Are Mammograms Effective? Debunking Myths About Diagnosing Breast Cancer
Finding out you have breast cancer can be devastating news to receive — however, it’s news you want to receive early. Mammograms are a safe and effective method for diagnosing breast cancer early, and the American College of Radiology recommends that asymptomatic women without a family history of breast cancer ages 40 and older get a screening mammogram annually. Earlier screening is also available for women with a family history or other risk factors for breast cancer.
A diagnostic mammogram is recommended for women noticing breast changes including a lump, pain, change in size or shape, change in skin appearance, and nipple thickening or nipple discharge.
Still, there are some myths surrounding mammography. As part of National Breast Cancer Awareness Month, recognized each October, we reached out to Sadaf Chaudhry, MD, medical director of the Breast HealthCare Center at Missouri Baptist Medical Center, to debunk several of them below.
When doctors examine mammograms, they are assessing breast tissue and categorizing it into four groups: fatty, scattered fibroglandular, heterogeneously dense and extremely dense. The closer tissue is to extremely dense breast tissue, the harder it is to find cancer hiding in the breast tissue.
In addition, having dense breast tissue increases the risk for breast cancer in women.
“Cancer can hide out in breast tissue in women who have heterogeneously dense breasts and women with extremely dense breasts,” Chaudhry said. “That’s not to say that mammography is not useful because mammography is still the best primary screening that we do in women of all densities.”
Women who have denser breast tissue or who also have a family history of dense breasts should talk to their doctor to see if they can benefit from adjunct screening such as an additional ultrasound evaluation, an evaluation with contrast-enhanced mammography or breast MRI.
Women who have other risk factors for breast cancer, including a family history of breast cancer, gene mutations or a history of receiving radiation as a child, might also talk to their doctor about additional imaging.
Chaudhry says that’s not true. “The whole point of mammography is that a woman is asymptomatic — she doesn’t feel anything in her breasts — and she gets her annual screening,” she said. “We don’t want someone to say, ‘Hey, I’m feeling something, because at that point the cancer is likely sizable. It’s still, hopefully, treatable. We have lots of patients who find their breast cancers through physical exams or during their breast self-exam, but the point of the screening mammogram is to find it when it’s small.”
Breast self-exams aren’t that reliable. Just because you don’t feel anything doesn’t mean you don’t have breast cancer.
“The cancers that we’re trying to diagnose are all so small that no one would feel them,” Chaudhry said. “Also, there’s still ductal carcinoma in situ, which is a very early form of breast cancer that most people do not feel at all. It shows up as calcium deposition on the mammogram.”
Chaudhry says that there are many state and federal standards regarding mammography, and because of those, breast centers calibrate their machines and perform quality assessment tests periodically to ensure that the exams are as safe as possible with the least amount of radiation per study.
“There is radiation associated with the mammograms, but it’s considered safe, and the benefit is that having your annual mammogram could diagnose breast cancer in its earliest stage,” Chaudhry said.
Chaudhry admits mammograms can be painful and recommends taking acetaminophen or ibuprofen prior to the appointment for anyone who has had a painful mammogram in the past. You can also let your technologist know that you feel pain during the mammogram.
“They can apply the compression more gently or let the patient direct the compression of the mammogram,” Chaudhry said. “We like to compress as much as possible because it allows us to spread out the breast tissue to obtain a high-quality image.”
Mammography is safe during pregnancy and while breastfeeding. Chaudhry says it’s best to not delay your mammogram.
“We see a lot of women who breastfeed,” Chaudhry said. “They may be older than 40, or they may have a family history and start mammography earlier. We encourage people to stick to the yearly mammogram schedule as best they can.”
For those ages 40 and over
Who are not experiencing breast problems
Who haven’t been sent by a provider for additional imaging
A diagnostic mammogram is recommended for women who have a clinical complaint such as a palpable lump, focal breast pain, nipple discharge or recent breast skin changes.