Effects of mammograms in the treatment of breast cancer

Screening: Breast cancer screening refers to the regular breast examinations recommended by doctors to detect breast cancer before symptoms develop. The purpose of these examinations is to find breast cancer at its earliest, most treatable stages. APCC recommends screening at age-specific levels: 

• Women between the ages of 40 and 44 should start with breast cancer screening mammograms (X-rays of the breast) at least once a year and regularly consult a specialist. 
• Women aged 55 and above should switch to mammograms every 2 years, or continue yearly screening.
• Ultrasound can be recommended for women with dense breast tissue.
• All women should consider having a monthly self-breast test starting at age 20 and should be familiar with their breasts so that they are better able to notice changes.

Some women have a genetic predisposition to breast cancer and it manifests over time. For such cases, APCC recommends: 

• A clinical breast exam every six months.
• Annual mammogram starting at age 25.
• An annual breast MRI

Mammogram: When talking about breast cancer detection, we're talking about screening for breast cancer. Meaning: There are no abnormalities in the breasts felt by the patient or the physician and the imaging may be normal. The goal of cancer screening is to identify the smallest cancer possible to increase the chances of cancer being cured. In other words, the goal is to reduce mortality from that cancer.

The gold standard, as of March 2016, is a mammogram that is nothing more than a breast x-ray. To date, several clinical trials have used this technique to reduce mortality by 15-30%.

Sonogram: Ultrasound, or sonogram related, is a very useful tool for diagnosis, but as mentioned earlier, breast tissue should be used in addition to mammograms, especially in women with very dense breasts (a large amount of breast tissue as opposed to fatty). The modern makes it much easier to see swelling or lumps and other abnormalities because the abnormality of the breast tissue itself has such a similar density when the former can obscure that.

When an abnormality is seen, such as a lump seen on a mammogram or felt by a patient or physician, it is very effective to add ultrasound to a difference in the cyst of a hard nodule (in 80%) (A small ball of fluid, basically innocuous). But it will still have a 20% chance of being fatal. Other features of the nodule seen in both exams will say if this change is much higher or much smaller.

Advantages:

• The mammogram can detect minimal cancers, including those that haven't formed a palpable lump: the treatment for small cancers is much less aggressive than to those which are higher stage at diagnosis, with many initial cancers not requiring chemotherapy or disfiguring surgeries; not to mention that a great majority is curable. 

• The mammogram can also detect microcalcification, with occasional small white dots indicating that the breast has an early form of cancer called cancer: the same advantage over the above items: less invasive treatment and more curable disease. 

• Decreases mortality from breast cancer by up to 30% when large populations are studied. 

• Useful in young patients (<40 years) as breast tissue is dense in three patients and mammography is not sensitive. 

• No radiation exposure, so it is safe during pregnancy. 

• The sonogram can differentiate between a solid and a cystic (fluid-filled) lesion.

 Disadvantages:

• Radiation exposure: It involves radiation exposure. Many studies have shown that the risk posed by radiation is lower than the benefit of testing (the risk is lower than that of a woman at risk of dying from an average level of cancer). 

• Possibility of false-positive: When the test is abnormal and more tests are needed, which leads to anxiety and the results are again negative? 

• Sensitivity is not 100%: a mammogram is not a perfect exam and will miss some cancers. Currently, several studies are looking at the addition of ultrasound to increase the detection rate.  

• Overdiagnosis: Some small cancers detected by mammograms may not become clinically relevant, which means they do not need to be treated.  Since there is no way to differentiate them from what will kill you, today’s guidelines, suggest some form for each cancer that is detected. There is enough research at the moment to find a way to separate the two with molecular identifiers. Although considering these disadvantages, it is important to remember that mammograms reduce mortality, so not all small cancers fade.

 Are mammograms dangerous?

Cancer and Mammogram, both are potentially dangerous. Mammography is much less so. The incidence of cancer as a result of mammography radiation is calculated.086% and the risk of death is .011%. Contrast this with the incidence of breast cancer. One in eight women will get invasive breast cancer (12%) throughout their lifetime.

The problem is that mammography does not accept all cancers (dense breasts, MRI, and ultrasound help in difficult cases). Another problem is that what is found on mammography appears to be much more benign but causes additional testing and in some cases a true biopsy (which proves to be unnecessary).

The overall risk for most women: the ratio of benefits to the imperfections of a given technology. To be frightened by the risk of the radiation is not supported by evidence. Additionally, newer techniques are reducing the amount of radiation by reducing the number of repetitive views and the number of additional images required. We can expect that the amount of radiation will decrease as technology continues to improve.

One last thing. Thermography and other "alternatives" (besides ultrasound and MRI) have shown no efficacy in early cancer detection (when it matters most for survival) and should not be taken seriously.

Does screening for breast cancer reduce mortality?

Modern equipment and the best studies (especially mammography fellowships) trained by radiologists, especially in mammography, show a reduction in breast cancer mortality.

