Breast Cancer Screening...

"Yes...I did have my Mammogram today...
Why do you ask?"

For detecting breast cancer

Mammography is simply a breast x-ray. It allows the x-ray specialist, or radiologist, to see the internal structures of your breasts without the need for injection of dyes or contrast materials. A breast cancer screening mammography can uncover unexpected problems in women with no other symptoms.

Diagnostic mammograms -- which are conducted in virtually the same manner -- help identify a lump or other change found during a BSE or clinical breast cancer screening examination.

Your doctor may recommend the use of mammograms earlier or more frequently than usual if there's a reason to believe that you are at higher than average risk. Increased breast cancer screening may be warranted, for instance, if you have a family history of breast cancer (a mother, sister, or daughter with the disease).

You are also at greater risk if you have never been pregnant or had your first child after age 30, began menstruating early, or had a late menopause.

Radiation exposure from a mammogram is minimal. There is much evidence to support the belief that the benefits of detecting and successfully treating early breast cancer far outweigh any hypothetical risks from the x-ray -- especially for women over age 50.

The US Food and Drug Administration maintains a listing at its web site of all certified mammography facilities. Federal regulations required all of them to meet national quality control standards and receive federal certification. When scheduling a mammogram, double-check to be sure the facility observes these standards.

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What To Expect...

Mammography requires no special dietary or physical restrictions, though your doctor may advise you not to use deodorant, talcum powder, or skin lotions on your breast or underarms on the day of the test.

You should also wear a two-piece outfit, since you'll have to undress from the waist up. You may feel nervous, frightened or embarrassed by the idea of disrobing to the waist and having your breasts manipulated for various x-ray views. Don't hesitate to voice your concerns to your physician and the mammography technologist prior to the procedure.

Ask the technologist to explain before your breast cancer screening what to expect. Many of these professionals are sensitive to a woman's desire for modesty and a sense of self-control.

During a mammogram, each breast will be gently flattened between two plastic plates so all of the tissue can be viewed. The x-ray machine will send a tiny amount of radiation through your breast to create an image. Generally, breast cancer screening mammograms include two views of each breast -- from the top and from the side -- and take only 20 minutes to complete.

Although mammography is relatively painless, some women feel uncomfortable because the breast is compressed during the procedure. This pressure is necessary to obtain good detail of the breast on the x-ray film and only lasts a few seconds.

Though mammography is effective at any time during the menstrual cycle, women who are still having periods may want to schedule the procedure a week after their period, when their breasts are less swollen and tender, and avoid mammography during the week before their period.

Be sure to ask your doctor when the test results will be available. A long delay causes many women intense anxiety; so, many hospitals and women's health centers have responded with full-service screening programs that offer results within 30 minutes of the test.

Your doctor or the radiologist who reads the x-ray films should be on hand to talk with you about the results. If any additional views are necessary, you can often have more x-rays taken on the spot. Your doctor can also schedule procedures such as a biopsy within 24 hours.

Federal law now requires that women must be informed of their breast cancer screening results in writing. The law was passed because of reports that some health care providers did not tell the patient about suspicious findings.

Women with breast implants should also follow regular screening guidelines for mammography. Tumor detection is more difficult after breast enlargement, especially in women who have developed scar tissue around the implants, have their implants in front of muscle, or have little breast tissue to begin with -- which is often the case after implant surgery.

The mammogram should be taken with a more thorough technique called a "modified compression view," since both saline and silicone implants can obscure x-rays.

It's important to tell your mammography technologist that you have breast implants so that he or she can exercise special care during the test. The radiologist will take several low-dose x-rays of each augmented breast, pushing the implant away from your breast tissue to get the best possible views. The technique requires more time than a basic screening mammogram.

Mammography itself is very unlikely to rupture the implant, though it sometimes detects preexisting damage. Nevertheless, ruptured implants often appear normal on mammography, so magnetic resonance imaging (MRI) is recommended if an implant needs to be checked.

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New Tools For Detection:

Because mammography does not detect all cancers, researchers are studying other ways to screen women. New methods for breast cancer screening include magnetic resonance imaging (MRI), digital mammography, computer-aided diagnosis, and computed tomography laser mammography.

