Search for tag: "mammograms"

So you just had your Pap smear or your mammogram and it wasn't that bad was it? Or your colonoscopy. Okay, it really was that bad, but you didn't remember it. Are you wondering when you can stop doing these tests?

I asked a woman I know, who is in the health and fitness business, when she thought she could stop doing her cancer screening, you know, Paps, mammos, colonoscopy. She said, "Never," with a smile. She never wanted to stop her cancer screening, "It isn't all that bad, and it makes me feel safe," she said. I replied that cancer screening decisions about when and how often is a cost, risk, benefit analysis, and there are some data to inform that decision. She said, "You go with your brain, I go with my heart."

Well, let's go with the brain for a little while, okay? Let's start with Pap smears. The recommendations about Pap smears have been changing as we know more about what mostly causes cervical cancer -- the HPV virus -- and how fast it grows, usually not too fast. Cervical cancer does not increase with age for a lot of reasons. Sexual activity and the number of partners doesn't increase with age. Well, usually. And the cervix in postmenopausal women may not be as receptive to the virus. So there are good reasons to say that when you get to 65, if you've had normal Pap smears for the past 10 years, that means you actually have been having Pap smears in the past 10 years, and you haven't had an abnormal Pap in 20 years, you can stop testing. There's some pretty solid numbers to back this up, and the U.S. Preventive Services Task Force makes that recommendation.

Okay. How about colonoscopy? Well, colon cancer does not decrease with age. But if you don't have any family history of colon cancer and if your previous colonoscopies, that assumes that you've had some, have not shown any polyps or precancerous lesions, you can stop at 75. That's the recommendation of the U.S. Preventive Services Task Force and the American College of Physicians.

Lastly, mammography. Breast cancer does not decrease with age. It increases with age. The aggressiveness of breast cancer is less in older women than it is in younger women. But women still will get treated, which can be aggressive in and of itself. The U.S. Preventive Services Task Force said there's not enough evidence to recommend for or against mammograms at age 75 and older. But about a quarter of deaths from breast cancer each year are attributed to a diagnosis made in women after the age of 74. Women as they get older are less likely to get mammograms. About three-quarters of women 50 to 74 have had a mammogram in the past two years, but only 40% of women over 85. Of course, many women over 85 are in poor health, and mammography is just not on the list of things to do. And clinicians are less likely to recommend mammography if a woman is in poor health. The American Cancer Society suggests women should continue mammograms as long as their overall health is good and they have a life expectancy of at least 10 more years.

Well, how long am I going to live? I went online and Googled, "How long will I live?" There are lots of calculators because insurance companies and pension plans really want to know. Well, I tried a life expectancy calculator that was developed by the University of Pennsylvania and has been mentioned in the mainstream media. It asks sex not gender, age, height, weight, alcohol, smoking, diabetes, marriage status, whether I exercised, ate my veggies. I didn't fudge my weight or height. This calculator said I was going to live till 93 and I had a 75% chance of living to 85.

Another life expectancy calculator from confused.com asked me just a few questions, not my height or weight,or smoking, or alcohol, or diabetes. It did ask my relationship status, and options included happy relationship and married, but these were mutually exclusive. You could only pick one. Well, this one had my life expectancy of 97. And the calculator from Northwest Mutual, a well-respected life insurance company, cranked me out at 98.

Well, I really don't want to hang around the planet all that long. But I really hope that my savings will take me up there, and I'm going to have to have mammograms for a while yet.

Thanks for joining us for the "Seven Domains of Women's Health" on The Scope.

Dr. Jones: With respect to breast cancer risk, smaller breasts doesn't mean less. All breast sizes need mammograms. Women with different size breasts have ideas that breast size may affect the risk of breast cancer and the need for screening mammograms.

Well, breasts are different, and here to unravel some of the issues for us is Dr. Helen Mrose, a specialist in breast imaging and a radiologist here at the University of Utah. Welcome to The Scope studio, Dr. Mrose.

Dr. Mrose: Thank you for having me.

Dr. Jones: Okay, so when it comes to breast cancer risk, does size matter?

Dr. Mrose: Actually, no.

Dr. Jones: Okay.