• If you combine every study that was ever done, good and bad like the USPTF did to generate their recommendations, one doesn't see mortality reduction. 

• Bad screening using 1970's technology and untrained radiologists isn't going to be helpful. Why would anyone think that it would? Those studies should be eliminated in any reasonable analysis, but they aren't. 

• Larger breast cancers may also have a higher cure rate with more invasive surgical treatments such as mastectomy, radiation therapy after mastectomy, and chemotherapy. 

• If the goal is to have more mastectomy and chemotherapy for more patients for healing, then the path is less frequent or even the omission of mammograms.

The benefits of modern breast cancer screening are controversial because many of the early studies on mammograms were done in what is now considered very old technology.

What are the costs and benefits of breast cancer screening?

The benefits of modern breast cancer screening are controversial because many of the early studies on mammograms were done in what is now considered a very old technology; old machines, inadequate training of staff and radiologists and poor study design. We’re talking about the 1970s era technology reported in some older studies. Due to poor data analysis, there is controversy over survival statistics, including breast cancer screening.

But diagnosing breast cancer shouldn’t just be a survival problem. Modern breast cancer treatment can transform highly advanced breast cancer into a chronic disease that most women can survive for years or even decades, even if they metastasize to other areas of the body. Early breast cancer can be cured with many more limited treatments such as lumpectomy where the cancer is simply removed by radiation where the whole breast and nipple are removed instead of a mastectomy. Most patients with small cancers can also avoid chemotherapy.

So the benefit of breast cancer screening less surgery and less treatment with a high cure rate. The controversy over breast screening should be like that. What does it take to get similar survival numbers in countries that screen every other year? More surgery, more chemotherapy. The negative risk of screening is that some cancerous conditions do not require treatment. These are mainly small lower-grade non-invasive cancers, namely, DCIS, in-situ dual carcinoma, and LCIS, in-situ lobular carcinoma. These non-invasive cancers can take decades to become aggressive, so anti-hormone treatments, including lumpectomy and radiation or mastectomy, are probably being treated too much older.

That is the argument for the US Preventive Task Force recommendations for mammograms every 2 years instead of every year. That might make statistical sense. But it doesn’t make clinical sense. The problem with over treatment should be the education of the public and having qualified cancer specialists involved in the treatment plan. Anyone who sees hundreds of new breast cancer patients each year, I would rather do invasive chemotherapy and mastectomies rather than find them first and treat them appropriately and less aggressively and intensively in the early stages of the disease as I try to turn things around. Yes, those who have more cancer in the breast and lymph nodes do very well over time. But it takes a lot of treatment to get them there.

Breast Cancer Screening – There’s more to it Than Mammograms

Many women use mammograms as their only line of defense when it comes to breast cancer detection, but mammograms are only one part of a variety of detection methods and should not be used alone. For proper breast care, you should be performing regular breast self-exams and getting breast exams from a doctor. Besides, you may also require extra screening, including a digital mammogram. Mammograms are generally given starting around age 40, but it is common for women to develop cancer before that age. Plus, breast cancer tends to spread faster in younger women. That’s why it’s important to perform regular breast self-exams and get breast exams from a medical professional.

Most breast health issues are first discovered through breast self-exams, not mammograms. This is because they can be done more often. Because you get to know what your breasts are supposed to look and feel like, you can notice changes more readily and you can catch problems sooner. When the girl develops breasts she can start doing self-examination every month (maybe at the age of 20+) It is necessarily done if she has the breast cancer issue in her family history. Also, it is a myth that if one person has a problem in her family then she will also get it owing to the gene. The self-breast examination is done only to make sure that the person is safe and that everything in his body is normal. This self-examination has found the problems of breast cancer. If it is found in the early stages, it can be easily cured with proper treatment. The first step in a BSE is to look at your breasts in the mirror. Look for dimpling of the skin, changes in color and texture of the skin, changes in the nipple, and any secretions. You should then feel your breasts, looking for lumps that appear and don’t disappear, or grow and change with time.

The best time to do a self-breast examination is the seventh day of your monthly periods. It is also okay when you are doing it about 3-5 days after the monthly cycle starts. Divide your breasts into four equal parts and gently press down using the fingers. Don’t press it too much as they are smooth and sensitive areas. Find out if you are feeling anything wrong there. Raise your hands and do it in your underarms area too. Repeat it at the same time every month. The presence of lump will make you feel like rolling the ball with your hands (like when you press and squeeze you will feel like it is coming along with your fingers).

In addition to these traditional methods, a new technology, called the digital mammogram, is now being used as another weapon in the fight against breast cancer. The methods used in taking a digital mammogram are essentially the same, except that the results can be viewed immediately instead of having to wait for the film to develop. This is often used in finding the specific spot of growth, so they can take a biopsy. Faster results mean that the procedure can be done more quickly and with less pain or discomfort.

Remember, if you want to have proper protection against breast cancer, you need to do monthly self-exams and have regular breast exams along with your regular mammograms.