Mammography:
An Important Tool for Breast Health
October is designated National Breast Cancer Awareness Month. About 1 in 8 U.S. women face an invasive breast cancer diagnosis within their lives. A woman’s risk of breast cancer nearly doubles if she has a mother, daughter or sister diagnosed, yet about 85% of breast cancers occur in women having no family history of the disease.
Some breast cancer statistics:
- Breast cancer is the most common cancer among American women. In 2021, it’s estimated that about 30% of newly diagnosed cancers in women will be breast cancers. For women in the U.S., breast cancer death rates are higher than those for any other cancer, besides lung cancer.
- In 2021, an estimated 281,550 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S., along with 49,290 new cases of non-invasive (in situ) breast cancer.
- About 43,600 women in the U.S. are estimated to die from breast cancer in 2021.
- About 2,650 new cases of invasive breast cancer in men are estimated in 2021. A man’s lifetime breast cancer risk is about 1 in 833.
- Breast cancer became the most common cancer globally in 2021, accounting for 12% of all new annual cancer cases worldwide, according to the World Health Organization (WHO).
Therefore, it’s important to monitor and manage your breast health through regular prescribed mammography, a valuable breast cancer screening and diagnostic tool.
October 18 is designated National Mammography Day and your local Capital Women’s Care team wants to share the importance mammography has within your breast health plan. We also include general guidelines for establishing routine mammography as part of your personal well-woman health care and explain mammography and its technological advances currently in development.
What Is Mammography?
A mammogram is an x-ray of the breast. The breast is positioned on a special x-ray machine’s plate and compressed with another plate to view breast tissue for signs of abnormalities. Technicians take 2 views of each breast, including areas of the underarm where lymph nodes occur.
The entire procedure takes about 20 to 30 minutes. You should receive mammogram results from your doctor within 10 days.
Mammogram Tips
- Try not to have your mammogram the week before or during your menstrual cycle, as your breasts may be tender or swollen. The week following your menstrual cycle offers you the best comfort and opportunity for clear breast imagery.
- Don’t wear deodorant, perfume or powder on the day of your mammogram, as they can show up as white spots on the X-ray and interfere with accurate screening.
- Some women prefer to wear a top with skirt or pants, instead of a dress. You will need to undress from the waist up during your mammogram.
Types of Mammography
There are different types of mammography screening currently available. Mammogram technologies currently in use include:
2D mammogram (conventional digital mammography) takes low-dose x-ray photos of the breast from front and side perspectives. The photos combine to create a single image of each breast, though sometimes the images show a little overlapping breast tissue. 2D mammography sometimes requires a call back to obtain different images to confirm abnormality isn’t present.
3D mammogram (digital breast tomosynthesis or DBT) captures multiple breast views from a variety of angles within seconds. DBT combines multiple breast X-rays to create a 3-dimensional picture of the breast. It can be used to look for breast cancer in people who have no signs or symptoms, plus investigate breast problem causes, including breast mass, pain and nipple discharge. The technique may be particularly important for women identified as having dense breast tissue.
When used for breast cancer screening, 3D mammogram machines create 3D images and standard 2D mammogram images. Studies show combining 3D mammograms with standard mammograms reduces additional imaging requirements and slightly increases number of cancers detected during screening.
The 3D mammogram is becoming more common, but it isn’t available at all medical facilities.
A 3D mammogram is generally more reliable than the 2D version. In studies, 3D mammography has been shown to have higher cancer detection rates than 2D mammography. A 3D mammogram also makes it less likely for the radiologist to identify a noncancerous structure as cancerous, giving a false positive.
Positron emission mammography (PEM) is a newer breast imaging test that is very similar to a PET scan. A form of sugar linked to a radioactive particle is injected into the blood to detect cancer cells. A PEM scan may be better able to detect small clusters of cancer cells within the breast.
Discuss your breast cancer risk with your doctor who can help you determine the best screening method for you based on your personal breast cancer risk assessment.
Mammography’s Role
in Breast Health
Mammography plays a vital role in optimizing breast health as both a screening and diagnostic tool. Several key studies indicate regular mammography use cuts women’s risk of dying from breast cancer by nearly 50%.
Mammography is used for breast cancer screening because it can distinguish subtle breast tissue differences, making it a valuable tool for early breast cancer detection, a significant factor in deriving the most favorable outcome and prognosis should you be diagnosed. Early detection via mammography also enables women to be treated with less extensive surgery, fewer mastectomies and less chemotherapy.
Mammography also plays a significant role as a diagnostic follow-up test if a breast change is discovered via screening mammogram, during a clinical breast exam, or is discovered by you or by your partner.
Mammography in conjunction with other technologies discerns important breast health information, especially if you experience breast abnormalities, and helps your doctor monitor you for potential breast health concerns.
Doctors can’t distinguish between breast cancers that may spread beyond the breast and those that will remain confined to the breast, so annual mammograms remain the best option for detecting cancer early and reducing risk of death from breast cancer.
More women are being diagnosed with early breast cancer due to mammogram screening, even though the number of women diagnosed with advanced breast cancer hasn’t decreased.
It’s important to follow your doctor’s mammography guidelines. Establishing baseline and subsequent routine mammography is important as doing so provides an annual visual history of your breast tissue and helps your doctor determine if any changes occur within your overall breast health.
General Mammography Guidelines
Age is the most significant breast cancer risk factor. The disease is rare in women under age 25 years. The incidence heightens with increasing age, reaching a plateau in women ages 50 to 69 years. In 2017, 50% of all new cases of invasive breast cancer occurred in women ages 50 to 69 years.
Not all organizations agree on breast cancer screening guidelines; however, most emphasize meeting with your doctor to review risks, limitations and benefits of mammography to determine what’s best for you.
