Have You Had Your Annual Mammogram?

 

By Kim Hwang, MD

 

Early detection and treatment is still our number one defense against losing lives to breast cancer. This means that monthly self-examination and yearly mammograms for women after the age of 40 save lives. And while the vast majority of breast cancers occur in women, a small percentage of men are also at risk for this form of cancer and should periodically check for lumps or alterations in appearance and follow up with the doctor should any changes occur.

 

The American Cancer Society recommends that women obtain a baseline mammogram at 35 years of age, which provides your radiologist with an image of your healthy breast. This serves as a basis for comparison in coming years, making it easier to spot changes in the breast with subsequent mammograms. 

 

What is the advantage of digital mammography?

 

Digital mammography provides us with better contrast resolution, which helps us see through denser breast tissue. This gives us an advantage in spotting tiny changes that are difficult to detect with regular mammography. The digital advantage is doubly significant because many women under age 50 have dense breast tissue and cancer in this young age group tends to be more aggressive, so it is best to catch it in the very earliest stage.

 

What happens if the radiologist finds something on my mammogram?

 

The radiologists at Cayuga Medical Center and the Ithaca and Cortland Convenient Care Centers review your mammogram during your appointment. If they find something suspicious, they will talk with you and recommend one of two follow-ups.

 

If the spot they see on your mammogram is palpable (can be felt during manual examination), you will have an ultrasound and learn the results during the same visit. An ultrasound tells the radiologist whether the mass is solid or filled with fluid. A fluid-filled mass is a cyst and no further action is required. However, if the mass is solid the radiologist will usually recommend a biopsy. Bear in mind that 80 percent of breast biopsies are not cancerous.

 

If what the radiologist sees on your mammogram are tiny calcifications that are not palpable, the next step may be a breast MRI and stereotactic biopsy. Most calcifications are not cancerous, but a percentage of these tiny deposits of calcium are the very earliest signs of cancer. Because a breast MRI produces a thousand images for the radiologist to examine, you may have to wait 48 hours for these results.

 

What happens during a biopsy?

 

An ultrasound-guided biopsy can be scheduled within a week and is minimally invasive. It is performed with local anesthetic and a small-core needle making the procedure more easily tolerated. An MRI-guided biopsy is very similar. The radiologist is guided to the exact spot using MR imaging and extracts a marble-sized piece of tissue containing the tiny calcifications. The tissue is then examined by our pathologist for diagnosis.

 

Breast MRI screening is additionally recommended for certain patients who are at high risk due to family history or who have inherited the high-risk gene for breast cancer. MRI is also used to ensure the cancer isn’t anywhere else in either breast because multifocal cancer is not uncommon.

 

Discovery and intervention while the cancer is in its earliest stages dramatically increase the chances for a cure in women diagnosed with breast cancer. Be proactive: schedule your mammogram today!

 

Dr. Hwang serves on the medical staff of Cayuga Medical Center and is board certified in radiology. He is chairman of Imaging Services.