While it’s no secret that early detection of cancer can greatly improve treatment outcomes, less than two-thirds of eligible women in the US have had a mammogram in the last two years. Dr. Alexia Matheson, an OBGYN resident at Monash Health, recognizes the need for greater participation in breast cancer screening. In honor of National Mammogram Day on the 18th of October, Dr. Matheson agreed to share some truths and debunk some myths surrounding mammograms.
1. Do mammograms use radiation? Is it dangerous?
Mammograms do use radiation, although only a small amount. The benefit from mammography has been found to outweigh any risk from potential radiation damage if you are over 40. The radiation from one mammogram is equivalent to flying from Sydney to London and back 5 times, or the amount of background radiation you are naturally exposed to over a 24-week period.
2. Do they hurt?
I’ll just be honest here: yes. For some women it’s mild discomfort for others it’s really quite painful. This is because your breasts are placed between two plates and which are pressed together in order for the breast tissue to spread out evenly. This is so that the radiologist can properly assess potential changes. The good news – the whole process only takes 10-15 minutes and then it’s all over.
3. What do most patients worry about when getting a mammogram?
Some patients worry about the discomfort, for others it’s a matter of feeling vulnerable during the screening process. Whatever your specific fears are, feel free to discuss them with your GP, or the staff at the screening clinic. It’s normal to be anxious but it’s worth the peace of mind you’ll have afterwards.
4. Has there been any new technology in breast cancer screening?
There are technologies out there besides mammograms, but only mammograms are currently recommended for screening.
One example is combining mammograms with something called tomosynthesis, otherwise known as a “3D mammogram”. For patients this feels like a normal mammogram, only it might take a bit longer. Several images are taken of the breast and are then digitally reconstructed to a 3D, rather than 2D, image. Because of this, the 3D mammogram is better at picking up cancers. However, when translated into clinical practice, the reduction in mortality is minimal and the amount of radiation the patient received is increased.
5. How do you do a self-examination?
There is no evidence that one particular type of self-examination is better than any others. Be aware of how your breasts normally look and feel. You can feel your breasts in the shower, laying down, in front of a mirror – just any way you feel comfortable. Gently feel for any lumps, thickened areas, skin changes or nipple changes. Be careful not to miss areas near your underarm as the breast tails up in that direction. If you feel anything different to normal, book an appointment to see your GP.
6. Do women need to do both self-examinations and mammograms?
Absolutely yes. While it is true that just over half of all breast cancers are found after a breast change is detected by the woman or her doctor, mammography is still the best early detection method available for reducing deaths from breast cancer. In fact, studies have found that there is no evidence that self-examination alone has any impact on reducing breast cancer mortality.
7. Do mammograms work on dense breasts?
It does work, but unfortunately is less sensitive, meaning there are more false negatives. People more likely to have dense breasts are young women and those on hormone replacement therapy. Sometimes your doctor may recommend a breast ultrasound rather than mammogram if this may be an issue for you.
8. Are mammograms necessary for women who have breast implants?
Yes! Mammograms are still important even if you have implants. However, things do become a bit more tricky – the implants may cover some of the tissue, so extra images will be taken which will expose you to slightly higher doses of radiation.
There is an extremely small chance that the pressure placed on the implant by the mammography machine could cause the implants to burst. There is also a small chance that mammography could change the shape of the breast, and not always are both breasts affected the same way. Overall, breast screening is still recommended, but you need to be aware of the added risks.
9. How accurate are mammograms?
This depends on your age, the older you are the better mammograms are at picking up cancers. This is because when women are younger, their breasts are denser, and cancers are trickier to detect in dense breasts.
In the 40-49-year age group, 64% of cancers are detected. In the 50-69 age group, 78% are detected and in the 70 and overs, 90% are detected.
10. What happens if a mammogram is abnormal?
Sometimes you may need further imaging to clarify the nature of the abnormality – for example an ultrasound or more x-rays. Not every “abnormality” means cancer. If there is something worrying about your scan, the next step is a biopsy to detect what type of cells are growing in the area of concern. This will direct what sort of treatment – if any – you need.
Thank you Dr. Alexia!
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