The National Cancer Institute estimates that one out of every eight women will develop breast cancer in their lifetime. Breast cancer is the most commonly cancer detected in women, and is the second leading cause of cancer death for United States women. Nearly 300,000 women are diagnosed with breast cancer each year, and 40,000women die from breast cancer annually. Early detection of breast cancer makes a difference!
Inside a woman’s breast are 15 to 20 sections, or lobes. Each lobe is made of many smaller sections called lobules. Fibrous tissue and fat fill the spaces between the lobules and ducts (thin tubes that connect the lobes and nipples). Breast cancer occurs when cells in the breast grow out of control and form a growth or tumor. Tumors may be cancerous (malignant) or not cancerous (benign).
What can you do to help decrease your risk of breast cancer?
Women with a family history of breast cancer in a first-degree relative (mother, father, sister, or daughter) have an increased risk of breast cancer. Women who have inherited changes in the BRCA1 and BRCA2 genes or in certain other genes have a higher risk of breast cancer. The risk of breast cancer caused by inherited gene changes depends on the type of gene mutation, family history of cancer, and other factors. Many families never discuss cancer diagnosis and death. Please consider asking your parents or closely related relative what they may know about cancer in your family. Women with strong family histories of breast cancer may benefit from testing in addition to regular mammograms.
While we cannot reduce our risk related to family history or genetics, there are some risks that we do have control over. Alcohol is one example that has been linked to breast cancer. The risk seems to increase with the amount consumed. The American Cancer Society recommends no more than one drink per day. Being overweight after menopause also increases breast cancer risk. Before menopause, your ovaries make most of your estrogen and the fat tissue only makes a small amount. In menopause, our ovaries are no longer producing estrogen. Most of our estrogen comes from fat tissue. Maintaining a normal body weight will not only decrease your risk for breast cancer but will significantly decrease your risk for other conditions such as cardiovascular disease and diabetes. Women who had their children after the age of 30 and/or never breastfed also have a slightly higher risk of breast cancer.
Although we no longer recommend that breast self-examination should be done as a screening tool, your knowledge of your individual breast shape and texture is very important. You should be aware of how your breasts normally look and feel, and notify us of any changes so that we can further evaluation you. Please let us know about any unexpected nipple discharge as well.
Click here for additional information from the National Cancer Institute about Breast Cancer Prevention: https://www.cancer.gov/types/breast/patient/breast-prevention-pdq#section/all
What is a Mammogram?
The majority of breast cancers are discovered mammography. A mammogram is a way to take an image of the “inside” of the breast. Screening mammograms both allow early treatment for breast cancer and reduce the odds of dying of breast cancer. Mammograms can detect masses that are much too small to feel and also calcifications that can indicate early signs of a breast cancer.
A mammogram uses a machine designed to look only at breast tissue. The machine takes x-rays at lower doses than usual x-rays. Because these x-rays don’t go through tissue easily, the machine has 2 plates that compress or flatten the breast to spread the tissue apart. This gives a better picture and allows less radiation to be used. The radiologist can then look for changes in breast tissue.
A screening mammogram is used to look for signs of breast cancer in women who don’t have any breast symptoms or problems. X-ray pictures of each breast are taken from 2 different angles. Mammograms can also be used to look at a woman’s breast if she has breast symptoms or if a change is seen on a screening mammogram. When used in this way, they are called diagnostic mammograms. They may include extra views (images) of the breast that aren’t part of screening mammograms. Sometimes diagnostic mammograms are used to screen women who were treated for breast cancer in the past.
Mammograms can often show abnormal areas in the breast. They can’t prove that an abnormal area is cancer, but they can help the doctor decide whether more testing is needed. The 2 main types of breast changes found with a mammogram are calcifications and masses.
Our Women’s Health Alliance Mammography office uses digital mammograms, which means they are recorded, saved, and viewed on a computer. Our office only uses 3D mammographic technology as well, which is commonly known as breast tomosynthesis. For this, the breast is compressed once, and a machine takes many low-dose x-rays as it moves over the breast. Computer software then puts the images together into a 3-dimensional picture. Instead of a flat image of your breast, the radiologist can look at your breast tissue in one millimeter slices providing greater ability to look at breast tissue than before was possible. Studies have suggested it reduces the chance of being called back for follow-up testing (due to insufficient imaging). 3D mammograms may also be able to find 28% more cancers. It can be especially useful in women with radiographically dense breast tissue.
Mammograms expose the breasts to small amounts of radiation. But the benefits of mammography outweigh any possible harm from the radiation exposure. Modern machines use low radiation doses to get breast x-rays that are high in image quality. O n average the total dose for a typical mammogram with 2 views of each breast is about 0.4 millisieverts, or mSv. (A mSv is a measure of radiation dose.)
To put the dose into perspective, people in the US are normally exposed to an average of about 3 mSv of radiation each year just from their natural surroundings. (This is called background radiation.) The dose of radiation used for a screening mammogram of both breasts is about the same amount of radiation a woman would get from her natural surroundings over about 7 weeks.
There is mild discomfort associated with mammography. Scheduling your mammogram right after your menstrual cycle can help with tenderness and perhaps, taking ibuprofen 400-600 mg a few hours prior to your mammogram might be helpful. In general, the discomfort is minimal and resolves quickly after your imaging.
For the Women’s Health Alliance Mammography office your mammogram will be interpreted by a certified radiologist and the report will be forwarded to your provider in the Arbor ObGyn office. Your provider will review your report and then forward the results to you. You will also receive a summary letter in the mail to your home address. Your report will also give you information about the density of your breasts. The radiologist is required to alert you to the density of your breasts. Density is categorized as: almost entirely fatty, scattered fibroglandular tissue, homogenously dense, and extremely dense. Dense breasts are associated with a slight increased risk of breast cancer and can decrease the detection of breast lesions. Approximately 50% of women have dense breasts. Therefore, we strongly recommend women with dense breasts continue to utilize our 3D mammogram technology.
Occasionally, you will be recalled for further imaging after your screening mammogram. Your mammogram is frequently just considered ‘incomplete’. While that can be quite frightening, more than 90% of those are normal. The radiologist also may suggest take additional views of the breast with another mammogram and/or incorporating breast ultrasound.
When should you begin mammogram screenings?
Your provider will assess your family history and other potential risk factors to help you determine at the optimal age to begin mammogram screenings. Although many reputable national guidelines vary, in general, low-risk women should begin at age 40. Women with additional risk factors may start earlier. Women planning to get breast augmentation (implants) should consider having a baseline mammogram prior to surgery. Guidelines also vary with regards to screening interval, but most agree that testing should be every 1-2 years until at least age 75.
Mammograms and breast ultrasounds are also used when you have a specific concern about your breasts, such as a lump, pain, skin changes, or nipple discharge.
Breastfeeding women do not get screening mammograms typically. However, if you have an unexplained new lump, a mammogram should not be delayed or avoided.
There are other imaging techniques for evaluating the breasts. The necessity is determined on an individual basis and could include an MRI or breast ultrasound. We also recommend that you have a clinical breast exam with one of our providers at least yearly and perhaps, every 6 months if you have a family history of breast cancer.
We are pleased to let you know that we have our own mammography suite, Women’s Health Alliance Mammography. Our mammography suite is located at 4414 Lake Boone Trail, Raleigh, Suite 309. This is the medical office building adjacent to the Rex Women’s Center, and you can park in same parking deck. Your screening mammogram can usually be done on the same day as your annual exam.
Some information provided from the National Cancer Institute and the American Cancer Society.