While writing our recently released e-book on breast cancer screening, we spoke to a number of doctors about some of the most frequently asked questions they received from their patients. Many of them address popular myths about breast cancer; others were about the mammogram procedure itself, or about what happens after you get your result back. We’ve included some of these questions, and their answers, below.
- What is mammography?
- How accurate is mammography?
- How is it performed?
- What is the radiologist looking for?
- Can breast cancer be missed?
- Are there other screening options?
- Is it possible for my screening mammography to be normal and yet I may be harboring cancer?
- When do I start breast cancer screening?
- My mother and my aunt were diagnosed with breast cancer. When do I start breast cancer screening?
- Do insurance companies cover breast cancer screening?
- What is BRCA genetic testing?
- If I test positive for BRCA-1 or BRCA-2 mutation, what are my chances for developing breast cancer?
- I have a BRCA-1 mutation, what are my options?
- Can men get breast cancer?
- I have big breasts. I’ve been told that I will probably get breast cancer in the future. Is this correct?
- What is a sentinel lymph node?
- How do I prevent breast cancer?
What is mammography?
Mammography is an x-ray test to look at the inside of your breasts. It uses ionizing radiation to detect abnormal breast architecture and to evaluate for any abnormal lumps, lesions, tumors, mineralization, or signs of cancer.
How accurate is mammography?
Mammography is able to detect very small lumps and lesions. It can detect a lesion as small as 1 mm. It is able to pick up lesions about two years before the physician can detect it clinically in the office during the routine physical examination. A lesion has to be about 10 mm before a physician can feel it.
How is it performed?
The breast tissue is compressed against a plate. This may be uncomfortable but only lasts a few minutes. Compression is needed to accurately visualize all the breast tissue on the film. Four films of the breasts are taken from different angles by the radiology technician. The 4 images are then examined by a radiologist (MD, DO, or MBBS) trained in this field.
What is the radiologist looking for?
The radiologist examines the films to assess for suspicious findings that may be consistent with cancer. The physician examines for lesions, masses, micro-calcifications, and distortion of the breast tissue architecture.
Can breast cancer be missed?
Mammography is not 100 percent accurate. Yes, it can miss breast cancer, but it is the most widely available breast cancer screening test we have. It is also of note that the “axillary tail” is difficult to visualize on the films and may be missed. This is the part of your breasts that extends into the armpit. A mammography can also give a false-positive test. This means that the test comes back positive (something abnormal) even though you do not really have cancer.
Are there other screening options?
The magnetic resonance imaging (MRI), digital mammography and positron emission tomography (PET) are in experimental stages of development. They are not yet available for routine breast screening. Ultrasound of the breast is performed after the patient has been found to have a lump or palpable mass during the physical examination.
Is it possible for my screening mammography to be normal and yet I may be harboring cancer?
Yes, this is known as the false-negative test. This means that your mammography shows no evidence of cancer, lumps, or tumors, and yet you may have cancer in your breasts. This is very disturbing. This gives you the false sense of security. Younger women and women who have dense breasts have problems with false-negative tests. However, USPSTF states that it found no data that these false-negative tests led to any delay in the proper diagnosis of true breast cancer.
When do I start breast cancer screening?
These are the recommendations. You may follow one of the two.
1. Begin at age 45 as recommended by the American Cancer Society.
2. Begin at age 50 as recommended by the US Preventive Services Task Force.
This is assuming you are average risk for breast cancer. The ACS recommends annual screening as long as the patient is in good health. The USPSTF recommends screening every two years and stopping at age 74.
My mother and my aunt were diagnosed with breast cancer. When do I start breast cancer screening?
At a much earlier age depending on your risk factors. Your doctor will determine for you the age at which you should begin screening. Mammograms and MRI are used in some high risk individuals annually beginning at earlier age.
Do insurance companies cover breast cancer screening?
Yes, all the insurance companies I know of cover most health screening including breast cancer. If your insurance company does not cover common types of screening procedures, I suggest you change your insurance company.
What is BRCA genetic testing?
This is breast carcinoma (cancer) genetic blood testing to identify if you carry this marker of malignancy.
If I test positive for BRCA-1 or BRCA-2 mutation, what are my chances for developing breast cancer?
If you test positive for BRCA-1 or BRCA-2 gene, your chances of developing breast cancer are very high by age 70. For Ashkenazi women, the chances of developing cancer range anywhere from 26 to 81 percent.
I have a BRCA-1 mutation, what are my options?
For women who have either BRCA-1 or BRCA-2 mutation, the options are the following:
1. Intensive screening with MRI
2. Prophylactic mastectomy or oophorectomy
3. Chemo-prevention
Women who have a BRCA-1 mutation have estrogen receptor negative malignancy. BRCA-2 breast cancers are usually estrogen receptor positive. These women respond to tamoxifen with reduction in incidence of breast cancer.
Can men get breast cancer?
Yes. Men do have some breast tissue under the nipples. One percent of all breast cancers occur in men. Roughly 500 cases of breast cancer are recorded in men each year in United States.
I have big breasts. My friend told me that I will probably get breast cancer in the future. Is this true?
Your friend is misinformed. Large breasts do not increase your risk of getting breast cancer. However, large breasts often make it difficult to visualize breast cancer on mammography. This is because of dense tissue.
What is a sentinel lymph node?
The sentinel lymph node is the first lymph node to which breast cancer will spread in a long chain of lymph nodes. This is a very important discovery because it allows surgeons to biopsy this node and assess if cancer has spread. The presence of cancer in this node means cancer has spread outside the breast.
How do I prevent breast cancer?
Two preventive approaches are recommended in order to reduce the chances of getting breast cancer.
1. Obtain good health screening from your physician. Follow the recommended guidelines for the early detection of breast cancer as outlined in this book. Breast cancer screening begins at age 40 or 50.
2. Exercise and eat healthy. Engage in decent exercise 30 to 60 minutes a day. Eat healthy means consuming fruits and vegetables on a daily basis. These foods contain anti-oxidants that are believed to retard cancer growth.