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Women’s Health: Breast cancer screening saves lives

  • Dr. Louis Pacilio SUBMITTED PHOTO



For the Gazette
Tuesday, October 10, 2017

There are two things everyone needs to know about breast health. First, there are many things you can do to maintain it. Second, mammography remains the best way to detect breast cancer in its earliest stages.

Maintaining breast health is similar to many other healthy habits. Dental health, for example, requires regular brushing and flossing plus professional cleaning and checkups; bone health requires weight-bearing exercise, sufficient calcium and vitamin D, and not smoking.

For breast health, it’s recommended that women — and men — pay attention to factors including family history of cancer, types of cancer and the age at which family members were diagnosed with disease.

Families with a strong history of cancer sometimes carry gene mutations that may increase the overall risk. Other risk factors also play a significant role; The National Cancer Institute has a widely used risk assessment tool that can be completed online (http://www.cancer.gov/bcrisktool/).

It’s important to note, however, that while a family history of certain types of cancer can increase the risk of breast cancer, 85 percent of women (and men) who are diagnosed do not have a family history of breast cancer, nor do they have many of the common risk factors.

Performing regular breast self-examinations can be a key to detection. Though there are no major research studies showing the effectiveness of monthly breast self-exams, we see many patients each year at Cooley Dickinson Hospital in Northampton who have felt lumps on their own. It’s also helpful to ask your primary care clinician or OB/GYN to perform an annual clinical breast exam, which entails feeling the breasts for changes or abnormalities.

Mammography is the only proven way to identify breast cancer in its early stages. When found early, breast cancer is more curable, the long-term prognosis is better, the treatment choices are greater, and the interventions required are less invasive. Primary care physicians can give patients advice on screening guidelines.

There is considerable controversy about when to have a first mammogram. Some national organizations, such as the U.S. Preventive Services Task Force, recommend that mammograms begin at age 50. The American Cancer Society recommends age 45. The American College of Obstetrics and Gynecology recommends offering women the option of mammography from age 40 with all women starting by age 50. The American College of Radiology recommends yearly mammography beginning at age 40.

Therefore, when to begin annual mammography screening is a personal decision. Before making such a decision, however, it’s important to be well-informed. A first step is talking to your primary care clinician about the overall risks and benefits of mammography, your personal risk, plus the role of breast self-examination and other breast health steps can play.

I recommend having a first mammogram at age 40. Each year on average, we see 10 to 15 breast cancers in women below the age of 50 at Cooley Dickinson. I would recommend an even earlier start — age 35 — if a mother or sister had been diagnosed with breast cancer before the age of 50.

There are two main reasons why many women hesitate to begin or have annual mammograms. One is the chance of a false positive result, which is more likely to happen with women in their 40s. A false positive result can lead to additional testing — another mammogram, an ultrasound, or a biopsy — that confirms there is no cancer present. Costs are associated with that additional testing, both emotional and financial.

The other is exposure to radiation. At Cooley Dickinson’s new Breast Center, we use “low-dose” mammography equipment — machines that deliver less than half of the radiation you’re exposed to during a cross-country airplane flight.

There are other screening options available but they all have their weaknesses. Whole-breast ultrasound generates many false positives. Thermography, which relies on a heat-sensitive map of the breast, has not been shown to be effective. MRI is a reliable screening tool but is not used routinely because of its high cost.

Advances in mammography include the recent availability of 3D mammography, also called breast tomosynthesis. Approved by the FDA in 2011, the 3D equipment’s X-ray arm sweeps in a slight arc over the breast, taking several images from several angles and creating sequential layers that recreate a 3D image of the breast. In contrast, 2D mammography relies on a single, flat image.

The five main benefits of 3D mammography are:

It finds up to 20 to 30 percent more invasive cancers than 2D mammography.

It finds smaller invasive cancers giving patients more option for treatment.

It allows the radiologist to see through the breast density to find previously obscured abnormalities.

It decreases mammography callbacks by up to 40 percent.

Less radiation is used.

All mammograms at Cooley Dickinson are performed in 3D unless someone requests otherwise. Simultaneous with the 3D scan, 2D images are generated by software from the 3D data, resulting in half the radiation dose. The 3D images allow the radiologist to gain a better view and understanding of a woman’s breast tissue. This is especially helpful for women with dense breast tissue.

Whether you choose 3D or more traditional 2D mammography, getting into a routine of an annual mammogram is important to breast health.

We are excited that the new Breast Center at Cooley Dickinson offers spacious, comfortable rooms separate from the rest of radiology, where coordination among technologists, radiologists, surgeons, and patient health advocates make it a convenient, easy task to look out for your breast health.

Dr. Louis Pacilio, lead mammography radiologist at Cooley Dickinson Hospital in Northampton, is one of the Cooley Dickinson professionals who write a monthly column for this space.