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What is mammography?
Why is getting a mammogram important?
Who is at risk of developing breast cancer?
What are the signs of breast cancer?
Who should have a mammogram?
Do mammograms hurt?
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What should I expect during my mammogram?
What happens if the radiologist finds something on my mammogram?
Does insurance pay for mammograms?
Recently I read an article that said getting a mammogram is unnecessary and may even do more harm than good. Is this true?
Which Diagnostic Imaging Associates locations offers mammography?
| Click here to read an article on What All Women Should Know About Breast Health |
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Mammography is a procedure that uses x-rays of the breast to detect cancer and other disease or abnormalities before they can be felt or seen.
Why is getting a
mammogram important?
Breast cancer is the #2 cause of cancer-related deaths in women. One out of nine women will be diagnosed with breast cancer in her lifetime. The risk of developing breast cancer increases as a woman ages. Women over age 50 make up three-fourths of the breast cancer cases diagnosed each year. Although family history of breast cancer increases a woman’s risk of developing the disease, over 80% of women diagnosed with breast cancer have no relatives who have suffered from the disease.
The rate of breast
cancer in
Knowing you are free of breast cancer from your annual mammogram is the best way to put yourself at ease. It is estimated that death from breast cancer could be reduced by 30% to 40% with the use of annual mammography and clinical breast examinations (CBE). This is because early detection increases the chance of successful treatment that saves the maximum amount of breast tissue and has fewer side effects. The five-year survival rate for women diagnosed with breast cancer in an early stage is 90%. However, if the cancer is allowed to spread throughout the breast, the five-year survival rate decreases to 75% and then drops to 20% when it spreads to other areas of the body.
Who is at risk of developing breast cancer?
A woman is more likely to develop breast cancer if she has any of the following risk factors:
Increasing age (each 10-year increase in age is associated with an increased number of diagnosed breast cancers)
Family history of breast cancer
First pregnancy after age 30, or having no children
Previous diagnosis of cancer
Menarche (first period) before age 12
History of benign breast disease
Nipple discharge when not nursing
What are the signs of breast cancer?
Even though early breast cancer usually does not cause pain or symptoms, typical signs include:
A lump or thickening in the breast or underarm area
Change in the shape or size of the breast
Discharge from the nipple
Change in the color or feel of the breast or nipple, especially dimples or puckering of the skin
The American Cancer Society (ACS) recommends mammography for women age 40 years or older. Mammography should be performed in conjunction with a monthly breast self-examination (BSE) and a yearly CBE.
For women aged 20 to 39 years, the ACS recommends that a BSE be performed every month and a CBE every three years. Women in this age group with a strong family history of breast cancer should consult their primary care physician to discuss the appropriateness of screening mammography before age 40.
Over its history, mammography has developed a false reputation for being painful. There is no argument that the procedure can sometimes be uncomfortable, but it should never be painful. One way to avoid discomfort during mammography is to schedule your appointment after your period.
Is there any preparation for a mammogram?
The day of your mammogram, please do not wear deodorant, perfume, powder, or lotion on the breast or underarm area. To make your mammogram go as smoothly as possible, wear a 2-piece outfit so that you only have to remove your top when changing into the examination gown. If this is your first appointment at Diagnostic Imaging Associates, please call our staff to make sure we have obtained your previous mammogram films.
What should I expect during my mammogram?
After you have changed into a waist-length examination gown, you will be led into the mammography suite. Your study will be performed by one of DIA’s registered radiologic technologists who will fully explain the procedure to you. At this time it is important to alert the technologist if you have breast implants.
The technologist will position one of your breasts on the bottom plate of the mammography machine. A second plate will be placed over the top of your breast. These two plates will slowly press down on your breast, spreading the tissue so that it is easier for the radiologist to see abnormalities. The compression of the breast can cause discomfort; however, most women report none. Two x-ray images will be taken of each breast—one from the side and one from above. The entire procedure will take approximately 15 to 20 minutes.
After the films from your mammogram have been processed, one of our radiologists will compare them to your previous mammogram and examine them for any abnormalities or tumors. If you choose to have the ImageChecker scan your mammogram, the images will be run through the computer and analyzed for any areas that may need a second look. The radiologist will then examine at any areas of concern marked by the ImageChecker.
