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Reason
for Mammography
The reasoning behind going for regular mammograms
is based on two simple facts: 1) every woman is at increased
risk for breast cancer as she ages, even without a family
history of the disease; and the strongest argument for getting
a regular mammogram is 2) its ability to detect breast cancer
up to two years before it becomes palpable. With early diagnosis
women have the advantages of both more conservative treatment
and a better chance for survival.
Detecting a mass on a mammogram doesn’t
guarantee a cancer diagnosis. In fact, approximately 85 percent
of all breast lumps are benign and are often the result of
poor nutrition; smoking or inhaling second-hand smoke; alcohol
consumption; excessive caffeine consumption; or hormones,
with symptoms becoming more noticeable just prior to menstruation.
Cysts and fibroadenomas are
the two most common benign breast masses. Cysts are
moveable, fluid-filled lumps that may be tender to the touch
or quite painful depending on their size and location. Women
with cysts are often referred to as having fibrocystic breasts,
“lumpy breasts”, or the misnomer “fibrocystic
disease” — it’s a condition not a disease.
Fibroadenomas are smooth, marble-like
breast tumors that show up clear on a mammogram. Most commonly
found in women in their 20s and 30s, fibroadenomas range in
size from microscopic to several inches, and should be monitored
for change on a regular basis. Two instances where removal
is advisable are when they grow large enough to distort the
breast’s shape, and when detected in middle-aged or
older women to rule out breast cancer.
POSSIBLE
PROCEDURES
One or more of the following procedures
may be done to rule out a malignant mass.
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In instances where the lump is not clearly
definable a physician may schedule a sonogram, a
non-invasive method of determining whether the lump is solid
or fluid-filled. A technician performs this procedure using
ultrasound equipment. If the lump turns out to be solid the
doctor may want to aspirate it in the office, or send the
woman to a surgeon more familiar with performing fine
needle aspiration. During the procedure some cells and/or
fluid are drawn from the lump into a thin needle syringe,
and sent for analysis. Should both the sonogram and fine needle
aspiration prove to be inconclusive, then further scrutiny
would necessitate either a core needle biopsy, where
a piece of the lump or a portion of the breast tissue is removed
with a larger needle, or a surgical biopsy, —
almost always performed as a outpatient procedure —
where either part of the lump or the entire lump is removed
for analysis.
The breast tissue of menstruating women — whether young,
middle age, or close to menopause — shows up denser
on a mammogram than the tissue of postmenopausal women. This
density is due to the abundance of milk glands, ducts, ligaments,
and fatty tissue in the breasts and appears as cloudiness
on the mammogram, making it more difficult for a radiologist
to interpret. In certain instances a mass is seen on a mammogram,
but cannot be clearly identified as benign or malignant. This
opens up the possibility of either a false negative or false
positive reading. Both situations arise more frequently in
pre-menopausal women. A false negative reading occurs
when it’s decided that a breast lump located on a mammogram
is benign and no further testing is done, leaving the cancer
untreated. A false positive occurs when an area of the mammogram
is read as abnormal although no breast cancer is present.
As you might surmise, a false negative can result in inadequate
treatment for a mass that calls for further medical attention.
On the other hand, a false positive might necessitate a woman
undergo one or more procedures in order to verify if a lump
is cancerous when it’s actually benign.
In spite of these failures, the NIH estimate mammography locates
75 percent of breast cancers in women in their 40s versus
90 percent in older women. Therefore, it’s advisable
to err on the side of caution. Have that mammogram!
Many women look forward to getting older and entering menopause,
gladly relinquishing the burden of their monthly period. With
the cessation of menstruation, women’s bodies undergo
a number of physiological changes. Some of these changes become
evident in the breast tissue, including a decrease in density,
and an increase in fatty tissue. The good news is these changes
make it easier to differentiate between normal and abnormal
tissue, and consequently increase the effectiveness of a yearly
mammogram in diagnosing whether a breast tumor is present.
Unfortunately, a major problem exists — getting women
to go for their mammogram, especially menopausal and postmenopausal
women who are at greater risk. Women offer a variety of excuses
to avoid going for a mammogram (you may even have voiced a
few yourself) they include:
- Health care provider didn’t suggest
it
- Fear it will be painful
- Fear of finding a lump
- Fear of radiation exposure
- Lack of health insurance
- Lack of time
- Lack of transportation
- Lack of child care
- No perceived risk
- No family history
- Communication barriers
Some of the obstacles listed are poor excuses
for non-compliance. The remaining barriers can be overcome.
Every state and county has clinics and women’s health
care centers (many affiliated with local hospitals) that will
accommodate women dealing with a lack of health care coverage,
transportation or child care; limited financial resources;
or communication barriers. While no one would like to hear
those ominous sounding words, “you have breast cancer”,
the remaining reasons are simply invalid excuses for rejecting
a protocol that offers the peace of mind women feel upon learning
they don’t have breast cancer.
Alternative resources for information on free
mammograms are county departments of health, state medical
societies, local breast cancer coalitions, the American Cancer
Society, the NCI’s Cancer Information Service, or other
health and cancer affiliated organizations.
Awareness of the age at which women are at greatest
risk is not enough. The medical establishment cannot tell
us who will get breast cancer — even women with known
genetic abnormalities or first-degree relatives with the disease
may never receive a diagnosis themselves. For that reason,
we each need to do whatever we can to reduce our risk and
increase our chances for early detection. Because going for
a mammogram on a regular basis after the age of 40 is advantageous,
it’s clearly in the best interest of every woman to
do so.
