
Top Questions (and Answers) about Mammograms and Breast Cancer
1.) What is breast cancer?
Cancer is a condition caused by cells in the body that divide and reproduce abnormally and which can spread, or metastasize, throughout the body. Breast cancer occurs when breast cells divide rapidly to form a lump or mass known as a tumor. Breast tumors may be benign (noncancerous) or malignant, (cancerous). Malignant tumors are those that penetrate healthy body tissues.
There are two general categories of breast cancer: noninvasive, where the cancer cells are confined to the ducts (milk passages); and invasive, where the cancer cells have broken through the duct into the surrounding fatty and connective tissues. Within these categories, there are a number of unique cancer types, affecting different components of the breast.
2. What causes breast cancer and how likely am I to develop breast cancer?
Although a great deal of research is underway to understand what causes breast cells to become cancerous, the cause of breast cancer remains unknown today.
In the United States approximately 230,480 women developed breast cancer in 20011 and nearly 39,520 women died of the disease, decreasing rate since 1990, especially among women 50 and under. Breast cancer is the most common cancer of women around the world and the second leading cause of cancer death in women in the United States, following lung cancer. The chance of developing breast cancer increases with age:
Ages for Woman's Chance of Developing Breast Cancer in the United States
By Age 40: 1 out of 208
By Age 60: 1 out of 26
By Age 70: 1 out of 29
By Age 80: 1 out of 16
Ever: 1 out of 8
There are some risk factors, such as a family or personal history of breast cancer, race, history of chest area radiation, long menstrual history (early onset of menstruation and late onset of menopause), the use of oral contraceptives or hormone replacement therapy, and alcohol use, that have been shown to increase a woman's chances of developing breast cancer.
3. What is the survival rate for breast cancer?
Successful treatment and survival rates for breast cancer patients are dramatically affected by early detection of breast cancers. When breast cancer is detected before it has spread to lymph nodes, the five-year survival rate is 98 percent. If the cancer has spread to the underarm lymph nodes, the five-year survival rate is 84 percent. If the cancer has spread to other body organs, such as the lung or brain, the five-year survival rate drops to 20 percent.
4. How is breast cancer treated?
Breast cancers are treated by a variety of methods including; surgery, chemotherapy or radiation therapy, either alone or in conjunction with surgery, and drug therapies, which can be used with or without surgery. The physician and the patient should determine an appropriate treatment program according to the specific type of breast cancer being treated and the stage of the cancer. Most breast cancers are treated surgically, using one of the following procedures:
Lumpectomy:
Removal of only the cancerous lump and a portion of normal tissue surrounding the lump. A lumpectomy is often followed by radiation therapy. Mastectomy Removal of the entire breast. There are several types of mastectomies that may be performed, depending on the stage of the cancer.
Simple or Total Mastectomy:
Involves removal of the entire breast, but not the lymph nodes from under the arm, or muscle tissue from beneath the breast.
Modified Radical Mastectomy:
Involves the removal of the entire breast and some of the underarm lymph nodes. This is the most common surgery for a woman who is having a mastectomy.
Radical Mastectomy:
Involves removal of the entire breast, underarm lymph nodes, and the pectoral (chest wall) muscles under the breast. This procedure is rarely performed today.
Along with surgery, some women will receive additional treatment to prevent further growth, spread, or recurrence of cancer. Additional treatments include:
5. How is breast cancer detected?
Methods for detection of breast cancer include breast self-examinations, clinical examinations by a healthcare professional, and mammography. In most cases, mammography can identify an abnormal breast mass as much as two years before it can be detected by touch. Although breast cancer is the second leading cause of cancer death in women, after lung cancer, the rate of deaths from breast cancer has declined in recent years.
It is believed that early detection and treatment of breast cancers is the key to successful treatment and survival.
The American Cancer Society recommends the following guidelines for detecting breast cancer:
6. What is a mammogram?
A mammogram is an x-ray examination of the breasts, used to detect and diagnose breast diseases. Screening mammography is used as a preventive measure for women who have no symptoms of breast disease. A screening mammogram usually involves two views of each breast. Although physicians routinely order mammograms for their patients as part of a preventive health maintenance program, women can request and receive a screening mammogram from any mammography facility without a referral from a physician. The American Cancer Society recommends that all women start getting an annual screening mammogram and clinical breast examination at age 40.
