If you are a woman aged 40 or older, you have probably been advised by your doctor to start getting regular mammograms.
What is a Mammogram?
If you aren’t familiar with the process, a mammogram is a cancer screening test that makes images of the tissue inside your breasts in order to evaluate them for signs of lumps and other anomalies. The mammogram machine compresses the breast between two radiographic plates and takes x-rays of the interior of the breast. From there, a technician can send the images to the radiology physician, who will determine if there are any strange growths or other issues that could signal the beginnings of breast cancer.
Why Get a Mammogram?
The self-exams that you perform in the shower, or that your doctor performs in the office, can detect larger lumps or masses, but can’t detect smaller lumps or other anomalies. A mammogram can detect things that a manual exam would miss, which makes it an excellent tool for the early detection and treatment of breast cancer. Because some breast cancers can be very aggressive, early detection can make the difference between life and death.
Issues with the Mammogram
One of the biggest issues with the mammogram is that it is not a pleasant experience. The machine has to really compress the breasts to get a good reading, which is uncomfortable for the patient, to say the least. If your breasts happen to be tender, that makes it even worse. For this reason, many women avoid getting them just to avoid the discomfort.
Another issue with the mammogram is that it is not an effective screening tool for all women. For example, women who have dense or fibrous breasts often have trouble getting a good reading on a mammogram.
Alternatives to the Mammogram
Women who have dense breasts or otherwise cannot get a good image with mammography could have success with Magnetic Resonance Imaging (MRI), computerized tomography (CT-scans), or ultrasound screening. For this reason, many women with dense breasts are referred by their doctors for ultrasound as a secondary or complementary screening.
The MRI takes pictures of a wider area, does not require you to compress the breasts between two plates, and doesn't expose the patient to radiation during screening. The MRI can also be used to screen for other issues in the breast, or in the chest cavity. The disadvantage of the MRI is that it is expensive and might not be covered by insurance as a breast cancer screening tool. The only women who might qualify for MRI coverage are those who test positive for the BRCA1 and 2 genes, or have other genetic issues that make them high risk for breast cancer.
CT Scans/CAT Scans (Computerized Tomography)
The CT scan is a radiographic technique like a mammogram, but it takes pictures of a larger area, like an MRI. This procedure also does not require you to compress the breasts. The CT scan is usually performed "with contrast" that requires you to drink a special dye that’s designed to make it easier for the machine to take photos, and the dye can potentially cause kidney damage. For this reason, CT scans are not generally used as an initial screening test for breast cancer, but they can be used after diagnosis to determine if treatments are working, or if the disease is spreading.
Ultrasound uses high-frequency sound waves, similar to sonar on a boat, to take a picture of structures inside the body. There is no radiation involved in ultrasound examinations. Unlike the MRI or CT scan, ultrasound includes a handheld device that the technician must use to touch your breast to get a reading of the internal tissues. However, administering the ultrasound is not nearly as uncomfortable as the mammogram.
The ultrasound is usually a backup screening tool that doctors use when they can’t get a clear reading on the mammogram. Ultrasounds are good at detecting larger masses, but they can’t detect all of the potential cancer indicators that the mammogram can.
How Often Should I Screen?
According to the latest guidelines, women aged 50 to 74 years should get screened every two years. However, if you have a strong family history of breast cancer, you should start screening as early as your 30s, or when your doctor suggests it, and screen at least once a year.