Empowered to Choose: What Women Should Know about Screening Mammography

These days women are getting conflicting recommendations about when to start screening mammograms and how often to have them. I talked with breast surgeon Janie Grumley, MD, who says that a better understanding of mammograms as a screening tool and knowing how early detection impacts cancer treatment provides the best context for decision making.


Grumley, Janie Weng 11

Janie Grumley, MD

You say some providers are telling their average-risk patients that annual screening for breast cancer may be unnecessary. Why are some women hearing that going two or even three years between mammograms is OK?

Dr. Grumley:  Recent studies have been in the media that give conflicting information about screening mammograms. What’s important to understand is that all the experts agree there is a benefit to breast cancer screening. Where conflict lies is around the ideal interval for screening. Many of the studies focus purely on the rate of survival, but survival alone is not the only benefit. When cancers are found early the treatments needed to achieve survival may be drastically different compared to cancers found later.

The reason why some practitioners are recommending longer intervals between mammograms is an attempt to lessen anxiety for women undergoing screening. But that may come at a cost, if the result is later detection of cancer and possibly the need for more treatment. Instead, I think it is more important to educate women about the limits of screening mammograms so they better understand the process and are not alarmed when called back for additional tests.

Mammograms are not perfect tests and a percentage of women will get called back for more views, and may even require a biopsy. What would you tell women whose anxiety may be keeping them from getting a mammogram?

Dr. Grumley:  Here’s something women should keep in mind: A mammogram doesn’t see cancer cells. It simply helps us see differences in how the breast looks. So we take that first look, and sometimes pick areas that need a closer look. Even biopsies are done when something looks different, not because we know it’s cancer. Providers could do a better job of helping women understand that after a mammogram, there is always the chance they will be called back. And that just means we’re not sure of the nature of the change we’re seeing. A very small portion of the women that come back will need a biopsy, and a much smaller percentage will actually have cancer.

Doing a mammogram every year, beginning at age 40, is the ideal way to track subtle changes in breast tissue and identify problems early. It’s the series of mammograms that will give us the best information. It’s like weighing yourself one day, but not tracking your weight over time. It’s a very limited piece of information. Getting mammograms every year creates a more complete picture and helps us see what we need to see.

That said, breast cancer screening is not one-size-fits-all. If a woman has very dense breast tissue, for instance, the type of imaging is important. Somebody with very dense breasts should have 3D mammography, and possibly a screening breast ultrasound. Those with fatty breasts can have a good test with a 2D mammogram. So it’s also about selecting the right tool for the right patient.

You mentioned the difference in treatment when breast cancer is found early versus at a more advanced stage. What do treatment options look like today for early breast cancer? For more advanced breast cancer?

iStock_000020255467XSmallDr. Grumley: I have a perfect example of a patient I treated. Her annual mammogram revealed a small tumor. Because the tumor was just a few millimeters, the patient could have a partial mastectomy, with breast reshaping using oncoplastic surgery techniques, plus one dose of radiation administered during surgery. She was done with her main treatment in one day. Had we waited another year, the tumor would likely be larger and require more extensive treatment, such as weeks of chemotherapy and radiation therapy. One day of treatment compared to months, with more toxicity and side effects.

We have to help women understand the screening process, how it’s important not just for survival, but also because if we get it early, we don’t have to do as much to treat you. Women often think breast cancer means mastectomy and chemotherapy, but early detection means we are doing far fewer of both. There have been great advances, including drug therapies that treat by cancer type, breast preserving lumpectomies and the possibility of intraoperative radiation therapy for localized tumors. Today there is good reason to be less fearful of what can be a very treatable cancer.

Educating women about the benefits of regular breast cancer screening could greatly affect decisions they make about their own health. How do you help more women get this information?  

Dr. Grumley:  I meet with primary care physicians and say it’s not about telling your patients what they should do, it’s about providing education. Explain what mammograms really tell us, what a callback means, what a biopsy means, and the patient can decide for themselves. Talk about how treatment plans change depending on when cancer is found. It only takes one good conversation. And if the provider wants more support for that conversation, they can have their patient follow up with a breast specialist. Because when it comes to screening decisions for breast cancer, receiving complete information is the best anti-anxiety medicine there is.

Comments

  1. Thank you for such a clear explanation of why regular routine exams are important! I read often how advanced treatments have come in treating breast cancer, even when detected later. But reading how catching it early can limit the amount of treatment, even down to one day, really put it all in perspective, since quality of life, and extent and length of treatment should be considered. There are some women in my family over 40 that don’t get annual exams. I am definitely passing this article along to them. Thank you!

  2. Thanks for your detailed explanation. Women should periodically do their breast check to identify cancer at earlier stage itself.

  3. Valerie Mazziotti says:

    Great response for a challenging question

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