Breast Cancer Screening and Follow Up

Breast Cancer Screening and Follow Up2018-10-08T16:15:47+00:00

This page provides information about breast cancer risk and the importance of mammograms in a woman’s preventive health care plan. Learn how mammograms work, how to prepare, and what happens when a mammogram indicates areas of concern.

Screen Mammography
Mammography Follow Up

Screening Mammography

Mammography is an important tool in the early detection of breast cancer. Women at average risk who are 40 and older are advised to obtain an annual screening mammogram.

Why Have a Screening Mammogram?

Some women may be tempted to skip their screening mammograms, either to avoid the discomfort associated with breast compression or because they fear receiving bad news. A screening mammogram requires only seconds of compression time for each breast, and although this can involve some discomfort, most women do not report that the procedure is painful. In the event cancer is present, finding it early will greatly improve your chances of survival. Mammography is a proven method of finding cancers at earlier stages, when they can be most effectively treated. Breast cancers that are discovered through the presence of symptoms are generally larger and more likely to have spread beyond the breast prior to detection than cancers found through screening mammography.

Early detection means better chances of survival and less invasive treatment.

The size and extent of cancer at the time of detection are among the most important factors in determining a breast cancer patient’s prognosis and course of treatment. Susan G. Komen reports relative 5-year survival rates of 99% in women diagnosed with localized breast cancer, 85% in those with regionalized cancer (cancer that is contained within the organ in which it began), and 26% in women whose cancer cells have spread to other parts of the body.

Those whose breast cancer is diagnosed early also tend to receive much less invasive and less debilitating treatments than later-stage patients.

According to a study by the American Cancer Society, 34% of women diagnosed in 2013 with stage 1 or 2 breast cancer (women with smaller tumors and little or no migration of the cancer into the lymph nodes) underwent only breast-conserving surgery (BCS) and radiation therapy (RT), and 8% received BCS alone. By comparison, among women diagnosed with stage 3 or 4 cancer (larger tumors, which usually have spread to the lymph nodes and other organs), 48% underwent mastectomy, RT, and/or chemotherapy; only 2% had BCS alone.

Major medical associations recommend annual screening.

The American College of Radiology, the Society for Breast Imaging, and the National Comprehensive Cancer Network all recommend annual mammography beginning at age 40 for women at average risk for breast cancer. If your risk is higher than average, discuss your options for additional steps to detect and prevent breast cancer with your health care provider. Mammograms are part of an overall preventive health care plan.

Back to top

Breast Cancer Risk

Breast cancer is the most common cancer among women in the U.S.; the average risk of a woman developing breast cancer in her lifetime is 1 in 8. For some women with additional risk factors, including a family or personal history of breast cancer or previous radiation therapy to the chest, the odds are higher. Risk factors for breast cancer also include genetic predisposition (including a mutation of the BRCA1 or BRCA2 genes), weight gain, tobacco use, breast density, a personal history of breast cancer, excessive alcohol intake, use of hormone replacement therapy, and other lifestyle factors.

If you are at a higher than average risk for breast cancer, your provider may recommend additional testing and screening (such as more frequent mammography, breast MRI, or genetic testing), prophylactic prevention (such as preventive chemotherapy or mastectomy), or lifestyle changes such as maintaining a healthy diet and exercise routine.

What Are the Risks of Mammograms?

When you get a mammogram, the machine uses X-rays to generate an image of your breast tissue. The radiation exposure and associated risks are very low.

Radiation

We are exposed to various forms of radiation every day. Solar radiation (sunlight) and radon, which occur in varying concentrations around the world, are the most common sources. Radiation dose is typically measured in millisieverts (mSv). The average natural annual dose of radiation from the environment in the U.S. is about 3 mSv. A modern 2-D mammogram exposes you to approximately 0.4 mSv of additional radiation; the exposure from a low-dose 3-D C-View mammogram is very similar.

False Positives

If your radiologist determines that a mammogram shows areas of concern, you will be sent for further testing. Although nationwide, approximately 10% of women are called back after their screening mammograms, approximately 8–10% of those women undergo a biopsy, and around 80% of those breast cancer biopsies turn out to be benign. Although no cancer is present in the vast majority of women called back after a mammogram, the additional testing can be psychologically stressful, costly, and time consuming.

Although nationwide, approximately 10% of women are called back after their screening mammograms, approximately 8–10% of those women undergo a biopsy, and around 80% of those breast cancer biopsies turn out to be benign.

