conventional mammograms, but is analyzed more effectively and gives a greater detail. Many radiology practices use digital mammography for routine screening as it is more exact. Digital mammography generally involves less compression, and is therefore less painful. It does tend to be more expensive but may very well be worth it as there is less follow-up for questionable areas not well seen on conventional mammography.
MRI of the breast. This gives the most detailed picture of breast tissue. The MRI machine is very large and logistically would be unable to screen the numbers of women that are regularly screened in mammography suites. MRI utilizes a magnetic type process and does not involve radiation. It is used primarily in staging of breast cancer or in patients who are at a high risk for breast cancer. It is extremely expensive and unfortunately at this point in time, not practical for mass screening.
It is important to understand the reasons different screening modalities are chosen, and to understand that although mammograms do involve radiation, they are the most practical screening method to use. Many experts report figures that indicate the standard radiation exposure of a mammogram is equal to 3 months of normal environmental exposure. This does not seem like much unless you are someone who has had a lot of radiation already, or have a very strong family history of cancer. It is important to know there are other options of evaluation of breast tissue and it is important to speak with your provider to decide which method is best for you.
What has been your experience with breast cancer screening? Do you have questions about when to do it or how it is done. Let me know in the comments section.
Remember all the controversy about mammograms?
When should a woman begin to have them and how often. It seems that there is no formula in medicine. What is the woman’s risk factors? What sets her up to have a breast tumor? We have written about this topic in posts on Breast Cancer tests for the type of Chemotherapy,
Now there is a news article about the science behind the guidelines. It is confusing when you try to apply a formula and not do what is best for patients. Some women obviously need screening earlier and some can wait. Click on the link to read more about the opinion of a Harvard Radiologist.
We all know that many women in menopause tend to gain weight. There are multiple factors for this that we have documented and some Ways to Eat we recommend to help with this problem. This news article on Weight gain after 50 being related to Diabetes after age 65 is one of a long list of reasons to become an expert on controlling your own eating and exercise habits.
What are your Challenges? Leave us a comment and tell us what you think, want and need.
Women everywhere, who have heard the news about the new recommendations for Breast Cancer Screening, have strong reactions. It appears that the scientific evidence for what we do is just not there and it goes to show how little real solid research has been done on the real health issues that affect women. Bruce and I review the guidelines and I give my strong opinion on what I will have my patients do about Breast Cancer screening exams.
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