Screening and Diagnostic Mammograms
In virtually the same breath we say mammogram, we say (in our minds) cancer. We all know it is important to have a mammogram every one or two years if we are over 40. If we've had breast cancer or other breast problems, or if there's a history of breast cancer in our family, then we should have a mammogram before we turn 40. We may need to have one done more frequently just because there is cause to be concerned.
The Benefits of Screening Mammograms
A mammogram is a method of screening for or diagnosing cancer. It can be used to check for breast cancer in women who exhibit no signs of the disease. A screening mammogram usually includes two x-rays of each of the breasts. All of us who have had a mammogram have stories to tell of the experience. Nevertheless, regardless the discomfort, we know they have the potential to be lifesavers - so we endure. With screening x-rays, the radiologist is able to detect tumors that are imperceptible by touch. Screening mammograms are able to detect microcalcifications that are tiny deposits of calcium which sometimes foretell cancer. With early screening we can be assured of early treatment and thereby catch the disease before it spreads. Studies have been done to support the fact that women between the ages of 40 and 74 benefit from early detection and that the number of deaths due to breast cancer are reduced when the problem is discovered in enough time.
How Diagnostic Mammograms are Used
Diagnostic mammograms are used to confirm breast cancer after a lump or other symptoms has been identified. Pain, skin thickening, nipple discharge, or changes in the shape and size of the breast are indicators of breast cancer. They can also be signs of benign situations as well. That is why a diagnostic mammogram is important. It can be employed to evaluate changes that are found in a routine screening or to "look" deeper, especially when there are circumstances like breast implants that may obscure the view. Diagnostic mammograms take longer to complete than screening mammograms because there is a need for more x-rays from various angles. Detailed pictures can be obtained from the area in question making diagnosis more accurate.
The Dark Side
Although there is tremendous good that comes from mammogram screening, there is the other side of the equation as well. We'd all like to believe that finding a mass means that it will be dealt with and life will go on. Sadly, that is not always the way it happens. Although a mammogram can detect malignancies that can't always be felt, it doesn't mean a woman's life is spared. If the cancer is aggressive and grows quickly, it may have spread before any affirmative action can be taken. Screening mammograms may not save a woman who is suffering from something more serious.
There are opportunities for false-negative results that are often related to the density of a woman's breasts. A false-negative is when a mammogram appears normal when, in fact, it is not and breast cancer is present but not identified. In the grand scheme of things, mammograms miss about 20 percent of cancers that are present at the time of screening. The glandular and connective tissue of the breast may be so dense that it obscures tumors. False-negatives tend to occur more in younger women than older because younger women tend to have more breast density than older women. Consequently there can be delays in treatment and a woman can have a false sense of security thinking all is well when it isn't.
On the other hand, false-positive results can occur when a judgment by a radiologist determines there is breast cancer when, in fact, there isn't. The best course of action when a positive result of a mammogram is received is to have follow-up testing with ultrasound and biopsy to determine if there is cancer present. Again, younger women tend to have more of this type of outcome, as do women who have had previous biopsies, women taking estrogen, and women who have a family history of breast cancer. The obvious outcome of a false-positive is anxiety, fear, and psychological distress in the woman who is affected. Additional costs that will be incurred can put a financial burden on a family and the amount of time consumed in testing can be draining.
Over-Diagnosis and Over-Treatment
Screening mammograms can also put a woman in the position of being over-diagnosed and consequently over-treated. Screening mammograms are able to detect cancers and cases of ductal carcinoma in situ, a noninvasive lesion where cells that are not yet cancerous but may potentially become cancerous. Some of these lesions will never become cancer and never cause symptoms for a woman, neither will they threaten her life. In cases like this, over-diagnosis is often the norm and unnecessary treatment is performed. Women may experience adverse effects of treatment that was not required in the first place.
Finally, although mammograms require little doses of radiation and are relatively harmless when performed routinely, when done repeatedly they have the potential to cause cancer. However, the benefits far outweigh the risks in most cases.
The use of mammograms and ultrasound to detect cancer and to assist in the proper diagnosis of breast abnormalities is further discussed in our article in this section.