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Why Aren't Mammograms Recommended for Women Under Age 40?
Physicians do not generally recommend that women under age 40 receive annual screening mammograms because
younger women tend to have more dense breast tissue. This breast density shows up on mammogram films as
white areas, just as breast cancer does. Therefore, it is difficult for physicians to detect breast cancer
in women with dense breasts. As women reach menopause, their breasts become less dense, making it easier to
interpret their mammograms. Women under age 40 should still practice monthly breast self-exams and receive
physician-performed clinical breast exams at least every three years. If an abnormality is detected with
physical exam in a patient of any age, she may receive
a diagnostic mammogram, ultrasound or other
breast imaging exam to further investigate the abnormality.
Why Aren't Ultrasound, MRI, or Other Tests Used to Screen for Breast Cancer?
Currently, mammography is the only exam approved by the U.S. Food and Drug Administration (FDA) to help
screen for breast cancer in women with no signs of the disease (such as a lump). Mammography helps detect
approximately 85% of all breast cancers and has contributed to a 2% annual decline in breast cancer deaths
in the past 10 years. While ultrasound, magnetic
resonance (MRI) breast imaging, and other tests may be
helpful when further investigating an abnormality first detected with mammography or physical exam, these
supplemental exams are not FDA approved as screening tools because of the limitations listed the chart below.
| Exam |
Pros |
Cons |
| Ultrasound
(sonogram) |
Good
contrast resolution, excellent for identifying non-cancerous cysts or dense mass. |
Lacks
spatial resolution, operator dependent, cannot detect calcifications (may indicate
cancer). |
Breast MRI
(magnetic resonance
imaging) |
Good
at imaging dense breasts, implants or small lesions, helps stage extent of cancer. |
Long
and costly exam, difficult to differentiate between cancerous and benign lesions, cannot
detect calcifications. |
Why is
Mammography Not 100% Accurate?
It is estimated that mammograms can detect approximately
85-90% of all breast cancers. While the vast majority of abnormalities are detected by
mammography, there are some that are simply not detectable. Sometimes an irregularity goes
undetected because surrounding breast tissue is the same density as the irregular tissue.
The goal of mammography is to try to identify women who have breast cancer but are unaware
of it (asymptomatic women). If a patient has a lump or other change and the mammogram is
"negative" (interpreted as not suspicious or cancerous), the patient should
pursue that finding further with her doctor. In some cases, a lump that is not suspicious
on a mammogram may be followed up with clinical breast
exam or a follow-up mammogram in six months instead of the normal twelve.
A negative mammogram report should not
be interpreted as meaning that there is no chance of breast cancer. It also does not mean
that the breasts are "normal". Many (if not most) breasts contain
"abnormalities" such as calcifications or masses. It is only when these areas
show changes sufficiently different from the average patient that the mammogram is
interpreted as "abnormal." That is why regular mammography and comparison with
prior films is critical.
Breast cancer starts as a few malignant
cells and generally takes years to grow to a detectable state. Often, radiologists may
watch an area on a mammogram for change over several years to demonstrate that an
initially benign-appearing area has a reasonable chance of malignancy that requires
biopsy. To remove the uncertainty in determining whether each area is benign
or cancerous would require many more biopsies to be performed.
Performing more biopsies would add a great deal of worry, discomfort, and potential
complications to a large number of women (who do not have breast cancer) while only
detecting a very small number of additional cancers.
Is Digital Mammography Better Than Standard Film Mammography?
One of the most recent advances in x-ray mammography is digital mammography. Digital
(computerized) mammography is similar to standard mammography in that x-rays are used to produce detailed images
of the breast. Digital mammography uses essentially the same mammography system as conventional mammography, but
the system is equipped with a digital receptor and a computer instead of a film cassette. Studies of digital
mammography and standard film mammography have shown that digital mammography is "comparable" to standard film
mammography in terms of detecting breast cancer. To date, studies have not shown that digital mammography allows
radiologists to detect more breast cancers than if they use standard mammography systems.