MRI uses magnetization and radio waves, instead of x-rays, to produce detailed images. This test does detect some abnormalities not seen on a mammogram. However, it is less accurate than routine mammography in determining whether the abnormal areas are cancerous. Researchers are continuing to refine technology for breast MRI.

Digital mammography differs from the standard technique in the way the image is recorded, viewed by the doctor, and stored. Standard images are recorded on large sheets of photographic film; digital images are captured electronically and viewed on a computer monitor, allowing radiologists to manipulate the images and, hopefully, miss fewer cancers.

A one-and-a-half year trial showed digital mammography to be at least as accurate as standard films, and prompted the FDA to approve the technique early in 2000. Many experts believe it will eventually become the preferred method for breast cancer screening.

Computer-aided diagnosis harnesses computers in the search for abnormal areas on a mammogram. The program analyzes a digitized version of the mammogram, then displays the image on a video screen, with markers pointing to areas it "thinks" the radiologist should check especially closely.

Preliminary tests have shown that the system can locate cancers that a doctor would find. However, critics are concerned that the technique may lead to unnecessary biopsies by falsely identifying benign abnormalities as suspected cancers. The FDA has already approved one of these systems.

CTLM uses laser technology to produce a three-dimensional image of the breast that radiologists can manipulate on their computer screens. The scans are done easily and cause no discomfort. However, CTLM is still under evaluation in clinical trials, and is not yet available for general use in breast cancer screening.

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Breast Lumps: Diagnosis & Testing

If any lumps are found during an examination and screening, your doctor will need to do additional tests. At this point, you should remember that only about 20 percent of biopsied breast lumps are cancerous. Even malignant masses, when diagnosed early, respond very favorably to treatment.

If surgery is required, often removal of the lump and a small amount of surrounding tissue is all that's necessary. And, most women treated for early breast cancer do not experience a recurrence.

The first step will probably be a diagnostic mammogram to assess the mass. If this raises any suspicion of breast cancer, your physician may recommend one or more of these additional breast cancer screening tests:

Ultrasound sends high-frequency sound waves into the breast, then converts the echoes from those waves into an image of the breast's interior.

Ultrasound is an accurate way of distinguishing between solid and fluid-filled lumps; but it cannot detect small calcium deposits that may indicate cancer, and it does not identify small tumors. If your doctor discovers a suspicious lump during pregnancy, ultrasound may be a preferable breast cancer screening to a mammogram for the sake of the baby.

Needle aspiration determines whether a lump is solid or fluid-filled. If the lump is a cyst, the doctor drains the fluid and sends it to a laboratory to check for the presence of cancer cells. The procedure is generally done in a physician's office or clinic using a local anesthetic, and further treatment is rarely needed.

Needle core biopsy (also called stereotactic breast biopsy) is used to remove a core of tissue from a solid lump. Using a computerized x-ray technique, your doctor will guide a needle into the suspicious breast area to obtain a sample for microscopic examination.

The procedure uses a local anesthetic, leaves no scar and is considered highly accurate. More and more physicians are choosing this breast cancer screening technique to confirm a diagnosis and develop a treatment plan.

Surgical biopsy is still the predominant method of confirming a suspicion of cancer. After removing the breast lump surgically, your doctor will have the tissue examined under a microscope. You can usually have this procedure done in a walk-in care center under local or general anesthesia and go home the same day.

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Best Breast Tests:

These breast cancer screenings increase your odds of detecting cancer early.

Self Exam:

Who it's for:

All women, starting in their 20s, should be doing a self check. It will get you well acquainted with your breasts so you can identify anything out of the ordinary.How often you should do it:

Once a month. Some experts say self exams aren't strictly necessary, but there is no harm in checking. Not all lumps are palpable, but some are, so we say, feel away!How it works:

Perform each of these steps with your arms at your sides. Then do them again with each arm raised. You can even feel for irregularities while you're in the shower.

• Feel for lumps. Imagine pressing on a bag of grapes: It may seem a bit lumpy in some areas, but a small rock in the bag would stand out. Visit your doctor as soon as possible if you sense something unusual.

• Examine your nipples. Look for an inverted nipple, color changes, a rash or discharge. Cancer rarely causes soreness, so pain in the absence of a lump is probably nothing to worry about.

