SCREENING FOR BREAST CANCER

Breast cancer is the second-deadliest cancer in women. This year, about 200,000 women will be diagnosed and more than 40,000 will die from the disease. Most cases of breast cancer can be detected through mammography before it causes any symptoms. The earlier breast cancer is discovered, the greater a woman’s chances for survival.

Screening mammograms are conducted in women who have no signs or symptoms of breast cancer. A mammogram is an x-ray of the breast in which the breast is squeezed between two plastic plates attached to a specialized machine. This squeezing ensures that the tissues will be spread apart to produce a better picture and allows the radiologist to use a lower x-ray dose. Many women worry that the compression will be painful but, while it often causes some discomfort, the squeezing only lasts for a few seconds.

The most common form of mammography is a conventional mammogram in which the x-ray pictures are printed onto film. Rapidly growing in popularity, digital mammography is similar to a regular digital camera in that images are produced on a computer screen rather than printed to film. In a computer-aided detection (CAD) system, an image is obtained from either a conventional or a digital mammogram. A computer software program then scans the image for abnormal areas that may indicate the presence of cancer.

A diagnostic mammogram is different than a screening mammogram because it is used for women who have a sign or symptom of breast cancer like a lump in the breast, nipple discharge, skin thickening, or an abnormal screening mammogram. While a screening mammogram usually involves two x-ray views of each breast, a diagnostic mammogram requires more x-ray views of each breast to look at the breast from several angles. The radiology technician will probably use magnification techniques to thoroughly investigate the area of the breast that was abnormal on physical exam or screening mammogram.

The role of screening mammography is to identify a large number of women who may have breast cancer so that as few women as possible who have the disease are missed. As a result, a large number of women who do not have breast cancer will have an abnormal screening mammogram result. Out of 1,000 women, about 100 will receive an abnormal result and be called back for a diagnostic mammogram or other studies. Only 10 percent or fewer of these women will require a biopsy and most of these will not be cancerous. On the other hand, screening mammography does not identify all cases and, in fact, misses 10-15 percent of breast cancers. To increase the rate of detection of breast cancer, in addition to screening mammography, women should have a clinical breast exam once a year by their doctor and may also benefit from monthly self-breast exam.

Many medical associations including the American Cancer Society, American Medical Association, and the National Cancer Institute recommend starting routine screening at age 40. Most groups recommend that women obtain screening mammograms every one to two years between ages 40-49 and every year after age 50. Not everyone agrees about when a woman should stop receiving mammograms but some suggest that women over the age of 70 should receive screening mammograms if their life expectancy is at least 10 years.

For the best mammography experience, you can follow some simple tips. Do not wear deodorant or lotion on the day of your mammogram. These substances can produce confusing images on your mammogram pictures and may lead to misdiagnosis. Remember that you will need to undress from the waist up and so may find a two-piece outfit most convenient. Your breasts may be tender in the week or two before your period, so having your breasts compressed during this time may be more uncomfortable. Try to schedule your test during the week after your period.

If you do not have adequate health insurance or cannot afford a screening mammogram, the Mammogram Voucher Program (MVP) through the American Cancer Society can provide free care throughout western Pennsylvania. In addition to screening mammograms, this program covers most testing that may be required if you have an abnormal screening mammogram. The MVP can be reached by calling 1-888-MVP-0505.

Dr. McMahon, a graduate of Yale University and the University of Pittsburgh School of Medicine, is board certified in Internal Medicine. She is a member of the American College of Physicians and the Allegheny County and Pennsylvania Medical Societies. She is in solo practice in the North Hills of Pittsburgh.