Like all medical procedures, follow-up tests have their own risks. For example, in a biopsy, a small sample of tissue is removed from the breast so it can be examined under a microscope for cancer. It’s a very low-risk procedure. However, some women do experience bruising or swelling, infection, or bleeding at the biopsy site or altered breast appearance (depending on how much tissue is removed and how the breast heals).

Back to top

Should I Get a Low-Dose 3-D Mammogram?

What is low-dose 3-D mammography?

Standard mammography relies upon two-dimensional X-ray images of the breast to detect possible areas of concern. 3-D mammography, or breast tomosynthesis, is a process that incorporates many X-ray images taken from a range of angles to create a three-dimensional image of the breast that can be closely examined a millimeter at a time. C-View, a low-dose 3-D form of mammography, allows for quicker procedure times and lower radiation doses than previously possible.

How is it different from traditional mammography?

The computer can translate 3-D tomosynthesis images into 2-D images that are clearer and more detailed than images from a traditional 2-D mammogram. This allows radiologists to view a much clearer picture of structures within the breast tissue. The appearance of linear structures, radiating lines, and bright spots, which can be indicative of particular breast conditions, is enhanced with tomosynthesis.</P

What are the advantages of low-dose 3-D mammography?

3-D mammography allows for more accurate diagnosis of masses, distortions, and variations in density than standard mammograms, especially in women with dense breasts—those having a higher proportion of brous or glandular tissue in relation to fatty tissue. Research has linked higher breast density with higher breast cancer risk, so increased vigilance in detection is even more vital in women with denser breasts. Getting the clearest picture possible is especially important for women with dense breasts because both dense breast tissue and tumors appear white on traditional x-rays. As a result, cancerous abnormalities can be missed. Also, many benign conditions appear on mammograms; dense tissue can more frequently appear to be suspicious, resulting in many costly (and often stress-inducing) additional tests, such as biopsies.

Using 3-D mammography, practitioners have been found to make 20–40% fewer callbacks for diagnostic procedures while detecting invasive cancers at an approximately 41% higher rate compared with digital mammography alone,and the rate of false positives has been shown to be 15% lower with the addition of tomosynthesis. Low-dose 3-D mammograms are both faster and safer. The procedure requires just 3.7 seconds of breast compression time and delivers a radiation dose that is comparable to 2-D exams and well below the maximum safe dose set by the FDA.

Back to top

What to Expect

Preparing for Your Mammogram

It is helpful for the radiologist to be able to compare the images obtained at your appointment to images from previous exams. In preparation for your mammogram, let us know when and where your last mammogram was performed, and if possible, we will contact that clinic

and obtain previous images before you come in. Also let us know if you currently or have ever have had breast implants, surgery, or other medical history relevant to your breast health. Mammograms involve pressure on and manipulation of your breasts, so try to schedule your mammogram for the point in your menstrual cycle when your breasts are least tender (usually the week after your period).

Day of Exam Don’ts

Day of Exam Do’s

DON’T overdo caffeine, as it can enhance breast tenderness.

DO dress in a two-piece out t so you can keep your lower half comfortably covered during the procedure

DON’T use deodorants or antiperspirants.

DO bring along any deodorant, lotions, etc. you would like to apply after your procedure. (We also provide aerosol deodorant for your convenience.)

DON’T apply powders, lotions, perfumes, or creams on your arms or breasts.

DO feel free to take an over-the-counter pain medication such as ibuprofen, acetaminophen, or aspirin if you experience pain following your procedure.

Your Exam

The technologist will position your breast in the machine, and a plastic plate will compress your breast. This is to ensure that we get best possible image of your breast tissue. You’ll be asked to hold your breath for a very short time, which helps prevent blurring from the movement of your breathing.
Images will be taken of each breast, compressed both horizontally and vertically. Each image should take only a few seconds. Your technologist will look at the captured images to make sure they’re the best quality possible. More images may have to be taken to provide enough information for the radiologist, but the whole visit should take only about 30 minutes.

Back to top

Mammography Follow Up

While most abnormal mammography results are ultimately found not to be breast cancer, it’s important to promptly schedule any recommended follow-up tests to ensure that if cancer is present, it’s identi ed as early as possible. Even in the modern age of advanced breast cancer treatment, patients whose invasive breast cancers are identi ed when they are smaller and involve fewer lymph nodes enjoy a more favorable prognosis, including increased survival rates and less invasive treatments.