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clearing up the mammogram confusion

by Mark Dixon, MD

Fall is a special time in Virginia. The back-to-school routine begins again as the humid and hot days of late summer become a distant memory and cooler temperatures arrive. The leaves begin to change into vibrant shades of orange, brown, and yellow. And most importantly for breast imagers and other doctors like me who specialize in breast health, fall gives us a chance to recognize October as National Breast Cancer Awareness Month. I am grateful to have been given this venue to clear up some of the confusion about breast cancer screening, and to leave you with a simple fact — mammography saves lives.

The mission of any breast imager is to save lives through early detection of breast cancer and its precursors. As a radiologist specialized in breast imaging, I take this job very seriously. While significant progress has been made in the fight against breast cancer, it remains the most frequently diagnosed type of non-skin cancer and the second leading cause of cancer deaths among women in our country. This year alone, over 200,000 Americans will be diagnosed and nearly 40,000 lives will be claimed. This October, during National Breast Cancer Awareness Month, we reaffirm our commitment to educating all women about the importance of early detection.

Annual mammograms can detect cancer early — when it is most treatable. In fact, mammograms can show changes in the breast up to two years before a patient or physician can feel them. Mammograms can also prevent the need for extensive treatment for advanced cancers, and improve the chance of breast conservation. Thanks to earlier detection and better treatments, mortality rates for breast cancer have steadily decreased in the last decade. Due to the introduction of widespread screening with mammograms, in addition to advances in treatment, the breast cancer death rate in the United States declined by approximately 26 percent between 1975 and 2007.

Some have argued, using statistical analysis that has been proven flawed time and time again, that women age 40–49 do not need regular mammography screening. A recent study published this September in Cancer showed that 50 percent of breast cancer deaths occurred in women under the age of 50. The majority of those who died from breast cancer never had a mammogram prior to diagnosis. With more prevalent screening, especially in younger women, this study suggests that breast cancer mortality could continue to decrease — but not without early detection. This study confirms the need for annual mammography in women beginning at age 40. These are in line with current guidelines from the American College of Radiology, the American Cancer Society, and the Society for Breast Imaging: women should receive annual mammograms starting at age 40, even if they have no symptoms or family history of breast cancer.

Understandably, mammograms can cause a lot of anxiety for women. Waiting for the results, either by mail or a phone call, can lead to endless worry on behalf of some of our patients. This is the very reason that we offer same-day, while-you-wait results at our dedicated breast centers — Bon Secours St. Mary’s Women’s Imaging Center, and Bon Secours Watkins Women’s Imaging Center. If you would rather wait in our clinic for a radiologist to interpret your mammogram, you may do so. If you have other things to do, and prefer to spend less time with us, the vast majority of the mammograms in our hospital network are interpreted within 24 hours, and many are read the same day they are performed. We believe this customized approach will let you find a path to screening that fits with your needs; we are happy to accommodate all of our patients and know that every woman is different.

I’d like to share with you some facts about mammograms, in the hopes that it may lessen any anxiety and add a layer of depth to your thoughts, should you ever be told that your mammogram is abnormal. For every 1,000 women who have a screening mammogram, about 100 are recalled to get more mammography or ultrasound images.Twenty are recommended for a needle biopsy. Five are diagnosed with breast cancer. I hope this demonstrates that most mammograms are normal, and of those that aren’t, most of the abnormalities can be cleared up with additional pictures.

If a biopsy is recommended by the radiologist, we will let your doctor know while you are in our clinic and will help with any follow-up appointments that are necessary. Additionally, we try our best to offer any recommended needle biopsies on the day of your additional views, although we realize that some women need more time to process the information and talk to their doctor and loved ones. This is a personalized approach for a highly personal journey.

Hopefully, I’ve cleared up the confusion about when to start mammograms and why it’s important to begin at 40 for most women. Screenings and early detection are essential components in the fight against breast cancer. It’s also important to know your risks. Risk factors for breast cancer include family and personal history, radiation therapy to the chest for previous cancers, obesity, and certain genetic changes. Being aware of these possible risk factors is important. Also important is knowing what you can do to decrease your risk of developing breast cancer. Maintaining a healthy body weight and balanced diet, exercising regularly, and getting regular mammograms may help lower the chances of developing breast cancer. A clinical breast exam by your health care provider every year is another vital step in maintaining breast health. Finally, knowing your body is always important. If you feel a lump or other change in your breast, talk to your doctor; a diagnostic mammogram (a specialized mammogram with extra pictures directed at the area of concern) and ultrasound may be indicated.

So unveil the pink ribbons, the pink coffee mugs, the pink headbands, and the pink soccer cleats! This October, as National Breast Cancer Awareness Month, and every day throughout the year, we stand with our mothers, our sisters, our wives, our daughters, and our friends. We recognize all who are currently fighting this battle, the community of survivors, and all who have come before us. We honor and remember our loved ones who have lost their lives to this terrible disease. By educating our patients and by supporting our researchers and health care providers, we will continue to save lives.

Mark Dixon, MD
Medical Director, Bon Secours Watkins Women’s Imaging Center
Medical Director, Bon Secours St. Mary’s Women’s Imaging Center
Bon Secours Cancer Institute, Division of Radiology
Director of Breast Imaging, Commonwealth Radiology

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