An Update on Mammograms


The Newest Facts on Breast Cancer Prevention

Every October, we’re reminded one in eight U.S. women will develop breast cancer over the course of her lifetime. This year, as stark statistics are reviewed, the mammogram’s role as an early detector comes under pressure.

A sense of urgency fills Lindsay Avner every time she hears about another young woman diagnosed with breast cancer. As founder/CEO of Bright Pink, a non-profit organization focused on prevention and early detection of breast and ovarian cancer in young women, Ms. Avner makes it her personal goal to drive awareness to action.

For the general population, proactivity involves getting yearly mammograms starting at age 40. Recently, however, the age at which women should begin mammograms has been debated, and findings show having mammograms too early in life may lead to false positives, especially in dense-breasted women.

“Mammograms, at this point, are the gold standard,” says Virginia Kaklamani, MD, oncologist, Northwestern Memorial Hospital. “Overall, we have good studies to show that mammograms help decrease mortality in women significantly, starting at the age of 40.”

In 2009, the United States Preventative Services Task Force made the controversial recommendation of biennial screening mammography for women 50 to 74 years old. This recommendation has since been scientifically rejected by major medical organizations with breast cancer expertise, including the American Cancer Society and American College of Radiology, who continue to recommend annual screening mammograms starting at age 40.

The American Cancer Society guidelines suggest high-risk individuals should start mammograms even sooner, up to 10 years earlier than when a relative was diagnosed. Determining a patient’s risk level not only involves family history but also genetic makeup, hormone levels, illnesses, environment and diet.

Ms. Avner, who has a strong family history of breast cancer, tested positive for the BRCA1 gene, meaning her risk of developing breast cancer was 87 percent. She took a huge step to reduce her risk by becoming one of the country’s youngest women to receive a bilateral prophylactic mastectomy at age 23.

“Statistically, young women shouldn’t develop breast cancer, but if you do you should be proactive,” cautions Ms. Avner. “While mammograms are the most common form of screening, it’s still important to talk with your doctor, especially since younger women are known for having denser breasts.”

Dense breast tissue is common in younger individuals due to constant bodily changes including pregnancy, lactation, menstrual cycle, weight gain/loss, hormone use and other elements. By definition, dense breast tissue is comprised of less fat and more connective tissue, which appears white on a mammogram. Cancer also appears white on a mammogram, thus tumors are often hidden behind dense tissue. Studies show as many as 75 percent of dense-breasted women are at risk of cancer being missed if they rely solely on mammography.

“In women who have dense breasts, you might not be able to see things in a regular mammogram,” says Dr. Kaklamani, “but the digital mammogram can look at things and find hidden tumors that otherwise wouldn’t be seen with the naked eye.”

Digital and conventional mammography both use X-rays to produce an image of the breast; however, digital information has the capability of being enhanced, magnified or manipulated for further evaluation. The American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial found that digital mammography detected up to 28 percent more cancers than film mammography in women with dense breasts.

Hologic, Inc. is on the cutting edge of breast imaging technology and recently debuted Selenia Dimensions. This system has both traditional digital mammography and breast tomosynthesis, offers 3D imaging and is said to make a difference in diagnosing patients with dense breasts.

According to Jim Culley, senior director of marketing at Hologic, breast tomosynthesis is one of the most exciting technologies in many years, and access to digital mammography will continue to increase, which will enhance early detection efforts within the medical community.

No matter the controversies, major medical associations continue to recommend mammography as the preferred tool for breast cancer screening. It has helped to reduce the U.S. breast cancer death rate by 30 percent.

“It’s truly unacceptable for women to die of breast cancer; we know far too much about this disease,” affirms Ms. Avner, who adamantly instructs young women to ask questions, know your risk, know your body and be proactive.

The Facts
Estimated new cases in 2012: 226,870 women; 2,190 men
Estimated deaths in 2012: 39, 510 women; 410 men
Median age of diagnosis: 61
Median age of death: 68
Percentage diagnosed as Stage IV (metastasized): 5%
Five-year survival by stage: local 98%; regional 83%;
metastasized 23%
Five-year survival overall: 89%
Diagnosed in lifetime with breast cancer: 1 in 8 women
Stage 0 (noninvasive DCIS): lumpectomy or mastectomy and radiation, sometimes hormone therapy
Stage I or II: lumpectomy or mastectomy, radiation and often chemotherapy
Stage III: chemotherapy and radiation before or after mastectomy, underarm lymph nodes removed, often targeted therapy
Stage IV and recurring: surgery (depending on where cancer has spread), chemotherapy, radiation, hormone and other therapies
Statistics and information according to
The Wall Street Journal/National Cancer Institute

About Sarah Osterman Myers

Sarah Osterman Myers pursued studies at Mercyhurst College and the University of Nebraska Lincoln before transferring to Columbia College Chicago to study journalism and dance. As a writer, Ms. Myers is interested in the arts/culture world and has published work in ECHO Magazine and Today’s Chicago Woman. As a dancer, she's open to all types of movement experiences and has performed with Laboratory Dancers and Mucca Pazza.