Diagnostic mammography involves additional views of the breast, and is used when an abnormality is found during screening, or in women who have breast complaints.
7. Are there different types of mammography?
Two kinds of mammograms are available:
In screen-film mammography, x-ray beams are captured on a film cassette. Special x-ray machines developed exclusively for breast imaging are used to produce mammography films. These machines use very low doses of radiation and produce high-quality x-rays. The procedure produces an image of the breast tissue on a film, which is examined by a radiologist for abnormalities or evidence of cancer. In digital mammography, x-ray beams are captured on specially designed digital detectors. The digital detector converts the x-ray beams into electronic signals, which are then sent to a computer. The radiologist can review the digital mammogram on a high-resolution computer monitor.
8. Is digital mammography better than screen-film mammography?
The National Cancer Institute and the American College of Radiology Imaging Network (ACRIN) completed a large clinical study involving over 49,000 women in the United States and Canada. This study is referred to as DMIST (Digital Mammography Imaging Screening Trial). Women who participated in the study had both a screen-film and a digital mammogram as part of their annual breast cancer screening exam.
The DMIST study showed that digital mammography is better than screen-film mammography for the following women2:
Screen-film and digital mammography were equally beneficial to all other women in the study. Whether you have a screen-film or digital mammogram, the most important action is to get your annual mammogram.
9. How is mammography performed?
Mammograms are performed using equipment specially designed to take x-rays of the breast. When a mammogram is performed, the woman must undress above the waist and wear a wrap provided by the mammography facility. A technologist will position the breast on the mammography unit and use a paddle to compress the breast. The breast is compressed to spread the tissue apart and allow the maximum amount of tissue to be imaged and reduce radiation dose. The compression lasts just a few seconds. Once the breast is positioned appropriately, the technologist will step behind a screen and take the x-ray images. Your mammogram will be examined before you leave the facility, to assure that the quality and positioning are acceptable.
10. If I have breast implants do I still need to have a mammogram?
The guidelines for screening mammography for women with implants are the same as for women without them. Breast implants create a unique imaging situation, because some breast tissue will be covered by the implant and cannot be seen on x-rays. To compensate for this, the number of films taken for each examination for a woman with implants is greater to allow for as much breast tissue as possible to be imaged.
11. What are the guidelines for mammography screening?
In November (2009) U.S. Preventive Services Task Force (USPSTF) introduced its new guidelines, recommending that women should begin getting mammograms at age 50, and after that routine screening every two years. Yet, just seven years prior to this ruling, the same task force (USPSTF) had recommended that women age 40 and up get routine mammograms every one to two years. As you can imagine, this has caused great confusion among both the medical community and women around the country.
What do the experts say?
The American Cancer Society, American College of Radiology, and Susan G. Komen for the Cure® continue to agree that breast cancer screening should begin at age 40 – even earlier if a woman is a “high risk” patient.3 We’re sure you are wondering, "What does that mean for me?"
Most private insurers may not follow these guidelines. But as always, be an advocate for yourself – talk with your doctor about your concerns, and if they are for this ruling you may want to seek another opinion. If you still have more concerns, contact the American Cancer Society (www.cancer.org) for more information.
FACTS
You've heard the statistic—Every American woman has a one in eight chance of developing breast cancer at some point in her life. But thanks to modern medical technology, this condition is becoming more treatable. The most valuable player in the struggle with breast cancer isn't your doctor. It's you. As a woman, you play a critical role in maintaining good breast health to detect cancer in its earliest, most curable stages.
One of your most important breast-saving tactics is regular self-exams. Use this guide based on suggestions from the American Cancer Society (www.cancer.org) to correctly perform breast self-exams.
All women over the age of 20 should perform breast self-exams every month, ideally seven to 10 days after the start of her period when the breasts are least swollen and tender. Women who don't have regular menstrual cycles should perform her breast self-exam on the same day every month.
