Mammograms are important, ‘year after year’
Breast cancer remains one of the most common cancers affecting women in Butler County and globally. Successful treatment and improved survival rates depend on early detection. Mammograms — X-ray exams of breast tissue — are the gold standard for breast cancer screenings.
Regular mammograms have contributed significantly to reducing breast cancer mortality rates since their widespread inception in the 1980s. Mammography screening and appropriate follow-up treatments can lower the risk of breast cancer deaths by nearly 40% in some age groups, according to data from the American College of Radiology.
Annual mammograms are recommended starting at age 40 for women without risk factors or a family history of breast cancer, said Dr. Suzanne Coopey, a breast surgeon with Allegheny Health Network. Women at greater risk or those with mutated BRCA1 or BRCA2 genes may require more frequent screening.
“It’s not enough to have just one mammogram,” Coopey said. “You need to come back year after year so we can compare prior mammograms to current mammograms to identify subtle changes.”
Women who have had previous mammograms know what to expect. For those new to the experience, Coopey said a mammogram takes two separate views of each breast while compressed in a special X-ray machine. “Your breast is being squished between two plates for a short period of time, which can be uncomfortable. However, it doesn’t take long, usually just a couple of minutes.”
Coopey said mammogram technicians can adjust the compression pressure for women who find it too painful. Some women take ibuprofen or Tylenol before having one to help with the discomfort. She recommended scheduling a mammogram for the week after a menstrual cycle.
“Women with periods may have tender breasts during certain times of the month, especially one to two weeks before their periods when breasts are more swollen and tender,” she said.
Women sometimes receive callbacks after a mammogram. Dr. Danika Hogan, a board-certified radiologist with Independence Health System, said the most common reasons include suspicious calcifications, masses in the breast, and architectural distortion — an inflammatory process that causes a central point with branches of tissue that resembles a star — that can signify breast cancer.
What happens during a callback depends on the radiologist who reads the original mammogram diagnostic imaging.
“For me, if it’s a mass seen on a 3D mammogram, I go right to an ultrasound,” Hogan said. “But there are other ways of doing it. Some people do spot-compression mammograms first, and if the suspicious area persists, they move to an ultrasound.”
A common follow-up to calcifications is magnification views of the affected areas using a regular mammography machine.
Coopey and Hogan agreed that a 3D mammography machine on the first scan reduces the callback rate because it produces higher-quality images. Most women’s imaging centers and hospitals now use 3D as standard practice. Pennsylvania law requires insurance companies to cover the cost as a preventive screening.
New U.S. Food and Drug Administration rules require mammography reports to include information about whether a woman has dense breast tissue. Coopey said dense breast tissue can show up white on a mammogram, while fatty tissue appears dark gray or black. Dense breasts show up white for more than half of all women screened. Breast cancer also can present as little white spots, she said, which makes it harder to detect cancer in dense breast tissue.
Hogan said some radiologists recommend a secondary screening such as an ultrasound for women with dense breasts. A breast MRI may be recommended for patients with a greater than 20% risk of developing breast cancer.
Both doctors recommended continuing with monthly breast self-exams as an additional precautionary measure.
“It’s important to know how your breast feels so you can detect changes in between mammography screenings,” Coopey said. “Cancer can be more than lumps. You can have nipple and skin changes. Skin dimpling and nipple inversion or retraction can signal problems. You may not even feel a well-defined lump, but rather a thicker or different tissue.”
As to when women should stop getting annual mammograms, both doctors said it’s a subjective cutoff point that considers the overall health of the woman.
“We have some women who are 90 and very vibrant and they still come in for their mammogram,” Hogan said.
Most health care providers notify women when it’s time for their annual screening. Making an appointment depends on your provider. However, Independence Health System has launched a new chatbot feature on its website to streamline the process. Simply click on the chat bubble to begin. The new feature isn’t appropriate for all patients. Women who have breast implants or require special accommodations should still call to schedule.