Dr. Mrose: Size does not matter. People with small breasts and large breasts get breast cancer in equal frequencies or so we think.

Dr. Jones: Right.

Dr. Mrose: There are many things that matter having to do with breasts, including whether the breasts are dense or not, but that doesn't necessarily have a lot to do with breast size.

Dr. Jones: Oh, good.

Dr. Mrose: That's something we inherit.

Dr. Jones: Or we grow postmenopausal women, it turns out who gain weight after menopause, which happens. It's not uncommon for postmenopausal women, it's breasts that get larger, or for women who go on a diet and lose a lot of weight for their breasts to get smaller.

Dr. Mrose: Correct.

Dr. Jones: So there's some changes that go through in a woman's life.

Dr. Mrose: That's absolutely true. The breasts are composed of basically just two things -- fat and what's called fibroglandular tissue. And it's the fibroglandular tissue that is what's called dense. And for some reason, some people have very little fiber glandular tissue and some people have lots of it. And that has been found to be associated with breast cancer risk, but you're born with that or you develop when your breasts developed. You have a certain amount of that fibroglandular tissue, and you're absolutely right when the breasts get bigger, which they tend to do when people get older and they gain weight, they get more fat. But that's not known to be associated with breast cancer risk specifically.

Dr. Jones: So when it comes to early detection of breast cancer, does size matter in terms of how you do the mammogram or whether the mammogram is good at picking up cancers?

Dr. Mrose: Hopefully, not.

Dr. Jones: Oh, that's what I want to hear. Doesn't matter.

Dr. Mrose: Of course, when someone's breasts are very small, or if they're very large, it's more challenging for the technologist. We do have different size compression paddles to accommodate different sizes. And one thing that really matters is the skill of the technologist who's performing this study. And many people think it maybe it doesn't matter. It's just like snapping a chest X-ray. But doing a mammogram is quite an art that technologists who perform this are specially trained, they have to go through quite a bit different training than a regular X-ray technologist. And they have to keep up a certain number that they do and take exams. And they need to be supervised by people like me, who are the people who are watching the quality of their work and making sure that they're doing an adequate job. It's difficult to include all the breast tissue on the mammogram.

Dr. Jones: Well, here in the studio today, we have breasts of different sizes. And we won't use names, of course, because that would be HIPAA. But clearly, people with larger breasts to get all of the breast into it means you have to squeeze hard and squeeze all of it. So women who are large breasted tend to think that their mammograms hurt more, and people who are small breasted think that their mammograms hurt more. And I'd say hurt is all up to the person in this not up to the breast size. What do you think about that?

Dr. Mrose: That is true. It can be very painful or not painful at all. And a lot of it has to do with expectations, I think. A lot of it has to do with the skill of the person who's performing the examination. Because I think everyone having a mammogram feels some kind of stress because it's a test for cancer. It's one of the only tests that we do that's the only question is, is there cancer there? So of course, that's stressful.

But some people do not feel much discomfort. And it only lasts for a few seconds. The compression, which is what you're talking about that can be uncomfortable is really important for a number of reasons. The thinner we can get the breast tissue, the less radiation is necessary to produce the image. And this is really important, but also the thinner the tissue, the more detail we get by a lot, and the more things are spread apart, which is very important for our detecting things.

But when you ask a question about the size of the breast, when people have fatty breasts, which you can't tell by how they look or feel or even the size, they are easier to read, because we're looking for white things on the black background. Fat is black. When people have dense breasts, they have a lot of white background. And so we're looking for white things that might be hiding in amongst other white tissue. And therefore that compression is so important. We're spreading things apart so we can see those little white things.

Dr. Jones: Well, I tell women who, particularly women who've had labor, that it's nothing like a contraction. And if they can count to eight slowly, it's not going to last longer than eight seconds. Usually, by the time they really start cranking it down, and maybe we can all handle something, just a slow count to eight would get you through it.

Dr. Mrose: We can. And breast cancer is much more painful than having a mammogram.

Dr. Jones: Right.

Dr. Mrose: So I do encourage people, if we can find something early, or even in the pre-cancer stage, that that is a lot less painful.

Dr. Jones: That's a good way to put it.

