Get Through the Mammogram Maze

There has been so much controversy lately about mammography for detecting breast cancer-whether to have a mammogram at all and if so, what type to have and when. It is difficult to make sense of recent studies.

Risk Vs. Benefit

For a long time, the medical establishment believed that regular breast screening with mammography reduced the death rate from breast cancer by almost one-third in women over age 50 and caused them little harm. Then, in 2009, the US government came out with its controversial recommendation that women ages 40 to 49 with no family history of breast cancer and at average risk for the disease should not get routine annual mammogram screenings. Women ages 50 to 74 were advised to get screenings every two to three years.. and women over age 74 were told that they do not need routine screening. In late 2011, the Canadian government basically echoed these recommendations.

Reasoning: Research seemed to point to the idea that the risks of testing outweighed the benefits.

One of the risks: Greater lifetime exposure to radiation. Another study, this one from England, published in British Medical Journal in 2011, identified a number of other harms associated with mammography, most notably negative effects on quality of life due to false-positive results and unnecessary surgeries, such as biopsies. These researchers determined that having regular mammograms over a 10-year period actually might result in more harm than good. The American Cancer Society (ACS) is one group that does not agree with the government's recommendations. The ACS maintains that all women should have annual mammograms after age 40. And certain studies support the idea of yearly mammograms.

Timing Is Everything

While the benefits and frequency of mammography remain under debate, other researchers are taking a closer look at when mammography is performed during a woman's monthly cycle. A study by researchers at Group Health Research Institute in Seattle, reported in Radiology, found that in premenopausal women, mammograms appear to be more sensitive at detecting breast cancer when the screening is performed during the first week of the menstrual cycle (when you have your period). Premenopausal women often have dense breast tissue, which can make detection with mammogram difficult, resulting in a high number of false-positive results. With most women, breast tissue is less dense during the first week of the menstrual cycle, so premenopausal women should schedule a mammogram for that time. Since postmenopausal women don't have many hormonal changes, the timing of their mammograms is not as important.

Which Screening Is Best

Researchers from the University of North Carolina School of Medicine looked at the diagnostic accuracy of film and digital mammography, which are both a form of X-ray. Film mammography has long been the standard, but it is not as good at detecting cancer in women with dense breasts as digital mammography (an electronic image of the breast stored on a computer), which provides doctors with greater detail. Researchers found that digital mammography was more accurate than film in pre- and perimenopausal women younger than age 50 with dense breasts. There was no difference between the two methods for women ages 50 to 65. For women over age 65 with fatty breasts, film was slightly more accurate because it gave a better view of problem areas.

In a study by Spanish researchers, published in Radiology, false-positive results were slightly higher for film mammography (7.6%) compared with digital mammography (5.7%). The researchers found no difference in cancer detection between the two types of mammography, Film mammography exposes women to slightly more radiation than digital mammography,

Other Tests

Other types of tests are sometimes recommended instead of, or to complement, mammography. Not all techniques are covered by insurance. Basic techniques include…

• Digital breast tomosynthesis (DBT). In 2011, the FDA approved a device that performs DBT, a form of 3-D imaging (mammography is 2-D). Studies show that DBT provides 7% better detection than other methods because it enables radiologists to pinpoint the location, size and shape of tumors more accurately than mammography can. The procedure does use more radiation than mammography-up to twice the amount. Currently available in a handful of hospitals around the country, DBT is recommended by some doctors for young women with especially dense breasts.
  
• Thermography. This technique uses infrared technology to assess variations in body heat. Areas of abnormal heat are considered to be areas that may be cancerous. Like many holistic doctors, I recommend that all women use thermography annually to detect any changes in breast tissue. There is no radiation exposure at all.
  
• Ultrasound. This technique, which is commonly used in conjunction with mammography, uses sound waves to make a picture of breast tissue. It emits no radiation.
  
• Magnetic resonance imaging (MRI). This technique provides details of the breast's internal structure. It can help physicians identify abnormalities not picked up by other techniques. There is no radiation exposure at all.
  

My Advice

In addition to thermography for women with dense breasts, I often recommend ultrasound as a screening test. You can speak to your doctor about the screening test that will provide the clearest view of your breast tissue.

Women of any age who have a family or personal history of breast cancer or other cancer should talk with their doctors about the annual use of thermography, because it can detect early, slight changes in breast tissue. Then, based on your circumstances, you and your doctor can determine if you need a mammogram every one to three years. You and your doctor will also need to discuss the timing and type of mammogram that is best for you.