After the radiologist has read your mammogram, the findings will be sent to you in a letter. The findings will also be sent to your referring physician.
What happens if the radiologist finds something on my mammogram?
After your mammogram has been read by the radiologist, a letter will be sent to you that reports any findings. Based on the results of your mammogram, the letter will provide specific instructions on any further action that is required of you. For example, these instructions may suggest another mammogram in six months, additional imaging, or follow-up with your physician.
Does insurance pay for mammograms?
The majority of
health insurance plans do cover annual mammograms for women over 40.
If you do not have insurance coverage, several organizations
dedicated to breast cancer awareness are located in
In the past two years the Journal of the National Cancer Institute and Lancet published controversial studies reporting that women in their 50s benefited no more from mammography than a clinical breast examination (CBE). Although some organizations feel that screening mammography for women aged 40 and older is unnecessary and may pose harm because it uses ionizing radiation, this opinion is not shared by respected members of the medical community. Immediately upon the publishing of these articles, the American Medical Association, the American College of Surgeons, the American Cancer Society, and the American Academy of Physicians released statements advising women to continue getting annual mammograms. Members of these organizations point out that this controversial view is based on only two articles that contradict over 30 years of clinical evidence showing that mammography can save lives.
The earlier breast cancer is detected , the better the prognosis is an undisputed fact. Currently, mammography is the gold standard for early detection of breast cancer because it is the most accurate screening tool available. It detects 85% of all breast cancers. However, because mammography is not perfect at detecting all cancers, every woman should perform a monthly breast self-examination and have regular CBEs in addition to their annual mammogram.
As for the amount of radiation exposure during mammography, there is no evidence that the current dosage poses a risk to the patient. The level of radiation typically received from modern mammography systems is between 0.1 to 0.2 rad per x-ray. At this level of dosage, a woman who has an annual screening mammogram (two x-rays per breast) from age 40 to age 90 will receive a total of 10 to 20 rads per breast. To put this dose in perspective, a woman undergoing radiation therapy for breast cancer will be exposed to several thousand rads.
Which Diagnostic Imaging Associates locations offer mammography?
Diagnostic Imaging
Associates has three locations in
What
are the ImageChecker and computer-aided detection?
How does
CAD work?
Why
should I have the ImageChecker screen my mammogram?
What
if the ImageChecker finds abnormalities on my
mammogram?
How accurate is the
ImageChecker?
Am
I being offered the ImageChecker because my radiologist is bad at
reading mammograms?
What
Diagnostic Imaging Associates locations offer the
ImageChecker?
What
are the ImageChecker and computer-aided
detection?
The ImageChecker® is
an optional service that can be added to your mammogram. This
technology uses computer-aided detection (CAD) to systematically scan
a mammogram for abnormalities typical of breast cancer. These
abnormalities include microcalcifications (calcium deposits) and
nodules/masses or tumors. Tumors are collections of cells that grow
abnormally and can be benign (noncancerous) or malignant (cancerous).
Studies show that use of the ImageChecker could result in earlier
detection of up to 23.4% of cancers currently detected with screening
mammography.
The ImageChecker is
manufactured by R2 Technology and is the most advanced CAD system
available for medical imaging. The ImageChecker is the first CAD
system approved by the Food & Drug Administration (FDA) for use
in breast cancer screening. The ImageChecker acts like another
radiologist reading the mammogram. By marking regions of interest
that may warrant a second review, the ImageChecker minimizes the
chance of subtle breast cancers being overlooked by the radiologist.
This second read assures you, the radiologist, and your referring
physician that any abnormalities in the breast tissue have been
analyzed.
CAD uses neural
network technology to perform an advanced analysis of your mammogram.
First the mammogram is read in standard fashion by the radiologist.
Then the film is read by the ImageChecker and scanned for
abnormalities. As the ImageChecker scans the mammogram, areas with
possible microcalcification clusters are marked with triangles and
dense regions with possible masses marked with asterisks (Figure 1). After the
ImageChecker has indicated suspicious areas, the radiologist looks at
the mammogram again to see if the computer found areas that may have
been overlooked or that may not be detectable by the human eye.