Dr. Mrose: Yeah.

Dr. Jones: You know, we've heard a lot more about digital mammography and mammography, this and mammography that. I've told my patients it was always important to go to a center that had their radiologists on-site looking and supervising and did a lot of mammography. But are there any particular kinds of mammograms that are important?

Dr. Mrose: The most modern technology that we have is called 3D mammography or tomosynthesis. And this is a digital mammogram, but rather than just producing a 2D image, there are several slices, one-millimeter slices of tissue. So that we can page through the tissue like on a CAT scan or an MRI and see much, much more detail. It's actually incredible how much more detail we get with a 3D or tomosynthesis mammogram than with regular 2D.

Dr. Jones: So the patient isn't actually turning around in a 3D, you know . . .

Dr. Mrose: No.

Dr. Jones: . . . scanner. It's just the way that computer takes the image. That process of for the woman of having the image taken it's the same, but it's the way that computer takes the data.

Dr. Mrose: The machine is very similar, except the tube head where the X-ray is coming from actually moves. The woman doesn't move. She's just in compression, but the tube is making an arc so that it's taking images at different angles, just like in a CAT scan. That then can be synthesized with the computer to make the one-millimeter slices.

Dr. Jones: So do insurances pay for 3D mammograms?

Dr. Mrose: Absolutely, they do.

Dr. Jones: And is that what we normally do here at the U at the University of Utah?

Dr. Mrose: Most of our sites at the University of Utah are 3D. Certainly the Huntsman is all 3D.

Dr. Jones: That's great.

Dr. Mrose: Everyone is a specialist in reading mammograms, and that's something that is also important.

Dr. Jones: Well, so when do you recommend starting mammograms?

Dr. Mrose: I recommend for someone who's that average risk. What I mean by that is someone without a strong family history of breast cancer or known gene mutation that's associated with breast cancer. I recommend starting at age 40, and doing it yearly. And I know there's a lot of controversy about that. But the reality is all women are at risk for breast cancer. The majority of cancers that we find are on women without any known strong risk factor. And this means that having a discussion with your doctor about whether you should have a mammogram at 40, or how often is almost meaningless because everyone is at risk.

Dr. Jones: Think that's an important point because many women say, "Oh, I don't need to be screened because there's no breast cancer in my family." And I say only 5% of breast cancers are familial.

Dr. Mrose: Right.

Dr. Jones: The rest are still gene, you know, mutations, but only 5% of breast cancers are familial. And the rest is a DNA mutation that's made a cancer, but everybody needs to be screened. Well, so when do you recommend stopping screening?

Dr. Mrose: Well, since other than being female, which is the strongest risk factor for breast cancer, age is the strongest factor after that. When you hear the statistic that one in eight women will get breast cancer, that is actually not correct. It's one in eight women who reach 80 will get breast cancer, and that's very different. So what is important is if a woman is healthy, if she has a life expectancy of at least 5 to 10 years, I would say she should continue mammograms indefinitely.

And I have a 94-year-old mother who's healthy, plays pickleball every day. And I think she should have mammogram not because if she had cancer, we would do something aggressive. But I would have them take it out, which is a very straightforward procedure under local anesthetic, which would keep her from going on to develop something that would be very painful.

Dr. Jones: Well, I consider it a chance to go out, get out of the house and go out for lunch. So I think having a mammogram is a reason to meet with your friends and you know, have somebody take you or go with you and party a little.

Dr. Mrose: Many women do that. I had a group of friends from college who all came together in the . . . they called it the mammo van, and they would all come together and then we will all go out to lunch.

Dr. Jones: Well, although some recommendations about when to start and when to stop are still . . . you may hear different things. All women do need to be screened no matter what size they are. And Dr. Mrose, thanks for joining us with this and thanks for all of you listening on The Scope.

Dr. Jones: You got your screening mammogram report and it said that you had dense breast tissue. What does that mean? Should you be worried? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care, and this is The Scope.

Announcer: Covering all aspects of women's' health. This is The 7 Domains of Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: First, a little about breasts. Breasts are mainly four kinds of tissue. There are the breast lobules, which is the part that makes the milk that is pretty quiet unless you're pregnant or breastfeeding. There are the breast ducts, which carry the milk to the nipple. There is the fibrous tissue around those other tissues that keep them from bumping into each other. And there is fat.

