What a Breast Cancer Screening Is Really Like
When Nancy Brinker's sister Susan died of breast cancer in 1980, the disease wasn't something anyone talked about. "Right before she died she asked me to cure this disease and make sure little girls didn't grow up without their mothers," Brinker says. She subsequently founded the Susan G. Komen Foundation, which has invested more than $2.2 billion in breast cancer research, education, screening, and treatment through initiatives like Race for the Cure. We spoke with the breast cancer advocate and two top radiologists about the newest mammogram innovations, breast density, and what women need to know now when it comes to their breast health and early cancer detection.
What Is Tomosynthesis, and Why Should You Demand It?
When it comes to mammogram technology, the term to know is "tomosynthesis," also referred to as digital breast tomosynthesis, DBT, and the 3-D mammogram. Breast tomosynthesis uses the same X-ray technology as a regular mammogram, but takes multiple photos from the front and side that look at thin slices of the breast tissue, similar to how a CT scan works. "You can see through the breast more clearly, and it has two good benefits," explains Dr. Linda Moy, a professor in the department of radiology at NYU's Perlmutter Cancer Center. First, this kind of mammogram is better at finding cancer hiding behind normal tissue; second, if you're called back in for a follow-up because something registered on the initial scan, the more-detailed scans make it easier for your doctor to see what's happening.
Are You Covered?
Whether you're able to get DBT is still at the discretion of the facility you visit because some will pay for this better mammogram and some will not. "[Digital breast tomosynthesis] has been widely accepted because it's so good, and has been covered in most places, but we need a lot of buy-in and advocacy from women and families who want the best screening," says Brinker. "Every center handles it differently," says Moy, "so make it known to your congresspeople and your state legislature that this is a good test. That grassroots effort is really helpful. In New York, Governor Cuomo heard about it and decided New York State was going to cover it before the carriers got on board, and that made a big difference. Women have a voice in all this." If your doctor doesn't offer a 3-D mammogram, it's worth asking for—repeatedly.
Family History Is Less of a Factor Than You Might Think
It's important to keep up with breast-cancer screening even if you don't have a family history of the disease. A 2005 study by the National Center for Biotechnology Information, a division of the National Institues of Health, found that 89 percent of women diagnosed with breast cancer have no family history of the disease. For the rest, Moy says, doctors look mainly at whether you have a first-degree relative (meaning a mother or sister) who had breast cancer pre-menopause or before age 50 to decide whether you need to begin early screening. What that means is even if a relative like your grandmother or your aunt had breast cancer, particularly if it happened to them later in life, it's not enough of a concern to begin screening early. The same 2005 study showed older women are far more likely than younger women to develop breast cancer overall.
What Is Breast Density, and Why Should You Pay Attention to It?
If you're measuring your risk factors, breast density is a term you'll hear a lot. Breast density is a measure of fat compared to glandular and fibrous tissue within a breast, and its relationship to breast cancer isn't fully understood. "We know women with dense breasts are at a slightly increased risk. Some doctors think it's because [dense breast tissue] masks tumors; some think it actually is related to causing cancer," says Dr. Pamela J. DiPiro, Clinical Director of Computed Tomography at Dana-Farber Cancer Institute in Boston. "Thirty-one states have passed what's called a breast-density-notification law, which means that when a person with dense breasts gets her normal mammogram report, she'll see a note that says her tissue is dense and she should discuss supplemental screening with her referring physician," says Moy. If you live in a state without a breast-density-notification law (you can see a list of them here) it's important to ask your doctor if density is a risk factor for you. Because breast tissue tends to be dense in younger women across the board, it's particularly important for women under 40 or getting their first mammograms to stay informed.
Don't Fear the False Positive
Cancer-prevention organizations have given a lot of focus in recent years to the problem of false positives-when a breast-cancer screen or biopsy comes back positive, but upon further examination turns out to be negative. It's stressful and scary for women to be told they might have breast cancer when they don't, but as an expert and a survivor herself, Brinker says, "I don't buy all that about false positives. If it looks suspicious, it's good to have a chance to have the scan repeated." The chance of a false positive after one mammogram ranges from 7 percent to 12 percent, depending on your age and increases after age 50. Moy says that in most practices, about 80 percent of patients brought in for a second look end up being told they're fine. Of the rest, most will be told to return in six months for another screen. Only a few will have a biopsy recommended, and around 80 percent of the time biopsies come back normal. So, if your doctor tells you she needs to take a second look, don't panic-most of the time, it's nothing.
Breast Self-Exams Aren't Officially Recommended—But You Might Want to Do Them Anyway
Self-exams were removed from the official American Cancer Society preventive-care recommendations after the U.S. Preventive Services Task Force releases new guidelines for screening in 2009. However, Brinker in particular is an advocate of the practice. "It's very important to know what's in your body and how your body feels—if you feel something, say something." Moy also sites continuity as another reason to do them. If you're seeing a new doctor, for instance, and that doctor feels a lump you've felt before, you'll feel much more calm and in control. "It empowers women, to know their breasts and whether this lump is normal and known or if it's new," she says.
Staying informed about what's happening in the breast-cancer space will help you stay up to date on what you should ask about at your next appointment. As far as medical and technical advancements, DiPiro recommends keeping up with the American Cancer Society updates, the American Society of Clinical Oncology, and the American College of Radiology's patient-facing website. For advances in research and advocacy, Susan G. Komen regularly updates their site with new information as well as maintaining resources to help women getting screened and diagnosed for the first time.