Mammograms

In the USA: According to the National Cancer Institute Women in their 40s and older should have mammograms every 1 to 2 years. Women who are at higher than average risk of breast cancer should talk with their health care providers about whether to have mammograms before age 40 and how often to have them.

In Canada: According to Health Canada, at present, the only proven strategy to reduce breast cancer deaths is early detection through mammography in women over 50. This is referred to as secondary prevention. There is clear evidence from population-based trials that screening mammograms can reduce mortality from breast cancer by approximately 30% in women aged 50-69.

The Issue

In certain situations doctors recommend that women have breast X-rays, known as mammograms, in order to detect breast cancers at the earliest possible stage of development. Some women may have concerns about being exposed to radiation during mammograms.

TBS Editor's Note: Curious that in the U.S., where there is no public health care system, the recommended age for mammogram is a full decade younger than in Canada. Could the Canadian recommendation have something to do with reducing the strain on the pubic system? And please take a moment to consider that women of all ages do not have a reliable, safe diagnostic tool for regular breast checks. Mammography is not fool proof. More young women die of breast cancer than any other cancer. Our medical community and our political leaders need to be urged by you to introduce safe methods for detection purposes.

Background

The risk of getting breast cancer increases as women age. Figures show that about 11 percent of Canadian women, one in nine, will get breast cancer.

Source: Health Canada It's Your Health

Mammogram: Details

The purpose of mammograms is to find developing cancer of the breast as early as possible. Early detection usually means more effective treatment. It can save lives and can also contribute to a better quality of life by reducing the need for radical treatments.

Mammography is an imaging technique that uses X-rays to provide a picture of the internal structure of the breast. The X-rays can show abnormal growths or changes in breast tissue before they can be found by any other method, including breast self-examination.

Your doctor will likely request a mammogram in the following situations:

  • If there is reason to suspect you might have breast cancer, for example, if you or your doctor discovered a lump in your breast; this kind of mammogram is called diagnostic.
  • If you have a family history (mother, sister) of breast cancer, this may indicate an increased susceptibility to breast cancer. Your doctor may request a mammogram for screening purposes at certain intervals.
  • If you are between the ages of 50 and 69.

TBS Editor's Note: If you feel that you need a mammogram, and you don't fit the profile, you can insist on having one. Being polite and following your doctors authority will not do your health any good if they are wrong and your instinct is right.

Many doctors recommend mammograms every two years, for screening purposes, for women between the ages of 50 and 69. Studies show that breast X-rays, taken on a regular basis, have the potential to reduce deaths from breast cancer for women in this age group by up to 40 percent.

Studies have also looked at whether regular mammograms would be beneficial for women aged 40 to 50. To date, the evidence is not conclusive. There are also concerns about the effect of increased exposure to radiation.

Source: Health Canada It's Your Health

Mammogram: What To Expect

Before a mammogram, your doctor and the X-ray technician will explain the procedure. During the mammogram the technician will use special equipment to compress your breast tissue to get as clear a picture as possible. This may cause some temporary pain, but it is usually not severe.

The technician will forward the results to your doctor, who will explain them to you. If the mammogram reveals anything that is irregular, your doctor will recommend the next steps.

These steps may involve another mammogram, an ultrasound, or a biopsy to remove a small piece of tissue for examination. If the biopsy confirms a cancerous growth your doctor will explain all the available options for treatment.

Most mammograms ordered for screening purposes come back with normal results.

TBS Editor's Note: I have just had my first mammogram. I am 46. The technician handled my breasts like slabs of raw meat. The squeezing of the tissue between the plates was very intense despite the fact that I do not have dense breast tissue. I've always been coached to breathe through pain. In this case, I was told to hold my breath. Very counter intuitive. Each breast gets X-rayed twice. I found the process completely devoid of any human kindness or compassion. And, no I was not expecting tea and scones. Just a bit of gentleness for a first timer. My results were immediate and normal.

Safeguard Your Health

Breast cancer is a risk for all women and the risk increases with age. If you are under the age of 50 ask your doctor to show you how to perform breast self-examinations and do them regularly. Make sure your doctor includes a breast examination during your regular physical examinations. Discuss your family history and the likelihood of getting breast cancer. Know about breast cancer risk factors.