The difference between large breasts and small breasts is the amount of fat in the breast. In young, premenopausal women, hormones keep the lobules and the ducts pretty active and the ups and downs of the hormones can increase the fibrous tissue. Weight gain can increase the fat, and weight loss can decrease the fat in the breast.

Of course there's also skin on the top of the breast, and the nipples and their blood vessels, and lymph glands, but they don't really count in the mammogram business. With the traditional mammogram, x-rays go easily through fat tissue but don't go through fibrous tissue very well, and don't go through cancer very well. So fibrous tissue and ductal tissue looks white on a mammogram, and so does cancer. When a woman is young, under 50, or premenopausal, the breasts are more dense according to the mammogram. When you get older, the breasts become mostly fat and are easy to see through.

When a breast is easy to see through, it's easier to detect cancers. When the breast is dense, it's harder to see the little cancers. Now, dense breast tissue is common. About two-thirds of premenopausal women have dense breasts, and about a quarter of postmenopausal women. Put the two together, and about 40% of women have dense breasts. Postmenopausal women on hormone replacement therapy tend to have denser breasts.

When my patients were worried about the term dense breasts, I just told them that they had youthful breasts. Which is always nice to hear, but it made it harder for mammograms to see through the entire breast.

So what are you supposed to do? First of all, the letter you received about the results of your mammogram is often not understandable. In fact, a recent letter to the journal of the American Medical Association noted that letters about dense breasts were written on average at the 11th grade reading level. Of course our Scope Radio listeners, wouldn't have any problem with that. But many people read much more below that level.

On top of that, about 24 states have legislated the wording of dense breast notifications. Yup. That's what the legislation is called, dense breast notifications. And we know how well the government explains things for those of you who do your own taxes. So if your report says you have dense breasts, it doesn't mean that you have cancer. It probably also said that your mammogram was normal. Remember, if 40% of women have mammograms have dense breasts, then it's normal.

However, the wording is there and in many states it is legislated to be there so women can know that maybe their mammogram isn't as good a screening test as it could be. This is the time to talk to your clinician about your breast cancer risk and your worries, and there are several risk calculators out there on the web. Other Methods of Breast Cancer Screening

There are other methods of screening if you're at high risk. If there's a lump that you or your clinician noted, then an ultrasound might be useful. If you carry a breast cancer gene that puts you at risk, then an MRI might be recommended.

For all of us, though, the invention of digital mammography several years ago made mammograms much better at looking through dense breasts. So there's been less of a chance of missing something. And there are also some new techniques.

So if you got the letter saying that your breasts were dense, don't freak out. You are normal. If you're at high risk for breast cancer, talk with your doctor and maybe another imaging technique would be right for you. And you can check out the website areyoudense.org and that can explain a little, and you can celebrate the fact that you still have young breasts. At least on mammogram.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: January 10, 2019
originally published: May 19, 2016

Interviewer: Can men get breast cancer? Turns out the answer is yes. Find out more about that next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Ginger Johnson is the president of GetScreenedUtah.com. Mainly, you're an advocate for women getting screened for breast cancer, but I was surprised when you said that I actually could be at risk for breast cancer. How common is that?

Ginger: It's not very common, but it is possible. Men are a little bit different. Their lifetime risk of getting breast cancer is about 1 in 1,000. But the interesting thing is that a lot of guys aren't even aware that if they have a family member, a blood relative that has breast cancer that their chances of getting that actually increase. And so it's very important for guys to be aware that they have pecs. Those pec muscles can also have fatty tissue over them, that is breast tissue. And that tissue can be susceptible to disease, just like a woman's breast can be susceptible to disease.

Interviewer: So, as a man, if I tend to be a little bit heavier and have more fatty tissue, does that increase my risk?

Ginger: Fat is an interesting thing because fat tends to hold onto hormones. And so those hormones can actually trigger different kinds of cancer in your lifetime. That's why women are tested if they're estrogen or progesterone positive or negative when they get a diagnosis of breast cancer. But what we're finding is that guys aren't aware that if they have a lump on their chest, they just kind of blow it off. They won't go and say, "Hey, is this something that I need to look at?" Because they don't have the knowledge to even think, "Oh, this might be breast cancer," because it's such a foreign idea to them.

