Written by Stephen Sevigny, M.D.
Mammography is not just for Breast Cancer Awareness month or October as it was previously known. Throughout the year mammography saves lives in our community. One of the most common questions I receive is when to start and what kind do I need.
There are essentially two different types of mammograms performed, screening and diagnostic. A screening mammogram is for the routine detection of breast cancer, typically beginning when a woman turns 40 years old. Screening mammograms consist of 2 views of each breast, with or without 3D tomographic imaging. The patient receives results a few days later. Diagnostic mammograms are more involved with routine views and numerous special views for different indications. Often a diagnostic mammogram will include a diagnostic breast ultrasound to further investigate an area. Indications for a diagnostic exam include a palpable lump, focal breast abnormality or to further investigate an abnormal screening exam. The patient receives final results that day.
For decades, medical organizations were nearly unanimous in regards to the practice of screening mammography. Routine screening for the detection of breast cancer typically began at age 40 and continued yearly until it made medical sense to stop. Numerous studies proved a 15-29% reduction in breast cancer mortality for screening women in their 40’s and 50’s. As screen film mammography progressed to current digital mammography, the radiology community expects that number to increase. Now that 3D tomography technology has been added, the quality of mammographic screening has grown substantially.
However in 2009, the independent US Preventative Services Task Force (USPSTF) recommended biennial screening for women between the ages of 50 – 74, and to only begin before 50 after consulting with her physician. The USPSTF concluded that “screening seems equivalent for women aged 40-49 and 50-59 years” but screening the younger population caused increased anxiety, additional testing, and unnecessary biopsies. The same study recommended AGAINST teaching breast self-examination to women. Numerous organizations including the American College of Radiology (ACR) and Society of Breast Imaging were quick to point out numerous flaws in their recommendations. One main criticism of the USPSTF position is based on the “over” diagnosis of ductal carcinoma confined to the duct. It is clinically unknown how many of these would have progressed to invasive cancer and put the patient at systemic risk versus remaining within the duct. Of course to judge its biological activity it must be biopsied or removed AFTER its detection with mammography. I prefer the earliest detection to allow for earliest treatment. Improving patient anxiety levels is an important part of the mammography examination. Our technologists and staff work every day guiding patients through their tests and what they can expect both that day and afterwards.
The ACR and our practice continues to recommend yearly screening mammography beginning at age 40 unless clinically warranted earlier. If the patient is breast cancer gene positive, alternating a Breast MRI exam every six months with yearly screening 3D mammography is the current recommendation. An informed patient makes the best patient. Discuss your screening options with your physician. Currently the Affordable Care Act or “Obamacare” mandates screening mammographic coverage at age 40, at NO charge to the patient.
Note: This article appeared in The Daytona Beach News-Journal and was written by Stephen Sevigny, MD, Board Certified Radiologist.