Figure 1. Mammogram scanned
by the ImageChecker with areas of possible microcalcifications marked
with triangles and possible masses or abnormal structures marked with
asterisks.
Why
should I have the ImageChecker screen my
mammogram?
According to the
American Cancer Society, more than 200,000 new cases of breast cancer
will be found in 2002 and approximately 40,000 women will die of the
disease. This translates into a breast cancer rate of 1 out of every
200 to 250 women who have a screening mammogram.
For women over age
40, getting an annual mammogram is important for detecting early
signs of breast cancer. But like most screening procedures,
mammography is not 100% accurate. According to leading medical
journals, between 20% and 40% of early stage breast cancers can go
undetected at the time of screening. This is partly due to the
complex anatomy of the breast and the subtle signs of breast cancer.
CAD is a significant
advancement in the complex interpretation of screening mammograms. In
clinical studies, the ImageChecker was shown to increase the
detection of breast cancers up to 23.4%. In another study in which
researchers analyzed screening mammograms of women recently diagnosed
with breast cancer, 23% of the women could have had their cancers
detected earlier with CAD by an average of 14 months. This kind of
early detection can greatly increase the survival rates for breast
cancer and decrease the cost and intensity of
treatment.
What
if the ImageChecker finds abnormalities on my
mammogram?
All of our patients
who have a mammogram receive a letter summarizing the findings by the
radiologist. If the ImageChecker marks abnormalities that are
confirmed by the radiologist, your letter will state that your
mammogram shows an area of abnormality that requires further
follow-up by your physician or other health care provider. The
radiologist who reads your mammogram will also forward these results
to your physician, who will review them with you and decide on the
appropriate course of action.
How accurate is the
ImageChecker?
The ImageChecker is
very effective at detecting cancer because the computer is thorough
and consistent. Two clinical trials conducted by the FDA studied the
accuracy and consistency of the ImageChecker. In the first study, CAD
correctly marked abnormalities on screening mammograms 81% to 92% of
the time. The other study showed that CAD correctly identified the
location and classification of abnormalities with 99% accuracy for
microcalcifications and 75% for masses. This gave CAD an overall
accuracy rate of 84%. More recent information from the FDA reported
that with using the latest CAD algorithms, the ImageChecker had a 99%
detection rate for cancers displaying microcalcifications, an
86%detection rate for cancers displaying features of masses, and a
90% detection rate for all breast cancers. In another recent study by
Burhenne et al, use of CAD reduced false-negative (missed breast
cancer) rates by 77%.
Am
I being offered the ImageChecker because my radiologist is bad at
reading mammograms?
Absolutely not. The
inspiration behind the ImageChecker was a study that showed an
increase in cancer detection of 4% to 15% when mammograms were read
by more than one radiologist. This process is called a double read.
Due to time and economical constraints, double reads by radiologists
are rarely possible. In order to gain the benefits of a second read,
the ImageChecker can be used to assist the radiologist in identifying
regions of interest that may warrant a second look. A double read
typically increases cancer detection because trying to find
early-stage cancers is often like trying to find a needle in a
haystack. There is an incredible amount of visual data on a mammogram
due to the complex structure and unique appearance of each breast.
Most of the time, this visual information is not significant and can
even look like an abnormality when, in fact, it is not. On the other
hand, the complex structure of the breast and the subtle signs of
cancer can sometimes lead to observational lapses, even for a highly
skilled radiologist. Observational lapses can also be caused by
fatigue.
Even though our
radiologists are board certified and highly trained, we recognize
that they are human. Perception has its limitations, which can
occasionally result in observational lapses. DIA has every confidence
in our radiologists. We are offering the ImageChecker to our patients
because we want to be assured that they benefit from the latest
developments in mammography technology. Clinical studies show that by
using the ImageChecker, our rate of detecting breast cancer in its
earliest stages will be even higher than it is now. By detecting
breast cancer in an earlier stage, treatment can be performed that is
lower cost, less traumatic, and more likely to increase survival
rates.
What
Diagnostic Imaging Associates locations offer the
ImageChecker?
All of our locations
that perform mammograms offer the ImageChecker. These locations
include Pike
Creek,
Brandywine,and
Glasgow