Mammograms are still the best screening exam for detecting breast cancer early.
By Carol Sorgen
Reviewed By Brunilda Nazario
>Mammograms aren't perfect, but they're still the best tool we have for detecting breast cancer in its early -- and most curable and treatable -- stages. That's the message breast cancer specialists want women to hear -- and to heed.
"Mammograms detect only 85% of breast cancers," says Lauralyn Markle, MD, medical director of MemorialCare Breast Center at Saddleback Memorial Medical Center in Laguna Hills, Calif. But 85% is a formidable number when it comes to such an important screening test, she explains.
Because mammograms aren't foolproof, they are considered one part of a three-pronged breast cancer detection program for women, along with monthly breast self-exams and a clinical exam conducted by a health care provider.
Seventy-five percent of breast cancer patients have no family history of the disease, Markle tells WebMD, emphasizing how important it is for all women to follow the generally accepted recommendations of an annual screening mammogram, annual clinical exam by a health care professional, and monthly breast self-exam.
Begin Screenings at 40
While there has been debate in recent years on when to begin receiving screening mammograms and how often to have them, many organizations and health care professionals -- including the American College of Radiology, the American Cancer Society, the National Cancer Institute, and numerous national women's groups -- recommend that women begin mammography screening by the age of 40, or as suggested by their physician. These groups also recommend clinical breast examinations by a health care professional every three years between the ages of 20 and 40, and every year for women 40 and over.
If you have a family history of breast cancer, see your physician for advice about your individual situation, Markle advises.
It's especially important for women in their 40s and 50s to receive an annual mammogram because breast cancer that strikes in younger age groups tends to be faster-growing. Breast cancer can also appear in just a year, Markle says, so if you skip your yearly mammogram, any cancer that might be there has that much more opportunity to grow.
"The whole point is to find the cancer early when it's curable," Markle emphasizes.
Where to Go
Your mammogram should be performed at a center that specializes in breast care, Markle adds. "There should be technologists and doctors whose specialty is mammography ? going somewhere where they just do a few a week doesn't cut it."
If you do not live near a major breast center, you can have your mammograms sent out for a consultation, Markle notes.
Mortality Rate Declines
According to the American College of Radiology, the breast cancer mortality rate has declined by nearly 20% since 1990, due in large part to more emphasis on regular mammograms and improved treatment options. Still, not enough women are including mammography in their health care routine, especially women in high-risk groups including minorities, older women, and women with low incomes.
"Women have a lot of reasons for not getting a mammogram," says Cheryl Perkins, MD, senior clinical advisor to The Susan G. Komen Breast Cancer Foundation. "They're too busy; they don't have cancer in the family; they're afraid; the mammograms are painful; they can't afford them."
There is no good excuse, however. Many health care centers, for example, offer free or low-cost mammograms to women who can't afford them or do not have health insurance. And if you're concerned about the discomfort of a mammogram, you are encouraged to talk to the technologist beforehand and voice your concerns. "You should feel some pressure, but a mammogram shouldn't be excruciatingly painful," Perkins tells WebMD.
New Technologies Aid Effectiveness
While mammography is still the mainstay of breast imaging, adjunct technologies are being used to increase its effectiveness, says Elizabeth J. Angelakis, MD, chief of mammography at Lahey Clinic in Burlington, Mass.
Computer-aided detection (CAD), for example, serves as a second pair of eyes in reading a mammogram. Some radiologists use a computer to help spot breast cancers on mammograms; these techniques highlight suspicious areas. Digital mammography allows an image of the breast to be manipulated electronically. By zooming in areas or magnifying other parts of the breast, this technique may offer some advantage over standard mammogram. They do not however improve the rates of detection of breast cancer.
Breast ultrasound and breast MRI (magnetic resonance imaging) may also be used in conjunction with mammography but as of yet do not replace mammography as the primary method of screening for breast cancer.
A study that appeared in the Sept. 15 issue of The Journal of the American Medical Association (JAMA), however, reported that Canadian researchers have found that breast MRIs may offer better results than mammography for women at high risk.
In a six-year survey of 236 Canadian women between the ages of 25 and 65, all of whom carried the BRCA1 or BRCA2 genes (meaning they have up to an 85% lifetime risk of developing breast cancer), the scientists screened the women annually using four different methods: MRI, mammography, ultrasound, and manual exams. During the course of the study, researchers found 22 cancers. The breast MRI found more than 75% of those, while mammography and ultrasound found only a third. Breast exams found less than 10%. MRIs also detected the cancers at an earlier stage, before they had widely spread.
Because the study focused only on women with the BRCA gene, researchers aren't certain whether MRI is a better diagnostic tool for women who don't carry the gene.
Research continues on other new technologies as well, including laser imaging. Clemson University physicist Huabei Jiang is currently leading a five-year $1.38 million research project funded by the National Institutes of Health to study a laser-imaging system that would provide more accurate views of breast tissue. Early testing showed the system able to detect some growths not detected by a mammogram. It also successfully predicted whether tumors were benign or malignant, which could lead to a reduction in the large number of biopsies performed in the U.S. each year. If the imaging system is proven successful in clinical trials, it could be a viable addition to mammograms in the next several years, says Jiang.
"Each imaging method offers additional information that, when used properly together, can be very effective in evaluating breast tissue," says Angelakis. But "with respect to the direction of breast imaging, "I think that mammography will maintain its position as the first line of defense against breast cancer, but that the addition of new methods will aid in its early detection."
Published Sept. 27, 2004.
SOURCES: Lauralyn Markle, MD, medical director, MemorialCare Breast Center, Saddleback Memorial Medical Center. Cheryl Perkins, MD, senior clinical advisor, The Susan G. Komen Breast Cancer Foundation. Elizabeth J. Angelakis, MD, chief of mammography, Lahey Clinic. News Release, American College of Radiology, "ACR Actively Participates in National Mammography Day and Breast Cancer Awareness Month." News Release, Clemson University, "National Institutes of Health Green Lights Additional Research Into New Breast Imaging System." Journal of the American Medical Association, "Surveillance of BRCA1 and BRCA2 Mutation Carriers with Magnetic Resonance Imaging, Ultrasound, Mammography, and Clinical Breast Exam."
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