If you are over the age of 50, in addition to performing breast self-examination, you should also talk to your doctor about having regular screening mammograms to detect possible cancers in their earliest stages.

Source: Health Canada it's Your Health

Mammography and Radiation Risks

TBS Editor's Note: This is one of those topics which leaves my gut feeling unsettled. The party line is don't worry, get mammograms. However, there are enough instances where, oops, we had no idea that this' would happen, comes after the fact... take silicone breast implants for instance. Anyway, another case of rock and a hard place for women's health. Certainly it's time for a safe, affordable diagnostic tool for women of all ages.

According to Health Canada the risk of getting cancer from mammography is considered to be extremely low.

Mammography uses X-rays, and the cell damage caused by X-rays can cause cancer. However, if mammography is conducted properly the radiation dose is generally quite low. After a dose this low, your body can usually repair the few cells damaged by the X-rays.

The benefit of early diagnosis and treatment far outweighs the risk of the small amount of radiation received during mammography.

The Benefits of Mammography

The benefits of mammography far outweigh the risk. There is plenty of evidence that early diagnosis and treatment of breast cancer can save lives. For a woman aged 50, early detection of breast cancer improves the chance of survival by up to 40 percent.

Quality of life is another benefit. Early diagnosis of breast cancer can reduce the need for radical treatments, including extensive surgery, chemotherapy and radiation therapy. These treatments can have serious side effects.

Source: Health Canada it's Your Health

Mammograms and Breast Implants

Women with breast implants who are in an age group where routine mammograms are recommended should be sure to have these examinations at the recommended regularly scheduled times. Some women who undergo reconstruction will have some breast tissue remaining and some have all of their breast tissue removed. It is important that a woman with remaining breast tissue continue to have mammograms of that breast, as well as of the other breast, to detect breast cancer (Those who have had breast cancer surgery on both breasts should ask their doctors whether mammograms are still necessary).

Women should be aware that breast implants may interfere with the detection of cancer and that breast compression (hard pressure) during mammograms may cause implant rupture/deflation.

Interference, with mammograms, by breast implants may delay or hinder the early detection of breast cancer either by hiding suspicious lesions (wounds or injuries or tumors) or by making it more difficult to include them in the image (x-ray, ultrasound). Implants increase the difficulty of both taking and reading mammograms.

Mammograms require breast compression, which could contribute to implant rupture. According to the FDA adverse event database, there were 41 reported cases of breast implant rupture during mammograms, reported between 1992 and 2002. An additional 17 cases of breast implant rupture during mammograms were reported in the medical literature.

In addition to special care taken by the radiological technologist to reduce the risk of breast implant rupture during this compression, other techniques are used to maximize what is seen of the breast tissue during mammograms. These techniques are called breast implant displacement views, Eklund displacement views, or Eklund views, named for the radiologist who developed the techniques. These special implant displacement views are done in addition to those views done during routine mammograms.

Because of the extra views and time needed women with implants should always inform the receptionist or scheduler that they have breast implants when making an appointment for a mammogram. They should also tell the radiological technologist about the presence of implants before a mammogram is performed. Then, the radiological technologist will use these special displacement techniques and take extra care when compressing the breasts to avoid rupturing the breast implant.

The displacement procedure involves pushing the implant back and pulling the breast tissue into view. Several factors which may affect the success of this special technique, in imaging the breast tissue in women with breast implants, include the location of the implant, the hardness of the capsular contracture and the amount of the breast tissue compared to the implant size.

Also, when reading the mammogram, the radiologist may find it difficult to distinguish calcium deposits in the scar tissue around the implant from a breast tumor. Occasionally, it is necessary to remove and examine a small amount of tissue (biopsy) to see whether or not it is cancerous. Frequently, this can be done without removing the implant.

As a last note, FDA does not consider mammograms an adequate means of detecting implant rupture/deflation for silicone gel-filled breast implants. As described in the Local Complications & Reoperations ( Rupture/Deflation of Silicone Gel-Filled Breast Implants ) section, FDA believes that MRI is currently the best method for detecting implant rupture for silicone gel-filled breast implants.

Source: FDA Breast Implant Consumer Handbook

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