In the future, digital mammography may provide many benefits over standard mammography equipment. These benefits include:
- improved contrast between dense and non-dense breast tissue
- faster image acquisition
- shorter exam time
- easier image storage
- physician manipulation of breast images for more accurate detection of breast cancer
- transmittal of images over phone lines or a network for remote consultation with other physicians
While digital mammography is quite promising, it still has additional hurdles to undergo before it can become a
suitable replacement for standard film mammography. Digital mammography must: provide higher detail
resolution (as standard mammography does), become less expensive (digital mammography is currently several
times more costly than conventional mammography), and provide a method to efficiently compare digital mammogram
images with existing mammography films on computer monitors.
What Does
"in situ" Mean?
The term "in situ" is used to indicate an early stage of cancer in which a tumor
is confined to the immediate area where it began. Specifically in breast cancer, in situ
means that the cancer remains confined to ducts or lobules, and it has neither invaded the
surrounding tissue in the breast nor spread to other organs in the body. Ductal carcinoma is situ (DCIS) is the most common type of
non-invasive breast cancer.
What are
Metastases?
Metastases are satellite tumors that indicate a breast cancer
has spread from the site where it began (referred to as the primary cancer) to a lymph
node or a distant organ, such as the lung, liver, or brain.
What are
Calcifications?
Calcifications (also called microcalcifications) are mineral deposits in the breast that
may be caused by dried-up secretions, trauma to the breast, resorbed blood, or dead tissue
cells. These small calcium deposits are often found in clusters by a mammogram. Dietary
calcium levels do not have any relationship to breast calcifications. If a woman has
calcifications in the breast she may continue calcium supplements which can be helpful in
preventing bone loss, osteoporosis and fracture. Calcifications are not equivalent to
cancer. But they are signs of changes within the breast, and certain patterns of
calcifications can be associated with cancer or benign breast disease.
What is a
Cyst?
Cysts are harmless accumulations of fluid in the breast (or other tissue or organs). The
exact causes of cysts are not known, but cysts are known to change with hormonal
variations, either during normal menstrual cycles or from post-menopausal hormone
replacement. Contrary to popular belief, caffeine has no proven effect on cysts. Cysts do
not become cancer or increase the risk of cancer. Most of the time, cysts may be left
alone, but sometimes a physician may drain them with a small needle.
What is
Fibroadenoma (FA)?
Fibroadenoma is the most common benign, solid growth
in the breasts. Fibroadenoma is round, movable, and firm. Fibroadenoma has no significant
risk of becoming cancer and does not put a patient at increased risk of breast cancer.
What is
Fibrocystic Breast Change?
Fibrocystic breast change (also called fibrocystic
disease) is single or multiple lumps in the breasts. The lumps are often harmless and
fairly common. Often the term fibrocystic breast disease refers to normal, dense
fibroglandular tissue. Fibrocystic disease is a term that is often misused in breast
cancer screening and diagnosis. In fact, there is usually no actual disease. Fibrocystic
disease can only be diagnosed after biopsy or needle aspiration of the lumps. Fibrocystic
change in most women is common.
My Breasts
are Lumpy; do I Still Need to Examine Them?
Yes. While lumpy breasts or breasts with many masses or cysts can be very difficult to
examine, monthly breast self examination (BSE) is still critical.
Even if a woman has lumpy breasts, she can learn the usual pattern of lumps and bumps and
then point out new or unusual lumps to her doctor. In fact, without knowledgeable
direction from a patient, it may be impossible for a physician to differentiate a new mass
from stable lumps.
What
Can I do to Lower My Risk of Breast Cancer?
There are many breast cancer risk factors that cannot be
controlled such as genetics, early menstruation and family history. Other aspects such
diet, early child-bearing, and weight can be controlled to help reduce the risk of breast
cancer. Click here to learn more about the various risk factors
for breast cancer and for information on a new tool to help determine a woman's breast
cancer risk.
Updated: May 4, 2008
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