Myths of Mammography
A screening mammogram is an important step in a woman’s preventative healthcare routine. Unfortunately, there is a lot of misinformation regarding screening mammography and breast cancer. Below are the most frequent myths I encounter when dealing with my patients.
Dr. Lisa Paulis, Elizabeth Wende Breast Care
Annual screening mammography is only important for patients with a family history of breast cancer.
Seventy-five percent of women diagnosed with breast cancer have NO family history of the disease. In the general population 12% of women will develop breast cancer in their lifetime and 42,000 Americans will die from breast cancer this year.
Women who are at a higher than average risk due to personal or family history, prior atypical biopsy results, certain genetic factors etc. may benefit from additional screening (ultrasound, MRI) and/or genetic counseling. However, the absence of risk factors should not prevent a patient from pursuing screening imaging. In our local patient population only 4% of the patients we diagnosed last year had a known gene mutation.
Major health organizations, such as the American Cancer Society, as well as our local imaging community continue to recommend that women should be screened annually beginning at age 40. For more information go to sbi-online.org and talk to your healthcare provider.
Screening mammography should not be performed in younger patients (ages 40-50) due to false positive results.
A false positive is an area that appears abnormal on initial imaging but represents normal tissue on subsequent studies. False positives can generate additional testing in order to determine a true result. In mammography, false positive results can mean anything from additional mammographic views, after which most patients will not require further workup, to ultrasound or minimally invasive biopsy procedures. Out of every 100 women who have a mammogram; 95 will be told that their mammogram results are normal, and 5 will be asked to return for additional mammogram and/or ultrasound testing. We feel strongly that women should be aware of these statistics to make an informed decision on how they weigh the risk of being one of the women who potentially needs additional workup versus the risk of not screening. Of note, 12% of the cancers we diagnosed in our community in 2018 were in women in their forties.
Mammography is ineffective in screening for cancer in women with dense breast tissue.
Breast density is determined by the proportion of fat and glandular tissue in the breast. The more glandular tissue a patient has, the more “dense” the tissue is graded. Each patient is assigned a breast density classification on their mammogram which ranges from entirely fatty tissue to extremely dense glandular tissue. Small breast cancers can be harder to identify on traditional mammograms in patients with dense tissue, however a newer technology called tomosynthesis (3D mammography) spreads out the tissue to improve detection. Additionally, screening breast ultrasound provides another way to “see through” the density and find small masses. Mammograms remain the most accurate tool available to diagnose ductal carcinoma in situ or DCIS which can be the earliest form of breast cancer we can identify. In patients with dense tissue, consideration should be given to screening mammography accompanied by ultrasound to offer the most comprehensive benefits of imaging.