Pictured left to right, top row: Dr. Russo and his wife and mother, Dr. Schroeder and his parents, Dr. Roy and his wife.
Pictured left to right, bottom row: Dr. Clemow and her mother, Dr. Tidwell and her daughter and mother, Dr. Patton and his mother.
Many individuals look to their loved ones for advice, and the topic of breast screening is no exception.
As many states and local governments in the United States look to resume elective procedures, breast health officials are speaking out in advance of Mother’s Day, reminding women above the age of 40 about the importance of maintaining their breast health by taking important steps such as getting their annual breast screening and knowing their breast density to help reduce their risk of breast cancer.
With screening centers and hospitals beginning to resume and reschedule these procedures, GE Healthcare spoke to several women’s health radiologists and Ob-Gyns across the country on what advice they would share with their own loved ones on the topic of breast screening:
- Dr. Joseph Russo, Radiology, St. Luke’s University Health Network
- Dr. Marc Roy, Radiology, Northwest Community Hospital
- Dr. Bruce Schroeder, Radiology, Carolina Breast Imaging Specialists
- Dr. Christina Clemow, Radiology, MetroHealth System
- Dr. Serena Tidwell, Obstetrics & Gynecology, Midtown OBGYN
- Dr. David Patton, Obstetrics & Gynecology, Dr. David Patton, MD, Inc
Many women are confused about when to start and stop mammograms, what would you tell your mother/sister/wife?
Dr. Schroeder: There is broad agreement, that to find the maximum number of breast cancers and save the greatest number of lives, and certainly to save the most years of life, screening mammography should begin at age 40 and continue for as long as the woman is in good health. Of course, if there is a strong family history, screening may start earlier and other tests may be needed in addition to mammography.
Dr. Clemow: I recommend you should start your annual screening mammograms at the age of 40, as do most major medical societies. As a breast radiologist, I am looking for subtle differences in your breasts from year to year and having a yearly mammogram is very important. You may continue annual mammograms while you are in good health with a reasonable life expectancy and willing and able to undergo treatment, if necessary.
Dr. Tidwell: The recommendations have been confusing; however, when you look at many of these recommendations, they talk about cost savings in spacing out mammograms. I strongly believe in annual mammograms starting at age 40. My mother is a low risk patient, and that is my approach for low or average risk patients. However, because my family has a genetic risk of breast cancer on my paternal side, I would explain to my daughter that her approach needs to be individualized for her specific risk.
How would you explain breast cancer risk factors to your mother/sister/wife?
Dr. Clemow: Most women that are diagnosed with breast cancer do not have a family history. In fact, 75% of women with breast cancer are not at high risk for the disease. However, there are some factors that may increase your risk of developing breast cancer, such as having first-degree relatives with breast cancer or being a BRCA1 or BRCA2 gene carrier. Other factors such as race and ethnicity, having dense breast tissue, some benign breast diseases, and certain lifestyle-related risk factors can increase your risk of developing breast cancer.
Dr. Tidwell: I recommend having your mammogram at a breast center that calculates a personalized breast cancer risk score for each patient. Given the new federal density law, we know that all patients will be informed of their breast density. So, in addition to annual mammograms, we all need to know our breast density and our risk score. These two factors determine the need for any supplemental screening in addition to an annual mammogram.
Dr. Patton: Some risks are uncontrollable and some we have control over. First, just getting older increases a woman’s risk to get breast cancer. One in 8 women will get breast cancer in their lifetime. Some women carry genetic mutations like BRCA1 and BRCA2 that greatly increases their risk, and these are picked up in women who have family histories of breast cancer or other certain types of cancer. Starting a period before age 12 or going into menopause after age 55 are also risk factors. Dense breast tissue is an additional uncontrollable risk factor and statistically found in 4 out of 10 women. Factors that women have some degree of control over include lack of physical activity, being overweight, taking certain hormones, drinking alcohol, and having a first baby after age 30. For those with dense breasts, I would recommend an ABUS (automated breast ultrasound) following a yearly mammogram.
How would you explain 2D vs 3D mammograms to your mother/sister/wife?
Dr. Russo: 3D mammography affords breast imagers the advantage of cross-sectional imaging that is often the standard of care in radiology (as in CT or MRI scans).
Dr. Schroeder: It’s like the difference between window shopping by strolling down the street where you can see some of what’s inside the store through the window versus going in and walking down each aisle where you can see the individual items. 3D mammography gives us much more detailed information by eliminating the overlap of tissues.
Dr. Tidwell: My mom is amazed by new car features like lane departure, back-up cameras and automatic braking systems. While these features don’t necessarily make us better drivers, they certainly make driving easier to avoid accidents. 3D technology makes it easier for the Radiologist to interpret your mammogram. 3D adds a level of detail to the imaging that can be very useful in cancer detection. The additional radiation exposure is negligible, and I definitely tell my mother to get 3D with her mammogram.
If your mother/sister/wife had a mammogram and was told she had dense breast tissue, what would you tell her?
Dr. Schroeder: Anything that isn’t made up of fat will be white on a mammogram. Normal tissue is white and so are all significant abnormalities (most are benign, and some are cancerous). So, the more non-fatty normal breast tissue that you have, the harder it is to find the abnormal tissue (It’s like finding a snowball in a blizzard). Since dense tissue represents active breast tissue and active tissues are more likely to become abnormal than inactive tissues, density is also a marker of breast cancer risk. So, if you have dense tissue, you have a higher risk of developing breast cancer while also making it harder to find on mammograms. For these reasons, if you have dense tissue you may want to consider adding an additional test (such as automated breast screening ultrasound) that can see through the dense tissue.
Dr. Roy: Although a screening mammogram is still the primary exam that physicians recommend for breast cancer screening, studies have shown that women with dense breasts benefit from additional ultrasound screening (ABUS). Breast tissue looks white on a mammogram, but unfortunately breast cancer also typically looks white. As a result, there is often not sufficient contrast between the normal dense breast tissue and the cancer. Small cancers may therefore be obscured. Dense breast tissue also looks white on an ultrasound, but fortunately with ultrasound, most breast cancers look dark. This often allows the radiologist to detect small breast cancers with ABUS that could not be visualized on the mammogram.
Dr. Clemow: Having dense breasts is very common and 40% of all women are noted to have dense breast tissue. When we look at your mammogram, the dense breast tissue is white, but so is cancer. This is why the dense breast tissue can make it difficult for us to identify cancer that may be growing in the dense breast tissue. Secondary screening exams, such as automated breast ultrasound (ABUS), is an option to screen dense breasts in conjunction with mammography. The ultrasound allows us to see through the dense tissue and identify abnormalities that we cannot see on your mammogram, such as, hard-to-see cancers and other benign etiologies.
If your mother/sister/wife was called back for a biopsy, what would you tell her?
Dr. Russo: I would underscore the fact that most breast biopsies are negative. Today, advanced technologies help us locate and biopsy very small suspicious areas, as opposed to the past when most biopsies were for palpable abnormalities.
Dr. Schroeder: Women who come for biopsy are anxious about two things: the procedure and the results. The procedure is very common and most woman are surprised at how fast it is, and usually comment that they didn’t feel any pain at all. As far as the results, most biopsies do not show cancer. On average cancer is found in much less than 50% of the biopsies performed.
Dr. Tidwell: My mom really doesn’t like going to the doctor! So, the first thing I would tell her is the biopsy is truly NOT that big a deal. It’s likely going to be benign, but it’s important to get the biopsy. And, if it’s not benign, it’s likely very early. That’s why we do mammograms – to detect the early cancers!