Breast cancer is a scary reality that women have to deal with every day. While there are methods of catching it early, like regular self-exams, the most common form of detection is with mammography, or mammograms. However, recent research shows that mammograms may not exactly be all they’re cracked up to be. Studies have been conducted testing the efficacy of mammograms and the results are certainly interesting.
What Is A Mammogram
Mammography is a specialized medical imaging system that uses low dose x-rays to see inside the breast. A mammography exam, more commonly known as a mammogram, is used to detect breast cancer early when it is the easiest to treat, and to diagnose breast diseases in women .
There have been three recent advances in mammography: digital mammography, computer-aided detection and breast tomosynthesis ; the latter two are more specialized forms of screening. All three of these methods use radiation.
Digital mammography is a mammography system in which x-ray film is replaced by technology that converts x-rays into mammographic pictures of the breast. This system is similar to those found in digital cameras and it enables better pictures with a lower radiation dose. These images are then sent to a computer to be examined by a radiologist and for long-term storage. The process for digital mammography is similar to film mammography.
Computer-aided detection, or CAD, systems search digital mammographic images for abnormal areas of density, mass, or calcification that may indicate the presence of cancer. The CAD system highlights these areas on the images, bringing it to the attention of the radiologist for closer and careful examination. Radiation levels for this type of screening is the same as a standard mammogram.
Breast tomosynthesis, also called three-dimensional (3-D) mammography, is an advanced form of breast imaging where multiple images of the breast are taken from different angles and reconstructed into a three-dimensional image set. This makes 3-D breast imaging similar to computed tomography (CT scan) imaging where thin “slices” are assembled together to create a 3-D reconstruction of the body . 3-D mammography actually has higher radiation levels than a regular mammogram.
The Difference Between A Mammogram and Thermogram – Why They’re Not The Same Thing
While they may sound similar, there are actually a few key differences between mammograms and thermograms. While a mammogram uses radiation to see through the breast tissue, a thermogram uses digital infrared thermal imaging. An infrared thermal camera measures the skin temperature of the breast in a heat map type image.
Cancerous tissue shows up as a high temperature area due to a higher concentration of blood vessels and inflammation. While there is no radiation used, thermography may not be the best method when it comes to breast cancer screening. Thermograms have a high false-positive rate, meaning women will most likely have to have a mammogram done anyways. They also have high false-negative rates, which means avoidance of the standard mammogram, as a woman may feel she has been adequately screened. Lastly, they aren’t always covered by health insurance providers and can be costly to pay for on your own .
Benefits Of Mammograms
- Mammography allows for doctors to detect tumors early. When a tumor is small it is the easiest to treat and there are more treatment options for the woman.
- Using screening mammography increases the detection of small abnormal tissue growths confined to the milk ducts in the breast, called ductal carcinoma in situ (DCIS). These early tumors cannot harm patients if they are removed at this stage and mammography is an excellent way to detect these tumors. It is also useful for detecting all types of breast cancer, including invasive ductal and invasive lobular cancer.
- No radiation remains in a patient’s body after an x-ray examination.
Risks Of Mammograms
- There is always a slight chance of increasing cancer risk from excessive exposure to radiation, making repeated screenings dangerous.
- The effective radiation dose for this procedure varies.
- False positive mammograms are also a reality. Only five to fifteen percent of screening mammograms require more testing such as additional mammograms or ultrasound. Most of these tests turn out to be normal. If there is an abnormal finding, a follow-up or biopsy may have to be performed.It is estimated that a woman who has a mammogram every year between ages 40 and 49 has about a 30 percent chance of having a false-positive mammogram at some point in that decade and about a 7 percent to 8 percent chance of having a breast biopsy within the 10-year period.
The Studies Speak
In February 2014, a team of experts released a review of mammography screenings. The team of experts on the board included a medical ethicist, a clinical epidemiologist, a pharmacologist, an oncologic surgeon, a nurse scientist, a lawyer, and a health economist .
After a year of reviewing the evidence and its implications, they became ‘increasingly concerned’ that the evidence was contrary to the global consensus of other experts in the field suggesting that mammograms were safe and capable of saving lives.