• Scan your skin. One kind of breast cancer results in dimpled skin that resembles an orange peel, caused by cancer cells that block lymphatic vessels.

• Lie down so your breasts spread out. Probe the region next to your armpit, which many women forget to check. If you feel something lumpy in one breast, check the other side. A bulge in the same location is probably nothing, but if it's new, contact your doctor right away.

About 25 percent of breast cancers are first detected by a physical exam (try either of the two methods shown below). But don't skip your mammograms! They may find a smaller lump than a physical check, and the earlier a tumor is detected, the better your chance of survival.

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Clinical Exam

Who it's for:

All women, starting in their 20s, should have a physician examine their breasts. Trained fingers could locate a lump you might miss.

How often you should do it:

During your annual checkup. Your gynecologist should routinely perform it when you see her. Go ahead and remind her if she forgets.

How it works:

Just as in your self exam, the doctor checks skin and nipple texture and looks for color changes, discharge, a rash or lumps. Your GP can give a breast exam, too.

Need to know:

If your doctor says everything seems fine, take a minute to feel your breasts so you know what she considers normal and healthy. Use this opportunity to ask her questions ("Is this bump normal?") and show her how you perform your self exam to make sure you're doing a thorough job. If she spots something suspicious, she'll schedule you for a mammogram or ultrasound breast cancer screening.

Mammogram

Who it's for:

All women, starting at age 40, should have a mammogram (a breast X-ray). Women with a family history of breast cancer (an immediate relative such as your sister or mom had it) should start 10 years earlier than the relative's age at diagnosis.

If your mom was diagnosed at 42, get one at 32. If there is anything unusual, your doc will schedule you for a diagnostic mammogram to hone in on the suspicious spot.

How often you should do it:

Once a year.

Regular breast cancer screenings will increase your chances of finding a cancerous lump early, when treatment may be most effective.

How it works:

Mammogram breast cancer screeings are done standing up. A technician places one breast at a time between two plates that compress it for about 30 seconds while X-rays are taken. It's not so bad: Imagine sticking your breast in the middle of a Harry Potter opus and pressing the book closed slowly.

Don't wear deodorant on test day; on X-rays, the powder can look like white calcification flecks (calcium deposits in your breast ducts that suggest cancer). Learn about discount exams at 800-IM-AWARE.

Need to know:

Although the mammogram is the best general breast cancer screening test, it's only about 80 percent effective at finding cancers. More hospitals are investing in computer-assisted detection, software that does a second read of the mammogram film.

CAD may pick up another 5 to 6 percent of missed breast cancers and is particularly effective at spotting calcifications. Another key issue: The screen doesn't work as well in younger women because their breasts tend to have less fatty tissue, making them denser.

Because dense tissue and cancer both show up as white on an X-ray, picking out cancer is that much harder. (They may be asked to have an ultrasound instead.) Women with the breast cancer gene may also opt for an ultrasound or MRI breast cancer screening because their lumps develop at a younger age, when their breasts are denser.

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Ultrasound

Who it's for:

Women with a suspicious lump who have had an inconclusive mammogram and/or those with dense breasts

How often you should do it:

Only when your doctor tells you that you need one

How it works:

Ultrasound uses high-frequency sound waves to show the breast interior, creating an im-age on a computer screen. The visual helps doctors determine whether a lump is a fluid-filled cyst or a solid mass (possibly cancer). You'll lie down on an exam table and have cold gel applied to your breast; then your M.D. will gently move a probe over your skin.Need to know:

Ultrasound can't pick up calcium deposits in your ducts, which are often the first indicator of breast cancer.

MRI

Who it's for:

Women at high risk, as well as those with implants, dense breasts, or women who have had an inconclusive mammogram or ultrasound breast cancer screening.

How often you should do it:

Only when your doctor tells you that you need one.

How it works:

During an MRI, you lie perfectly still in the tube of a large, noisy machine that uses magnetic fields to create an image of the breast. You'll be in there for about an hour.

Need to know:

MRIs are 96 percent effective at finding cancer, the highest rate of any method. So why not use them first for detection? Because they pick up many false positives, as well, leading to unnecessary biopsies and emotional trauma. Unless you're at high risk, you're better off getting a mammogram breast cancer screening.

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