September 28, 2016
September 28, 2016
Louis Pacilio, MD
Lead Mammography Radiologist
Cooley Dickinson Hospital
There are two things every woman needs to know about breast health and breast cancer. First, there are a number of things you can do to maintain breast health. Second, mammography remains the best way to detect breast cancer in its earliest stages. Let’s talk about these.
Maintaining breast health is similar to many other healthy habits. Dental health, for example, requires regular brushing and flossing plus professional cleaning and checkups; bone health requires weight-bearing exercise, sufficient calcium and vitamin D, and not smoking.
I recommend four things for optimum breast health:
1. Know your family history. Make a list of relatives (both male and female) who have had various types of cancers and the ages they were diagnosed. Families with a strong history of cancer sometimes carry gene mutations that may increase the overall risk.
2. Assess other risk factors for breast cancer besides family history. The National Cancer Institute has a widely used risk assessment tool that can be completed online (http://www.cancer.gov/bcrisktool/). It’s important to note, however, that while a family history of certain types of cancer can increase the risk of breast cancer, 85 percent of women (and men) who are diagnosed with breast cancer do not have a family history of the disease, nor do they have many of the common risk factors.
3. Perform regular breast self-examinations. There are no major research studies showing the efficacy of monthly breast self-exams, yet we see many patients each year at Cooley Dickinson Hospital who have felt lumps on their own. It’s also helpful to ask your primary care clinician or OB/GYN to perform an annual clinical breast exam. This palpation (feeling the breasts for changes or abnormalities) is a good basic step to maintain breast health.
4. Talk with your primary care clinician about the screening guidelines for mammography. The only proven way to identify breast cancer in its early stages is through mammography. Found early, breast cancer is more curable, the long-term prognosis is better, the treatment choices are greater, and the interventions required are less invasive.
There is considerable controversy about when to have a first mammogram. Some national organizations, such as the U.S. Preventive Services Task Force, recommend that mammograms begin at age 50. The American Cancer Society recommends age 45. The American College of Radiology and the American College of Obstetrics and Gynecology both recommend beginning at age 40.
When to begin annual mammography screening is a personal decision. Before making such a decision, however, it’s important to be well informed. Talk with your primary care clinician about the overall risks and benefits of mammography and your personal risk, plus the role of breast self-examination and other breast health steps you can take.
I recommend having a first mammogram at age 40. Each year on average, we see 10-15 breast cancers in women below the age of 50 at Cooley Dickinson. I would recommend an even earlier start if a close relative (mother or sister) had been diagnosed with breast cancer before the age of 50.
There are two main reasons why many women hesitate to begin or have annual mammograms. One is the chance of a false positive result (more likely to happen with women in their 40s). A false positive result can lead to additional testing – another mammogram, an ultrasound, or a biopsy – that confirms there is no cancer present. The other is exposure to radiation. With low-dose equipment, the chances for harm from radiation are very slim – you would get more than double the dose of radiation during a cross-country flight as you get from a mammogram.
There are other screening options available. Whole-breast ultrasound generates many false positives. Thermography, which relies on a heat-sensitive map of the breast, has not been shown to be effective. MRI is a reliable screening tool but is not used routinely because of its high cost.
Advances in mammography include the availability of 3D mammography, also called breast tomosynthesis. Approved by the FDA in 2011, the 3D equipment’s X-ray arm sweeps in a slight arc over the breast, taking several images from several angles and creating sequential slices that recreate a 3D image of the breast. In contrast, 2D mammography relies on a single flat image. 3D mammography is better than 2D mammography in that it diagnoses 40 percent more invasive cancers, smaller cancers and decreases mammography recalls by up to 40 percent.
All mammograms at Cooley Dickinson are performed in 3D (unless a woman chooses to opt out of 3D) along with the standard 2D imaging. The additional 3D images allow the radiologist to gain a better view and understanding of a woman’s breast tissue. This is especially helpful for women with dense breast tissue.
Whether you choose 3D or more traditional 2D mammography, getting into a routine of an annual mammogram is a key factor in breast health. Early detection of breast cancer is so important – cancers so detected are smaller, more easily treatable, and more curable.