From Encyclopedia of Sex and Sexuality
The American Cancer Society (ACS) estimates that in 1994, 182,000 new cases of breast cancer will be diagnosed and approximately 46,000 women will die of this disease. (The ACS also estimates that 1,000 cases will be diagnosed in men in 1994.)These figures are alarming, especially when one considers that the usual warning signals for breast cancer—a lump, thickening, swelling, changes in the skin—represent late development of this disease. In addition, based upon current medical knowledge, breast cancer cannot be prevented.
What about risk factors? Unfortunately, 80 percent of women with breast cancer do not have any of the well-known risk factors: an age of fifty or over, a personal or family history of breast cancer, no children, or the birth of a first child after age thirty. It is obvious that early detection is the best protection, and today mammographic screening offers the best hope.
Mammography is a reliable method of detecting breast cancer at early stages, which are highly curable. Breast cancer grows slowly for six to eight years before reaching a diameter of about one-third of an inch that can be detected by breast examination. In this early preclinical stage the cancer can be seen and located precisely by mammography.
The mammogram is a special X-ray of both breasts. It was first described more than thirty years ago, and during the intervening decades there have been improvements both in safety of the equipment and the quality of the image produced by it. With modern equipment there is no danger of excessive radiation exposure. In fact, the amount of radiation associated with the current equipment is equivalent to the additional radiation received at increased altitudes, for example, living in Denver as compared to Boston or New York. This examination should never be refused based upon imagined dangers from radiation.
Mammography has reduced the death rate from breast cancer (but because of a higher life expectancy among the general population, there has been an increase in the number of women who contract the disease). More than thirty years ago, an American study demonstrated that among women over fifty years of age there was a marked decrease in the death rate from breast cancer for those examined by mammography on a regular basis. These figures have been duplicated in more recent studies in the United States and other countries, and there is increasing evidence that the death rate from breast cancer can be reduced in women who begin regular screening at age forty.
Despite this evidence, most American women do not take advantage of this detection program. A recent survey revealed that only 30 percent are following the recommended guidelines for mammograms beginning at age forty. While this represents an increase from just 10 percent a few years ago, more than two-thirds of American women still do not avail themselves of this important diagnostic test. Regrettably, almost half of the women who never had a mammogram said that their doctors had not recommended it.
The following statements can be made about mammography:
- The only method proven to reduce the death rate from breast cancer is periodic screening with mammography;
- Mammography is the only method of diagnosing malignant breast tumors that are so small that they cannot be felt even by a physician;
- The cure rate is over 90 percent if a tumor can be detected at an early stage;
- Mammography is safe.
The accepted guidelines for use of mammography include:
- Mammograms should be obtained promptly beginning at age forty. They should be performed every other year, but more frequently if there are suspicious findings noted by the patient or on physical examination;
- Beginning at age fifty, mammograms should be obtained every year;
- Patients with a strong family history of breast cancer (mother or sister), particularly if the tumor developed before menopause, should have their first mammogram at age thirty-five, or even age thirty, and annually thereafter.
Mammograms can be obtained in a hospital, in a special breast clinic, or in a doctor’s office. While there is little doubt about the effectiveness of a properly performed mammogram, the quality of the examination and interpretation of the film must be carefully monitored. The majority of installations now providing mammography are accredited by the American College of Radiology and this information can be readily obtained from the American Cancer Society or the local medical society.
The films are taken in a special room and in the sitting or standing positions. One image provides a side view of the breast and the other a top view: both are necessary. There is occasionally some discomfort because the breasts must be compressed in order to get a clear view of breast tissue. For most patients this is well tolerated and not objectionable. The films are developed and then interpreted by a radiologist skilled in mammography. Occasionally, abnormalities will be noted, such as densities or small areas of calcium. Recommendations include follow-up films in four to six months or, possibly, a biopsy.
Clearly, information that a mammogram is abnormal is unsettling to any patient. It should be noted, however, that 80 percent of the abnormalities revealed by a mammogram are not cancerous. If the mammogram is reported to be abnormal, medical consultation should be sought. If follow-up is recommended, additional films will be taken and further action will depend on these results. If a biopsy is recommended, referral to a surgeon specializing in the procedure is in order (see also breast cancer).
Since abnormal breast areas often cannot be felt by a patient or physician, the biopsy requires a specialized technique. The mammogram is reviewed and a small needle is placed in the area of the abnormality, usually under local anesthesia. The surgeon then follows the needle to the abnormal area. The abnormal tissue is removed and examined. In most cases abnormalities are related to fibrocystic changes and no further treatment is recommended, but if a malignancy is found, additional surgery is likely.