The 3 primary reasons that the Swiss Medical Board was against systematic mammograms are :
- Outdated Clinical Trials.The debate over mammography screening is based on a “series of re-analyses of the same, predominantly outdated trials.” The first mammography trial began more than 50 years ago and the last trial was in 1991. The mammography benefits that were found during these trials were prior to modern breast cancer treatment, in which the prognosis of women with breast cancer has improved significantly from even two decades ago. The expert panel questioned:
“Could the modest benefit of mammography screening in terms of breast-cancer mortality that was shown in trials initiated between 1963 and 1991 still be detected in a trial conducted today?”
The Benefits Don’t Clearly Outweigh The Harms.
The experts noted that they were “struck by how non-obvious it was that the benefits of mammography screening outweighed the harms.” They cited a study conducted by the British Medical Journal (BMJ) that followed 90,000 women over 25 years. They found that the death rate from breast cancer was virtually the same between those women who were regularly screened versus those who weren’t. They noted:
“This means that 106 of the 44,925 healthy women in the screening group were diagnosed with and treated for breast cancer unnecessarily, which resulted in needless surgical interventions, radiotherapy, chemotherapy, or some combination of these therapies.”
- Women’s Perceptions Of Mammography Benefits Does Not Match Reality.The experts were also concerned with women’s perceptions of the benefits of mammograms versus the actual benefits. In one survey, most women believed that mammograms reduced the risk of breast cancer by at least half, and 80 deaths out of 1000 women screened were prevented. In fact, mammography may offer a relative risk reduction of 20 percent and prevent in absolute terms only one breast-cancer death per 10,000 women. The experts asked a long overdue question:
“How can women make an informed decision if they overestimate the benefit of mammography so grossly?”
Another study conducted in Denmark followed thousands of women for over a decade and found that perhaps one-third of of the abnormalities detected by mammograms may never cause health problems .
The study took advantage of an unusual situation; Denmark made screening mammography available to all women at different times in different parts of the country. This enabled the researchers to compare the occurrence of early- and late-stage breast cancer in different regions, comparing those who got mammograms and those who didn’t.
Karsten Jorgensen, deputy director of the Nordic Cochrane Centre in Denmark, who led the study, said “We wanted to look at whether breast screening led to fewer advanced-stage cancers because screening is really based on the premise that you detect cancer earlier so you should have less advanced cancers over time.”
The analysis found that there was a, “reduction in the frequency of late-stage tumors in the screened areas compared to the non-screened areas,” Jorgensen says. “But we did see a huge increase in the occurrence of early-stage cancers.”
The findings revealed that mammograms are frequently picking up lumps that are not hazardous to a woman’s health. Like many prostate cancers, they may never grow or even regress themselves.
There are some alternatives to mammograms such as ultrasound and MRI, which do not use radiation. Ultrasound uses soundwaves to examine the breast, instead of radiation like mammograms. This is usually used for women with dense breasts, or those who had an unusual mammogram. MRIs don’t rely on radiation either, but use magnets to create a cross section of the breast .
With all things considered, these alternative methods of breast exam also come with their drawbacks, the most glaring of which being that they all are more likely to reveal a false positive than a mammogram.
At the end of the day it is important to understand that there are other screening options, each with their own strengths and weaknesses, and you have a right to utilize those options. Also remember that in order to truly avoid breast cancer, you need to focus your attention on actual prevention and not just early detection. It’s suggested that women over the age of 40 should get a yearly mammogram, and once they are over 50 they should have one every two years. It’ also important for women who are predisposed or have a family history of breast cancer to get checked frequently, whichever way they feel comfortable.
It’s important to note that breast thermography is not a replacement for or alternative to mammography or any other form of breast imaging. Breast thermography is a risk assessment tool that is meant to be used in addition to mammography and other tests or procedures. All thermography reports are meant to identify thermal emissions that suggest potential risk markers only and do not in any way suggest diagnosis and/or treatment.
Studies show that the earliest detection is realized when multiple tests are used together. This multimodal approach includes breast self-examinations, physical breast exams by a doctor, mammography, ultrasound, MRI, thermography, and other tests that may be ordered by your doctor.
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