As many of you know, October is Breast Cancer Awareness Month. This is an annual campaign to increase awareness of the early detection, cause, effects and treatment of breast cancer. Not only will one in eight women will be diagnosed with breast cancer; approximately 70 thousand men (yes men can get breast cancer too), as well as women ages 15 -39 will be also be diagnosed with the disease in the US.
One of the ways to detect breast cancer is by doing a monthly BSE (Breast Self Examination). Forty percent of diagnosed breast cancers are detected by women who found a lump, so it is of the utmost importance that an individual becomes familiar with their own breasts and notify their medical provider immediately if they find any unusual changes or lumps. This in conjunction with an annual clinical breast exam is an essential tool for early detection.
Another tool for detecting breast cancer is a mammogram. Most people are familiar with mammograms, but are uncertain as to what is involved. When you call to make your mammogram appointment, the scheduler will ask you if you are having a “screening mammogram” or a “diagnostic mammogram”. Screening mammograms are used to check for breast cancer for patients who have no symptoms or signs of disease. These are usually referred to as your annual or yearly mammogram. Diagnostic mammograms are for patients who have found changes in their breast such as a lump, pain, disfiguration or discharge.
Mammograms are essentially an x-ray picture of the breast. There are different types of mammograms: analog mammograms, digital mammograms and 3-D mammograms. Analog mammograms are when the breast is pressed between two plates and a fixed x-ray is taken on film and then developed. The process is similar during a digital mammogram, though a digital mammogram takes about half the time, there is less radiation exposure, and the images are viewed and stored on a computer, which can be printed out on film. 3-D (three dimensional ), breast imaging, also known as breast tomosynthesis, is a type of digital mammogram where the x-ray tube and imaging plate move from different angles during the exposure. It creates a series of thin slices through the breast and computer software can reconstruct the image. Mammograms can also use a CAD (Computer Aided Detection), software that searches for abnormal areas of density, masses or calcifications that may indicates the presence of cancer. The CAD program highlights areas of concern on the images, further alerting the radiologist for additional examinations or testing.
If your radiologist, (the physician who reads the mammogram), suspects there may be an area of concern, he or she may suggest that you have further studies. One may be an ultrasound of the breast. An ultrasound uses sound waves to make a picture of the tissues inside the breast. It uses an instrument called a transducer which is passed back and forth over the breast and images are captured. It does not use radiation like the mammogram. Your radiologist may also suggest an ultrasound-guided breast biopsy. This is performed by taking samples of some of the cells (usually through a hollow needle) from a suspicious area of the breast, then sending them to the pathologist to be studied under the microscope. The ultrasound helps guide the physician to the site of the area of concern.
Another test is an MRI (magnetic resonance imaging) scan. This uses powerful magnets and radio waves to create detailed pictures of the breast and surrounding tissues that are difficult to see clearly on a mammogram or ultrasound. These pictures can show the difference between normal and diseased tissue and provide the radiologist with information that is not found on a mammogram. An MRI may be done in conjunction with a mammogram and an ultrasound, but is not a replacement for a mammogram. MRI’s do not use radiation (x-rays). Breast MRI’s are not routinely done and must warrant a diagnosis to perform this test. They are much more expensive than traditional mammograms and most insurance companies will need justification (such as checking for more cancer after cancer has been diagnosed) to authorize this test.
There is also a type of x-ray called a CT scan, (computerized tomography) of the breast. This uses 2-dimentional slices or cross-sections from many different angles. The images are sent to a computer where they are put together to create detailed pictures. CT’s of the breast are not routinely used to evaluate the breast. This is another exam where your insurance will need justification to authorize it be done.
An additional test is a PET scan (positron emission tomography. During the PET scan, you are injected with a substance made up of sugar and a small amount of radioactive material. Cancer cells seem to be more active than healthy cells and as a result absorb more of the radioactive sugar. A special camera scans the body to pick up any highlighted (sugary) areas on a computer screen. The highlighted areas help the radiologist determine areas that may indicate cancer. Although, this test has only a limited ability to detect small tumors, it can be useful for evaluating people after breast cancer has been diagnosed. It gives the physician information to determine where the cancer has spread to lymph nodes and other parts of the body and to see if the cancer may be responding to treatment. Sometimes this is done in conjunction with a CT scan; PET/CT. Again, this is a very expensive test and insurance companies will need justification to authorize it.
Lastly, there is a blood test called the BRCA that analyzes two genes (BRCA1 and BRCA2) to see if you have inherited any abnormal changes that might increase your risk for certain types of cancer. This blood test is usually done on women that have a strong family history (parent, sibling or child) of breast and/or ovarian cancer or who have had breast or ovarian cancer themselves at a young age.
Mammograms charges can vary from place to place in price. Most private insurances cover the cost of a “screening” mammogram with no co-pay or deductible. Always verify this with your insurance company, as not all plans are the same. Also keep in mind, if you call for an appointment and have a lump or problem, this will change from a “screening” mammogram to a “diagnostic” mammogram and you will most likely owe towards your deductible and out-of-pocket expenses. During the month of October, a lot of radiology offices offer a reduced price screening mammogram. This is usually for women who don’t have insurance and couldn’t otherwise afford a mammogram. Lastly some state and local health programs provide mammograms free or at low cost. Information about free or low-cost mammography screening programs is available for the NCI’s Cancer Information Service@ 1-800-4-CANCER (1-800422-6237) and from local hospitals, health departments, women’s center, and the American Cancer Society. Don’t discard your physician as well. They may know of community groups that have programs to assist with mammogram fees.
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