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Mammograms are key to the early detection and best outcome for women with breast cancer. Although mammograms don't prevent cancer, they detect tumors, some of which are too small to be felt in a manual examination. According to research by the National Cancer Institute (NCI), mammograms reduced breast cancer deaths from 28 to 65 percent in the 1990s.

How often women should have mammograms has long been a point of contention between government and cancer organizations. The NCI and the American Academy of Family Physicians advise mammograms once every one or two years for women over 40; the American Cancer Society recommends that women over 40 have mammograms yearly. Women at higher than normal risk, such as those with a family history of breast cancer, should talk with their physician about whether to begin mammography sooner.

A mammogram is a low-dose X-ray that can detect early signs of breast cancer. Some tumors will show up on a mammogram two years before you can feel a lump, which may be early enough to spare you from a mastectomy or even chemotherapy. More important, a mammogram can pick up on cancer before it spreads to your lymph nodes, which may save your life.

You'll be asked to undress from the waist up and put on a gown that opens in the front. The technologist will position your breast on a plastic tray and then lower a second tray onto it to compress it for the X-ray. Then she'll ask you to raise your arm over your head and hold your breath for a few seconds as she takes the X-ray. She'll take two views of each breast, one from above and another from the side. On the day of your mammogram, don't wear deodorant, talcum powder, perfume, or lotion, since those things can show up on the film.

Having your breasts squeezed under about 20 pounds of pressure can be uncomfortable if not downright painful. But proper compression of the breast is necessary to get an accurate reading. Poor compression can lead to false positive readings. You can lessen the discomfort by scheduling your mammogram during the week after your period, when your breasts are least likely to be tender. You may also want to take aspirin or ibuprofen an hour before the procedure. Ask ahead of time if they can warm the trays, and be sure to let the technologist know if you're finding the procedure painful so she can make an adjustment. One more thing: Doctors don't know why, but some women find that cutting out caffeine or taking 400 international units of vitamin E each day for a few weeks beforehand makes their breasts less sensitive.

If you have particularly small or large breasts or if you have breast implants, ask for a technologist who has experience accommodating women like you. No matter how small your breasts are, a good technologist will find a way to get a reading. If your breasts are very large, the technologist may have to take more than one X-ray from each angle. Women with implants will need X-rays from several different angles so that the technologist can work around the silicone or saline, which can block views of the tissue behind it. An experienced technologist will know how to position your breasts to minimize the discomfort and the chance of rupturing the implant.

If your mammogram is "positive," which means that the radiologist noticed something unusual or different from your last mammogram, you should hear within a day. Never assume that no news is good news. If you haven't heard anything two weeks after your exam, call the lab or your doctor for the results. You'll probably be asked to come back in for a sonogram (also known as ultrasound), a painless procedure that uses high-frequency sound waves to create a clearer picture of the suspicious area. If the mass looks harmless on the sonogram, your doctor may recommend a "watch and wait" strategy and ask you to return for a second screening in one to six months to see if anything has changed. If there are still grounds for concern, she may want to take a tissue sample of the mass (called a biopsy) in order to check it for cancerous cells under the microscope. Seventy percent of biopsies turn out to be benign. In most cases, the surgeon takes only a tiny bit of tissue and leaves no scar. If a mass looks particularly suspicious, however, she may remove the entire lump.

Mammograms pick up only about 85 percent of cancers. It's harder to spot tumors in dense breast glandular tissue than in fatty tissue, and some women -- particularly those who are premenopausal or on hormone-replacement therapy -- have dense breasts (more glandular tissue, less fat). That's why a self-exam can be helpful. If you think you feel something that the mammogram didn't pick up, insist on having a sonogram to check it out. And if you're taking estrogen, ask your doctor about going off the pills for a few months in order to get a more accurate reading. Even a mammogram along with a sonogram can miss tumors. If you feel a lump and you or your doctor consider it suspicious the lump should either be biopsied or carefully monitored -- even if it looks normal on the mammogram.

Unless you've got a family history of breast cancer, you can probably wait until you turn 40 to start getting regular mammograms. (Many radiologists recommend that you get your first one around age 35, when things are likely to be normal, to compare with later results.) Experts are still split, however, on whether you should have a mammogram every year or every other year during your 40s. Some argue that since younger breasts are usually denser and harder to X-ray accurately, mammograms in the '40s are more likely either to miss tumors or to show "false positives" that result in needless biopsies. Others argue that although breast cancer is much less common before the age of 50 than in later years, breast tumors seem to grow faster in premenopausal women, so it's especially important to catch them early. And, in fact, the American Cancer Society recommends annual mammograms for women over 40.

Your doctor can refer you to a breast-screening clinic or you can find one in your area by calling the National Cancer Institute at 800-422-6237 or the American Cancer Society at 800-227-2345. Try to find a facility that does only breast screening, where the radiologist is reading at least 20 mammograms a week. If you can, go back to the same clinic each year; otherwise, make sure they send a copy of your X-rays to your doctor for comparison with future ones. Some insurance companies cover annual mammograms beginning at age 40, and many clinics offer free mammograms during October, which is Breast Cancer Awareness Month. The organizations listed above have information on low-cost facilities.

No one without health insurance should be deterred from getting breast cancer screening. The federal Centers for Disease Control and Prevention (CDC) offers free or low-cost screening and post-screening diagnostic services to women who can't afford them. In its 10 years, the program has screened more than one million women. For information on getting a free mammogram in your state, call the CDC at 888-842-6355.

Digital mammograms, which require the same breast compression as X-rays but produce a more accurate electronic image, are available but mostly at research facilities. Researchers are also looking into various techniques, such as magnetic resonance imaging (MRI), that would make it possible to painlessly screen the breast tissue for abnormalities while you lie facedown on a bed that has an opening for your breast. Also, a new technology that illuminates cancerous cells in still-tiny tumors has been used successfully on mice but is not yet approved for tests in women. It involves injecting fluorescent molecules into the breast that react with and illuminate cancer cells.

-- Tula Karras is a former staff member at WebMD in San Francisco.

References

First published April 2, 1999
Last updated March 13, 2008
Copyright © 1999 Consumer Health Interactive

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