Once again it’s October, Breast Cancer Awareness Month, which serves as a yearly reminder to hundreds of thousands of women who are of age to schedule their annual mammograms. There has never been a more important time to take your health seriously, especially when it comes to breast cancer, a disease that will directly affect an estimated 1 in 8 U.S. women in her lifetime. It is the most commonly diagnosed cancer in women (second to the skin) and accounts for 30 percent of all cancer diagnoses. In fact, this year alone, an estimated 268,600 new cases of invasive breast cancer are expected to be diagnosed in the United States, with 62,930 new cases of non-invasive (in situ) breast cancer, according to the nonprofit organization Breastcancer.org. “While we are finding cancers at smaller, more curable stages, and treatments have improved, sadly, about 40,610 women will die this year from breast cancer,” explains Kristi Funk, M.D., FACS, co-founder of Pink Lotus Breast Center and author of “BREASTS: The Owner’s Manual.”
Who is at highest risk?
We know now that those with inherited genetic mutations, such as the BRCA gene, as well as individuals with a strong family history of breast cancer are at a higher risk (even higher than the ‘1 in 8’ statistic). Still, these inherited genetic mutations only account for a mere 5-10 percent of cases, and only 13 percent of all women diagnosed with breast cancer have a single first degree relative with breast cancer. This leaves the near 80 percent of other diagnosed cases of breast cancer as caused by environmental and lifestyle factors that increase one’s risk, such as diet, exercise, alcohol consumption, smoking, estrogen exposure, birth control pills, stress and anxiety, and the list goes on.
Breast cancer will directly affect an estimated 1 in 8 U.S. women in her lifetime.
While these statistics are certainly scary, they serve as a reminder to be your own advocate when it comes to your health. And the most effective way you can do this is to stay on top of your yearly mammogram, a screening test recommended for women aged 40 and older and even younger for at-risk women.
What do mammograms do?
Although mammograms do not prevent breast cancer, they do allow for early detection, which can significantly reduce one’s chance of dying from the disease. “They are fast, cheap, widely available [since] most radiologists [are] able to read them, find cancer and they absolutely save lives,” says Funk. “As compared to ultrasound, MRI and your hands, mammography alone are best at finding suspicious calcifications, a harbinger for the earliest stage 0 cancers (DCIS) that never need chemo and never kill.” In fact, mammogram trials show that fewer women aged 40 to 74 die when receiving annual mammograms, averaging a highly significant 20 percent mortality reduction.
However, Funk points out that conflicting guidelines exist between different U.S. organizations and international recommendations about what age to begin mammography for those at normal risk, how often to perform it, and when to stop it. “To the committees assigned to set these guidelines, it all comes down to a cost/benefit analysis — how much downside (money, false positives, unnecessary biopsies, overtreatment, anxiety) should we tolerate to justify the upside of saving one life?” she says. “All options considered, assuming normal cancer risk, I side with The American Society of Breast Surgeons and suggest that you begin annual mammography at age 40, and don’t stop or skip years.”
Whether you are of age to start receiving yearly mammograms or not, here are some important facts breast cancer doctors want you to know.
A false-positive is a possibility
The most anxiety-provoking drawback of mammograms is the false positive, or when a mammogram detects breast cancer when it isn’t really there. However, Funk urges women to not let the fear of a false positive keep them from detecting curable cancer. To lower your chances of a false positive, she recommends timing your mammogram to the second half of your menstrual cycle (the two weeks before starting your period). “Your breasts appear less dense and feel less sensitive, allowing for more compression and a better image,” she says. Additionally, unclear findings occur in about 80 per 1,000 screening mammograms, resulting in an 8 percent chance of being called back for additional views. “Don’t fret if you are called back — 97 percent of callbacks are for benign things,” she says. “When you are called back, there is a 10 percent chance you will need a biopsy, and only two to three of those people will have cancer.”
Do research to find the right facility
You can trust your healthcare provider for recommendations and also do some work on your own. “There are several national organizations that accredit the quality of the breast centers that perform mammograms, so look for the following certifications: American College of Radiology (ACR), National Accreditation Program for Breast Centers (NAPBC), and the National Quality Measures for Breast Centers (NQMBC),” advises Richard Reitherman, M.D., Ph.D., medical director of breast imaging at MemorialCare Breast Center at Orange Coast Medical Center in Fountain Valley, California. If possible, try to get your mammogram at the same location every year, since part of reading a mammogram is to compare images from prior years. “If you go to the same center they will have images to compare and less variation in techniques,” says Janie Grumley, M.D., breast surgical oncologist and director of the Margie Petersen Breast Center at Providence Saint John’s Health Center and associate professor of surgery at John Wayne Cancer Institute in Santa Monica, California. “This can minimize uncertainty when interpreting findings on a mammogram.”
You may be told you have dense breasts
This is a term that signals that one breast has less fatty breast tissue and more non-fatty (fibro-glandular) tissue. There is nothing wrong with having dense breasts; however, it can make spotting cancer more difficult on a mammogram. “Dense breast tissue decreases the sensitivity in detecting breast cancer by mammography alone and therefore additional technologies such as tomosynthesis or 3D mammography and breast ultrasound may optimize your chance of early detection,” Reitherman further explains. “Having dense breasts also increases one’s risk of breast cancer, so it is important to know where you stand.”
If your doctor recommends an MRI, do it
While no one wants to undergo further testing, especially when it might lead to undesirable results, it is important to follow the plan of action recommended by your doctor. “We have seen women skip their MRI and then get diagnosed down the road,” says Nancy Elliott, M.D., breast surgeon and founder of Montclair Breast Center. “We always wonder if it could have been caught earlier and if they could have avoided chemotherapy.” With early detection, sometimes all women need is a lumpectomy and a pill for five years, she explains.
Choose the right day to schedule your mammogram
Ideally, you will want to schedule your mammogram on a day when your breasts are not tender. “A mammogram will compress the breast tissue between two plates in order to obtain quality images,” says Sara Veldman, M.D., radiologist and imaging specialist with Allina Health Piper Breast Center in Minneapolis, Minnesota. If you are lactating, breastfeed or pump before your mammogram. She also recommends letting your doctor know if you have any concerns prior to scheduling your mammogram. “Your doctor might want to see you first and examine your breasts before you have your mammogram,” she says. “Refrain from using deodorant or creams on your breast the day of your mammogram, as this can create artifact on your images.”
Mammograms don’t replace self-checks
It is still important to regularly examine your breasts for any changes, and particularly for any lumps or bumps. If women feel a lump or have breast symptoms, they should see a medical professional before their mammogram. “A screening mammogram is designed for people without symptoms,” says Grumley. “A different type of imaging is needed for patients who have breast symptoms, so seeing a medical professional will help them get the appropriate study.”