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Going For A Mammogram
Now for a brief rundown on what to expect when
you go for a mammogram. Though each facility varies the procedure
slightly, they will usually begin by sending you to a dressing
room to remove your blouse and bra and replace it with a cotton
cover-up that opens in front. You will then be escorted into
the room containing the mammography machine, and asked to
remove one arm from the cover-up to facilitate the procedure.
The radiologic technologist will then position your breast
for the mammogram. The machine contains two parallel shelves,
one stationary and the other moveable. The upper shelf is
lowered to compress the breast tissue, and the breast is x-rayed.
The same procedure is repeated for the other breast. Typically,
two pictures are taken of each breast, one with the shelves
in a horizontal position, and the other with the shelves oriented
vertically. The entire procedure takes approximately 20 minutes.
The actual breast compression may cause discomfort,
but fortunately the time elapsed for each picture is only
a few seconds. Don’t worry if you’re told additional
pictures are required. Occasionally, they are needed if the
entire breast tissue was not visible on the x-ray, or if a
particular area needs further scrutiny — this doesn’t
automatically signal the presence of breast cancer. Upon completion
of the mammograms you may be asked to remain in the waiting
room for a short time until the results are determined. Keep
in mind, facility procedures and the services they provide
vary. While some facilities provide the results immediately,
others choose to notify patients by mail. A clinical breast
exam (CBE) may or may not be given. If you don’t receive
a CBE on the day of your mammography appointment, follow up
and schedule one with your gynecologist or a trained health
care provider shortly thereafter.
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Mammography Checklist
Okay, now you’re ready to schedule your
mammogram. Before making the appointment be sure you’re
familiar with the following information:
1) The facility should have American
College of Radiology (ACR) accreditation. All mammography
facilities are required, through the Mammography Quality Standards
Act (MQSA), to display certification from the FDA containing
the facility name and the approval period of time. Certification
means the facility has met the strict standards required for
the equipment, record keeping, reporting, and the employees
involved in the screening process. Prior to scheduling an
appointment ask whether the facility is FDA certified, and
look for the certification and the equipment expiration date
on display.
2) The individual providing the mammogram
should be a certified radiologic technologist, an individual
who is properly trained to perform this task.
3) Many women — particularly
those with cystic (lumpy) breasts — find their breasts
are tender, swollen, and sensitive to the touch prior to menstruation.
That’s why it’s advisable to schedule a mammogram
7 to 10 days after menstruation begins. Women on HRT should
determine which days of the month are most appropriate, or
ask their health care provider. While mammography may produce
some discomfort, it shouldn’t be painful. If the procedure
causes sharp pain, don’t hesitate to inform the technologist.
4) If you have breast implants it’s
important to advise the facility staff when scheduling your
mammogram. If the facility won’t accept patients
with implants ask for the name of one that does. When arriving
for your appointment, remind the staff that you require a
technologist specially trained to x-ray women with implants.
The technologist will then be certain to x-ray as much of
your breast tissue as possible.
5) A mammogram’s clarity can be altered by any
of the following — caffeine, powder, perfume, or deodorant.
It’s best to avoid caffeine for several days prior to
your appointment, and not to use any powder, perfume, and
deodorant on mammography day. If you are uncomfortable with
the idea of having to disrobe completely when going for a
mammogram, wear a two-piece outfit.
6) The physician reading the mammogram should be a
certified radiologist accredited by the ACR. Your
regular health care provider, or gatekeeper, is not necessarily
the best person for the job. It requires someone with extensive
training in this area with the ability to recognize critical
changes. Having the mammography films read by someone with
this expertise is especially important for women with dense
breast tissue, where irregularities are more difficult to
discern.
7) After receiving the results, if
you have any doubt about what you have been told, don’t
hesitate to take your mammograms, along with a copy of the
written report of the results, and go for a second opinion.
Though facilities may provide copies of mammography films,
if requested, they’re required to give you the originals
(Effective April, 1999 New York State legislation requires
that all mammography facilities provide original films upon
request. In addition, the facility cannot charge the patient
for copies they make for their own files. Check your own state
laws to see if there’s similar legislation). Keep in
mind, if you’re not given the results at the time of
your visit, the 1999 reauthorization of the MQSA, requires
that mammography facilities send women their screening results,
written in layman’s language, within 30 days or less.
If an area requiring further scrutiny is identified you should
be contacted by the facility within 5 working days or less.
8) Once you begin having regular mammograms
return to the same facility each year, unless you have a specific
reason for not returning, like having moved since your last
visit. When changing facilities, bring the originals
of prior mammograms to the new location. These will be compared
with the newest pictures, and serve to assist the physician
in recognizing important changes in the breast tissue. If
you go for a second opinion, bring your original films because
the clarity will be much better than copies.
9) You can either schedule your next
mammography appointment before you leave, or ask to be sent
a reminder card. It’s always a good idea to
mark your calendar with a reminder when you get home. It’s
suggested you call to schedule your appointment a minimum
of six months prior to when you need it since you may find
that you are unable to get an appointment when you need it.
Keep in mind that when circumstances demand
it each of us must advocate for our own needs. If you are
told your mammography results indicate no problem areas, but
intuitively you feel something is wrong, take the films and
go for a second opinion. If your health care provider doesn’t
cover costs for a second opinion (the majority of health insurance
carriers do pay for a second opinion), check with your county
Department of Health, and the other resources mentioned above
for the names of facilities that provide either low or no-cost
service. The bottom line is that you need to do whatever is
necessary in order to receive the best health care possible.
 Breast
Self Examination: Personal Care
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