Lying with a pillow under your right shoulder, position your right arm behind your head. Using the pads of your left hand's middle fingers, press firmly to locate any lumps or changes in the nipple, areola, and breast tissue. Use the same steps on your left breast using your right hand. In addition to performing a breast self-exam lying down, complete a self-exam standing up. Follow the same pattern each month, whether it's circular, wedge, or straight up and down.
Every woman's breasts are unique and may have lumps and bumps that are completely normal. The key is to watch for changes such as new lumps, swelling, irritation, dimpling, nipple pain, inverted nipple, redness, scaliness, or discharge other than breast milk. While these changes don't necessarily indicate the presence of cancer, they can be warning signs you need to consult your physician.
A risk factor is any characteristic that increases your chances of developing a particular condition. While many women who develop breast cancer have no known risk factor for the disease, knowing your risk can help you beat the odds. If you have risk factors for breast cancer, talk to your physician to learn more about what you can do to protect yourself. According to the National Cancer Institute (www.nci.nih.gov) the following characteristics may raise your chances of developing breast cancer:
Sources: nci.nih.gov, cancer.org
Risk Factors You Can Control
According to the American Cancer Society (www.cancer.org), the most common sign that you may have breast cancer is a new lump in your breast. The lump is more likely to be cancerous if it's painless, hard, and has uneven edges, but some rare cancers are tender, soft, and rounded.
Other signs of breast cancer include:
It's important to have anything unusual checked by your doctor. If your doctor suspects that you have cancer, you'll need more testing. If you are diagnosed with breast cancer, the American Cancer Society suggests that that you give yourself time to adequately learn about the disease and your treatment options.
Sources: cancer.org, breastcancer.org
Scientists and doctors don't know exactly what causes breast cancer, but they do know certain factors are linked to it. Some of these risk factors can be controlled and others cannot. So, while all women are considered at risk for the disease, experts at the American Cancer Society (www.cancer.org) say that if you are of average risk you may be able to lower your choices slightly by controlling the factors you can.
Risk Factors You Can Control
According to the American Cancer Society (www.cancer.org), the most common sign that you may have breast cancer is a new lump in your breast. The lump is more likely to be cancerous if it's painless, hard, and has uneven edges, but some rare cancers are tender, soft, and rounded.
Other signs of breast cancer include:
It's important to have anything unusual checked by your doctor. If your doctor suspects that you have cancer, you'll need more testing. If you are diagnosed with breast cancer, the American Cancer Society suggests that that you give yourself time to adequately learn about the disease and your treatment options.
A new clinical trial by the National Cancer Institute (NCI) (www.cancer.gov) showed that a change in diet may reduce the chance of breast cancer recurrence in postmenopausal women. In the study, 2,437 women who had been treated for early-stage breast cancer were divided into two groups. One group was placed on a reduced-fat diet while the control group participants did not change their eating patterns.
The study, called the Women's Intervention Nutrition Study (WINS), was the first to show a clear relationship between breast cancer and dietary fat. When the trial began, both groups consumed comparable amounts of calories from fat, about 57 grams per day. Then the women in the reduced-fat diet group gradually decreased their fat intake to about 33 grams per day during the first year of the study.
The Results
After five years, the women in the reduced-fat diet group experienced a 24 percent reduction in relative risk of cancer recurrence compared with the control group. Women in the reduced-fat diet group whose tumors did not respond to the presence of the hormone estrogen (estrogen receptor negative or ER-negative cancer) had even more dramatic results. Their risk reduction was 42 percent.
This surprised researchers, who expected ER-positive rather than ER-negative women to benefit more from a reduced-fat diet because of the association between fat intake and estrogen levels. Women with ER-negative breast cancer usually have worse prognoses than those with ER-positive cancer. In the trial, ER-positive women in the low-fat diet group reduced risk by 15 percent.
Researchers noted that it took approximately four years to detect a reduction in risk, showing that women should not expect an immediate effect. They also noted that some women benefited much more than others, which suggests that genetics may affect whether or not a reduced-fat diet will be beneficial.
Sources: www.cancer.gov (National Cancer Institute), www.cancer.org (American Cancer Society)