The summer of 2007, I realized it had been eighteen months since my last mammogram and clinical breast exam. As a mammographer, I felt I should practice what I preached. So, I made an appointment with my doctor for a physical. My clinical breast exam was normal so my doctor wrote an order for a screening mammogram, which I had the Friday before father’s day.
The hospital where I worked still used film-screen technology then. So, after my co-worker performed the exam at the end of the day, I waited with her by the film processor and watched as she hung up each film. And there, right next to my chest wall was a tiny, spiky lesion that was not there on prior exams. I knew from having seen other lesions like it that it was most likely cancer, and my heart dropped.
The radiologist had already left for the day, so I had to wait until Monday for him to read my films.
The following Monday, I went into his office and told him I wanted him to be honest. By then, I’d had the entire weekend to consider all possibilities and I was prepared for the verdict. If this were cancer, we’d caught it early. There was NOTHING there eighteen months earlier.
The radiologist said he was 80% sure it was going to come back positive for cancer but he wanted additional imaging before he suggested a biopsy. On June 21, 2007, I had a diagnostic mammogram that confirmed the radiologist’s suspicions. He recommended a biopsy.
Because I work in a hospital that performs breast needle localization procedures and biopsy, my doctor and radiologist worked with the surgeon and got me on the OR schedule for the following week. And on July 3, 2007, I got the confirmation I had been dreading. I had breast cancer.
For the next five months, I underwent more surgical procedures, a breast MRI, chemotherapy, and radiation. I had a surgically implanted port-a-cath and I lost my hair. But all treatments ended the week before Christmas 2007 and I was declared “cured.” Which really means, I didn’t have any known cancer in my body.
Since being declared cancer-free, I have spent the last six years following up with oncologist and surgeons. I’ve had two more biopsies (done stereotactically with no visible scars) that were both negative, and I have x-rayed hundreds of other women’s breasts. I’ve heard their stories, assisted with their needle localizations before their surgeries, and I have read countless women’s pathology reports. And at the facility where I work, it seems as if breast cancer is on the rise.
Since 2007, most hospitals and imaging centers have changed from analog film to digital systems, which is more sensitive. I like to tell my patients that the good thing about digital mammography is that is shows everything. And the bad thing about digital is that it shows everything. More patients are being called back for follow up (diagnostic) studies following screening mammography because the radiologist is seeing more on the images than was clearly visible on film screen. With digital mammography, the radiologists are also able to use a computer software program called CAD–computer aided detection–which highlights possible abnormalities on the mammogram. It’s commonly known as a “second look” and it’s like having two doctors look at the images and decide if additional images are needed.
Since 2007, there have also been medical advances in imaging studies and increased sensitivity of tests used by the pathologist when looking at specimen slides and cells to determine the presence of cancer cells. This could possibly account for the increase in breast cancer diagnosises. Then again, can we discount the increase use of hormones in our food supply? Or the pharmaceuticals that have been flushed into our rivers and streams for decades?
In 2007, 70% of new breast cancers were in women with no family history of the disease. In 2012, the percentage rose to 80%. Is the rise due to an increase awareness and more women having mammograms? Or something else?
One thing is clear. Knowing your family history, performing self breast exams and having a yearly clinical breast exam is important, but it cannot replace a mammogram for the early detection of breast cancer. Although a mammogram cannot detect all breast cancers at an early stage, a mammogram in conjunction with a breast ultrasound and/or breast MRI when needed can increase a woman’s odds of catching breast cancer sooner. Once a breast cancer is palpable, the disease has already taken hold.
So, when should a woman have a mammogram?
With or without a family history of breast cancer, screening should begin at age 40, with yearly mammograms thereafter.
In patients with a mother diagnosed with breast cancer, an initial screening mammogram should be performed 10 years before the age at which the mother was diagnosed and every year thereafter following the patient’s 40th birthday.
In high-risk women–women with a BRCA gene mutation, women with a history of chest irradiation between the ages of 10-30, and women with 20% or greater lifetime risk of breast cancer should begin screening at age 25-30 or 10 years before age of first-degree relative with breast cancer was diagnosed or 8 years after radiation therapy, but not before age of 25. Mammography and MRI are complementary examinations, and both should be performed in high-risk patients according to the American College of Radiology guidelines for screening.
There are reasons doctors do not order mammograms on low-risk women under 35 without a palpable lump and why they normally request an ultrasound first on women under 25 before proceeding to a mammogram. The breasts of women younger than 35 are extremely dense and “lumpy.” The images are more difficult to read accurately and while radiation doses on mammography are low, it is still direct exposure to the breasts. The younger the patient, the more sensitive the tissue is to radiation. In most cases, palpable lumps in women younger than 35 are going to be cysts or other benign nodules such as fibroadenomas. These can usually be seen on an ultrasound and are most often diagnosed without the need for mammography. However, any woman 35 or older–regardless of family history should have a mammogram followed by an ultrasound if they feel a new or enlarging lump in their breasts. An any male who feels a lump in his breast should see a doctor immediately, as 1-2% of breast cancers are diagnosed in men.
Are you at risk for breast cancer? Use the breast cancer assessment tool to find out. http://www.cancer.gov/bcrisktool/ . And as always, if you are not happy or reassured by your physician’s recommendations, seek another opinion. It is your life and your choice.