The U.S. Preventive Services Task Force mammogram guidelines recommend women begin screening at age 50. The American Cancer Society (ACS) recommends women begin screening at age 45. Both organizations acknowledge initial screening at age 40 years may make sense for some women after consideration of mammography’s benefits and limitations.
Mayo Clinic supports screening beginning at age 40 because screening mammograms can detect early breast abnormalities in women in their 40s. Findings from randomized trials of women in their 40s and 50s have demonstrated screening mammograms decrease breast cancer deaths by 15% to 29%.
When to begin mammogram screening and how often to repeat it is a personal decision. Talk with your local Capital Women’s Care physician to determine the best mammography screening schedule for you to maintain optimal breast health.
Mammography Abnormalities
Oftentimes, mammography locates abnormalities, such as growths, lumps, cysts or breast calcifications, most of which aren’t necessarily determined to be cancer.
If an abnormality is detected on a mammogram, you may be asked to have additional mammogram images taken and, possibly, additional imaging tests, like ultrasound or MRI. These tests may determine the abnormality shown on the original mammogram isn’t cancer.
In some cases, it may be necessary to undergo a biopsy procedure to remove a breast tissue sample for testing.
Up and Coming
Breast Health Technologies
Many emergent technologies in mammography and breast imaging are in the developmental stages. Studies are pinpointing technology advances that can locate and target cancer cells at earliest possible stages to increase positive breast cancer outcomes and prognoses, providing hope for the nearly 7.8 million women living worldwide currently facing breast cancer.
The American Cancer Society (ACS) explains the most promising emerging technologies, including:
- Contrast-enhanced mammography (CEM) or Contrast-enhanced spectral mammography (CESM) uses contrast material combined with the mammogram to highlight areas that might be breast cancer and that could be missed on the mammogram alone. An iodinated agent is introduced intravenously to attach to potential malignancies to improve diagnostic accuracy, particularly in women with denser breast tissue.
- Optical imaging tests use safer non-ionizing radiation (visible light, infrared and ultraviolet light) to see subtle metabolic changes in the multiple properties occurring within soft tissue, indicating early markers of abnormal tissue functioning. Optical imaging can be used for repeated procedures to monitor disease progression or treatment results and may be combined with other imaging techniques for enhanced information. Diffuse Optical Tomography (DOT) and Imaging (DOI) are non-invasive techniques using light in the near-infrared region to measure tissue properties like total hemoglobin concentration and blood oxygen saturation. Because DOT and DOI work well in soft tissue, the techniques are widely used for breast cancer imaging.
- Electrical impedance imaging (EIT) scans the breast for electrical conductivity. EIT is based on the idea that breast cancer cells conduct electricity differently from normal cells. The test passes a very small electrical current through the breast and then detects it on the skin of the breast using small electrodes taped to the skin. EIT doesn’t use radiation or compress the breasts. This test can be used to help classify tumors found on mammograms. More clinical testing is needed to determine if it may be used for breast cancer screening.
- Elastography is a test that can be done as part of an ultrasound exam and is based on the idea that breast cancers tend to be firmer and stiffer than surrounding breast tissue. For this test, the breast is compressed slightly, and the ultrasound can determine firmness of a suspicious area. This test might prove useful in determining if the area is more likely to be cancer or is a benign (non-cancerous) tumor.
- Molecular breast imaging (MBI), also known as scintimammography or breast-specific gamma imaging (BSGI), is a type of nuclear medicine imaging test for the breast. A radioactive chemical is injected into the blood, and a special camera is used to see into the breast. This test is being studied mainly as a follow-up method for breast issues like a lump or an abnormal mammogram or to help determine extent of diagnosed breast cancer. MBI is also being studied as a test to be used in conjunction with mammograms to look for cancer in women with dense breasts. One potential drawback is MBI exposes the whole body to radiation, so it’s unlikely it would be used for annual screening.
Your Capital Women’s Care team is here to answer your questions or concerns about mammography or any women’s health issue. Our knowledgeable health professionals offer comprehensive expertise within all aspects of breast health, assisting you to devise a personal breast health plan including mammography so you can achieve and maintain optimal breast health and a long, quality life.
Sources:
https://www.breastcancer.org/symptoms/understand_bc/statistics
https://cebp.aacrjournals.org/content/21/1/66.abstract
https://academic.oup.com/jnci/article/106/11/dju261/1496367?login=true
https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.31840
https://pubmed.ncbi.nlm.nih.gov/29937340/
https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/experimental-breast-imaging.html
https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/getting-called-back-after-a-mammogram.html
https://www.cdc.gov/cancer/breast/basic_info/mammograms.htm
https://www.itnonline.com/channel/breast-imaging
https://www.itnonline.com/content/densebreast-infoorg-research-published-identifying-important-knowledge-gaps-breast-density
https://www.itnonline.com/content/decoding-effect-body-mass-index-breast-cancer
https://www.umms.org/umgccc/cancer-services/cancer-types/breast/diagnostic-treatment/mammogram/new-3d-mammography-technology
https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/experimental-breast-imaging.html
https://www.itnonline.com/article/technologies-watch-breast-imaging-0
https://www.cdc.gov/cancer/breast/basic_info/dense-breasts.htm
https://www.womenshealth.gov/a-z-topics/mammograms
https://www.mayoclinic.org/tests-procedures/mammogram/about/pac-20384806
https://www.mayoclinic.org/tests-procedures/mammogram/expert-answers/mammogram/faq-20057905
https://www.cdc.gov/nchs/fastats/mammography.htm
https://www.cancer.gov/types/breast/mammograms-fact-sheet
https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2019-2020.pdf
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