Challenges Breast Cancer Exams and Diagnosis
Milano, Medical Writer
Mammography is the best tool available
for detecting breast cancer. But questions we have no certain
answers for may stand in the way of successful detection: How
often should the test be given? How old should a woman be when
she first has a mammography? How sensitive is a given testing
procedure? And how much subjective interpretation is involved
in "reading" the results?
x There is consensus that women
over 50 should have an annual exam, but experts still disagree
over frequency of testing for women between ages 40 and 50. The
American Cancer Society and the American College of Radiology
have recommended mammography screening for women every 1-2 years
beginning at age 40.
But the US National Institutes
of Health concluded that there is not enough evidence to recommend
yearly mammography for all women in their 40s. Further, in Canada
and Europe, a screening mammography is not recommended for women
Revising its previous recommendation
to wait until 50 for annual screenings, the American Medical
Association (AMA) said in late June that women age 40 and older
should get yearly mammograms. The AMA cited figures saying that
18% of all new breast cancer cases in the United States occur
among women in their 40s, and it now encourages the medical profession
to come up with a unified recommendation on the matter.
While testing remains a
gray area for some women, when there is a family history of breast
cancer, you should aggressively pursue examination and diagnosis.
Once you've made it to the physician's office, there can be challenges
to getting tested and receiving accurate results.
|According to the
American Medical Association, women age 40 and older should get
It's often easy to feel intimidated
by a doctor and to become a passive participant in the process.
If a doctor doesn't ask about family history, be sure to offer
the information--especially if a relative has had breast cancer.
If a mass is found, an examination alone cannot determine whether
it is benign or cancerous, and you will need to have it tested.
Mammograms can reveal calcifications
(which can be markers for cancerous changes) as small as a pencil
dot before they become palpable, but the test is far from perfect.
Studies by major medical centers find this X-ray 80% accurate,
at best. (Mammograms are about 75% accurate in 40-year-old women,
but about 90% accurate in women in their 50s and 60s.) No one
knows why 10-15% of lumps or lesions simply do not record on
In addition, reading a mammogram
can be difficult. A given image may be open to differing interpretation
and may be misread. In a recent study at the University of California
at San Francisco, two experienced radiologists looking at the
same mammograms agreed on what they'd seen less than two-thirds
of the time. Keep in mind that no current screening tool is perfect,
though an ultrasound combined with a mammogram is about 95% accurate.
Choose your screening center
wisely by carefully checking credentials. For a mammography center,
make sure it has current Food and Drug Administration (FDA) certification
and has been given the nod by either a state accrediting agency
or the American College of Radiology (ACR).
"An ultrasound image is
only as good as the person who administers it," stresses
Marie De Lange, who chairs the American Registry of Diagnostic
Medical Sonographers (ARDMS). "To help protect against needless
tests, misdiagnosis, or unnecessary surgery to remove a tumor
that isn't there, I urge consumers to see a sonographer's credentials
before an exam." Says Dr. Henry Ferstenberg, a breast surgeon
in New York City, "A doctor should take the time and make
the effort to answer all your questions." He adds that requesting
a second radiologist's opinion is appropriate and provides additional
protection for the patient.
It is also important to provide
a new center you visit with copies of mammograms you may have
had elsewhere, says Dr. Ferstenberg. "They may not have
the old X-rays (for comparison). The percent of error would drop
if they did," he says.
Other important circumstances
may complicate diagnosis, such as age. False negatives and equivocal
mammogram results are most frequent in women under 40. This is
because the tissue of the breast is denser than in other age
groups, which makes it harder to see what lies within. Unfortunately,
breast cancer tends to develop more quickly, once it has begun,
in younger women.
During pregnancy, any tumor
that may be present will respond to the extra estrogen production.
To avoid radiation that could harm the baby, a sonogram can safely
be performed on pregnant women.
Your strongest defense against
this disease is top-quality screening. These steps may help protect
- Do a self-exam every month
at the same time in your menstrual cycle, preferably right after
your period has ended, or on the same date if you're menopausal.
- Have an annual mammogram and
professional breast exam if you are over 50 years of age and
talk to your doctor about the need for mammograms between the
ages of 40 and 50. From 20 to 39, it is sufficient to have a
clinical breast exam every 3 years.
- Find a certified mammography
center (or check the status of your own center) by calling the
National Cancer Institute (NCI) at 800-4CANCER.
- If you are going to a new mammography
center, get your previous X-rays and bring them with you. They
are your property.
- Read your written mammogram
report. If it is ambiguous, speak with your physician about whether
an ultrasound might be useful. Check your ultrasound provider
for ARDMS credentialing.
- If a lump is detected, make
sure that you speak with your doctor immediately. Make sure you
are comfortable with and understand all recommended courses of
- If you need a surgeon, seek
someone who has a good deal of experience treating patients with
Milano writes about health and business topics. Her articles
have appeared in MAMM, Essence, Working Woman, International
Business, Home Office Computing, Brooklyn Bridge, TWA Ambassador,
and many other publications.
Israel Deaconess Medical Center. Reviewed for medical accuracy
by physicians at Beth Israel Deaconess Medical Center (BIDMC),
Harvard Medical School. BIDMC does not endorse any products or
services advertised on this Web site.
Copyright: © 1999 Medscape, Inc.
Posted On Site: Sep. 1999
Publication Date: Aug. 1999