"Ask the Health Expert": Mammograms and Breast Cancer

Ed Cordivin, MD, is a radiologist at Page Hospital.

Question: How can I decrease my risk of breast cancer?

Answer: Early detection is key: the American Cancer Society recommends that all women age 40 and older receive a screening mammogram every year. (Some women may need more frequent or earlier screenings, so check with your doctor.) Women age 20 to 39 should have a clinical breast exam every three years. And every woman age 20 and older should perform a monthly breast self-exam. 

Besides early detection, there are things you can do to improve your chances of avoiding breast cancer in the first place.

• Limit your alcohol consumption or don't drink at all. Even one or two drinks a day appears to increase breast cancer risk.
• Get regular exercise. Moderate, regular exercise—including at least four hours of vigorous activity per week—has been shown to reduce breast cancer risk.
• Maintain a healthy weight throughout your life. Obesity is linked to increased breast cancer risk, especially in post-menopausal women. 

Smart Move: If you don't know how to perform a breast self-exam, ask your health care provider to show you the proper technique during your next visit.

Question: What is a mammogram?

Answer: The mammogram is simply an X-ray of the breast. Although breast X-rays have been performed for more than 70 years, the first X-ray machines designed specifically for breast cancer screening were introduced in 1969. They require only a small amount of radiation to capture their revealing images.

The procedure is simple, too. For a mammogram, a woman stands in front of the X-ray machine. The technician lifts each breast and places it on a platform that holds the X-ray film. The breast is gradually pressed against the platform using a specially designed clear plastic plate. Some pressure is applied for a few seconds to flatten the breast while the image is made. This pressure does not harm the breast, and most women find it only slightly uncomfortable. Flattening the breast lowers the intensity of the X-ray needed and makes for a clearer, more complete picture. A mammogram usually involves two X-rays for each breast, and the entire procedure lasts just 20 minutes.

Question: Recently, I have been hearing a lot about the different ways professionals detect breast cancer. What is the difference between a screening mammogram a diagnostic mammogram and an ultrasound?

Answer: A screening mammogram is done on a woman who is asymptomatic or has no problems with either breast. This is usually done as part of her well women exam and should be done yearly after the age of 40. A diagnostic exam is done for pain, lump, nipple discharge, or to recheck prior breast problems.

Many times, an ultrasound will be used in conjunction with the diagnostic mammogram. An ultrasound is used to help differentiate between normal tissue, a cyst, or a probable mass in the breast tissue. If a questionable area is seen on a mammogram, it can then be targeted on the ultrasound and at that time, a diagnosis can be made.  When receiving an exam, it is important for you to confide in your doctor if you are experiencing any breast problems, so the correct exam can be done. 

Question: Are mammograms really necessary?

Answer: There's been great success at spreading the word about the importance of mammograms. So most women know that regular mammograms, though not perfect, are the best method available to detect breast cancer early. Early detection allows more treatment options and a better chance to beat the disease.

But there are still some holdouts. Some women still don't put aside that half hour a year for a mammogram. Their reasons for resisting a mammogram usually have more to do with myth than fact. Listed below are some of the common myths about mammograms. 

Myth 1: I don't need a mammogram because no one in my family has had breast cancer.

Fact: Every woman has some risk for developing breast cancer during her lifetime. This risk increases as she ages. It's true that some women are considered to be at higher risk. And having close family members who have had breast cancer is one of those high-risk markers. But about 80 percent of the women who get breast cancer don't have any of the known risk factors.

Myth 2: I don't need a mammogram because I examine my breasts every month and have no symptoms.

Fact: Breast cancer takes years to develop. Early in the disease, most cancers of the breast cause no symptoms. A mammogram can find breast cancer when it is very small, as long as two years before it can be felt in an examination.

Myth 3: Why get a mammogram? If they find breast cancer, nothing can be done about it.

Fact: When breast cancer is caught in its earliest stage, as only mammograms can do, the five-year survival rate is 97 percent. The odds are not as good in more advanced cases.

Myth 4: The X-rays from mammograms are dangerous.

Fact: Mammograms are safe. Modern equipment uses very low-level X-rays, weaker than those for a routine chest X-ray.

Myth 5: Mammograms are just too painful.

Fact: For most women, the few seconds of discomfort seem a small price to pay for the protection of a mammogram. For a pain-free mammogram, avoid caffeine for two days before the test, and schedule it for a time when your breasts will be least tender. Avoid the week just before your period.