Mammograms are once again making news and just in time for Breast Cancer Awareness Month in October.

 

Over the summer, New York became the fourth state to require by law that a woman be notified if her mammogram results show she has dense breasts. Then in September, a study reported in the British Medical Journal (BMJ) found that, in women younger than 30 with a family history of breast cancer, mammograms may increase the risk of breast cancer from the use of radiation in the scans.

 

Though the chatter undoubtedly will continue, particularly during Breast Cancer Awareness Month, the fact is that mammograms are still considered the gold standard for breast cancer screenings. Numerous studies underscore the important role of mammograms in the initial detection of breast cancer. For that reason alone they should matter, but here are a few more reasons mammograms are here to stay:

 

Breast Density: Breast density took center stage in August when New York joined Connecticut, Texas and Virginia in passing a law that requires a woman be notified if her mammogram results show she has dense breasts. While a National Cancer Institute study found that women with dense breasts were no more likely to die than similar women who had breasts that were less dense, the fact that mammograms will reveal breast density will assist physicians in evaluating their patients.

Obviously a denser breast makes it more difficult to see through a mammogram, increasing the likelihood something could be missed. Potential cancerous spots, like dense tissue, appear white, and can blend in on a mammogram. In that case, additional diagnostic testing, such as an ultrasound, may be recommended. Like a mammogram, an ultrasound is relatively inexpensive; however, there is no radiation involved, and it is even easier on the patient, as there is no compression needed. Ultrasound, however, does NOT replace mammography as the initial modality for breast cancer screening.

 

Low Risk: The study in the BMJ did not prove that there is a link between breast cancer and radiation, but it did bring the issue to light. If used properly, mammograms are low risk with only a small amount of radiation. As with an ultrasound, mammograms are effective, fast and inexpensive. In comparison, an MRI is more expensive, takes longer, causes more patient anxiety and requires an injection of contrast.

 

Breast Reconstruction: I also know from personal experience that women who have had breast cancer and had their breast/breasts removed and/or reconstructed should continue to have mammograms. Even though there is no breast tissue, I have had multiple cases in patients with reconstructed breasts where mammograms have shed light on issues that required further follow-up, including recurrent/residual malignancy.

 

 

Promising Modality: While there are many modalities available that are complementary to mammograms, I believe Positron Emission Mammography (PEM) is particularly promising. In 2009, the National Institutes of Health announced the results of a multi-year study of women with breast cancer, which found that PEM scanners are more powerful than MRIs in detecting whether a lesion is benign or cancerous. While mammography and ultrasound reveal location, PEM scanners also will identify the lesion’s metabolic phase and that ultimately determines the proper course of treatment.

 

As we recognize National Breast Cancer Awareness Month, it’s important to understand that every patient and every situation is unique, and not every diagnostic modality is good for a patient every time. However, a mammogram is a very good place to start.