Interviewer: Yeah. It's fairly rare. Not a lot of guys are diagnosed with it, right?

Ginger: Not a lot of guys are. It's 100 times less common among men than among women. But, what we're seeing is that there are still about 2,000 new cases of invasive breast cancer that are going to be diagnosed this year.

Interviewer: So I'm sure you noticed that I started checking myself . . .

Ginger: You did.

Interviewer: Right?

Ginger: That's okay.

Interviewer: So is that what a guy should do? Is it, you're looking for a lump?

Ginger: Breast cancer can show up in a lot of different ways. There are actually 12 different ways that it can show up beside a lump. A lump, of course, is something that is very easy to see. You can feel it. But, it doesn't have to be a big lump. It can just be something small, like a pinhead, even, that's hard and immovable. If you think about breast tissue as, maybe, like a lemon. There's a great campaign on WorldWideBreastCancer.com that actually shows lemons. And, this is a great way for guys to really . . . that this can be, too. But, in their analogy of a lemon, you're looking for a bad seed. So it's going to be hard. It's going to be immovable.

It's going to be something that you go, "Oh, this, this isn't soft," like a bean, or something squishy, which could be fat tissue, or even a lymph node. This is actually hard and immovable.

Other symptoms, though, could be redness on the skin, itchiness that does not go away, hotness. If you feel like you're seeing erosion on the skin, or if your skin is starting to invert or look like an orange peel. There are a lot of different changes that can happen on skin. This is for men and women.

Interviewer: Okay.

Ginger: But, a lot of times guys don't get this education.

Interviewer: Yeah. Sure. I never would have thought that a rash could be something like male breast cancer.

Ginger: If it doesn't go away, it's always best, if it doesn't go away, if it stays consistent over the course of a couple of weeks, go in and get it checked. Just go so you can know and figure out what it is. Because, you definitely want to find it before you feel it.

Interviewer: So, are you recommending guys do self-exams? Are you recommending that they just be aware?

Ginger: I would say I would be aware. Because you are less at risk, I would just say, "Be aware of your tissue."

Interviewer: Okay.

Ginger: Be aware of your body. I would, honestly, talk to your doctor. I mean, guys don't often go into the doctor, we know how that is. But, if you're going to go in and talk to your doctor, and if you do have a family history of a mom, or a sister, an aunt, somebody in your family, just say, "Hey, Doc, what is this? Tell me what you know." Now, if the doctor you go to does not know, then you're going to want to do some research on your own because oftentimes doctors, themselves, we love them, they do as much as they can with the knowledge they have, but sometimes they might not have the knowledge for you. So you might need to get a second opinion.

Interviewer: Yeah. It might not necessarily even be on the radar . . .

Ginger: It's true.

Interviewer: Because it is, it does happen, but it is somewhat rare.

Ginger: It's true.

Interviewer: So, do guys then get mammograms, at that point? Just like a woman would?

Ginger: They would. They would have to go in . . .

Interviewer: Really?

Ginger: And have, have some kind of a mammogram, a ìMan-o-gramî if you will. But, they might do an ultrasound. There might be some other things that they're going to do for you. But there have been gentlemen that I know that have actually had mastectomies, where they've had to have that tissue removed. Now, it seems foreign to a guy to do that. But, they've actually had to go in and remove that breast tissue that is over the muscles so that they can remove any disease from that person.

Interviewer: All right. Any final . . . I don't know what else to ask at this point, other than, I'm going to start paying attention. And if I see something that's not going away, or feel any weird lumps, I'll talk to my doctor. And I'll know that if my doctor is, "What?" then I need to, perhaps educate myself. Anything beyond that?

Ginger: That's . . .

Interviewer: As a man?

Ginger: That's the best thing, and to realize, guys, how much influence you have in the women in your life. I don't think guys realize that the influence they have to say, "Hey, women, this is something that we all need to be concerned about. If I can get it, then obviously you can get it. Go in and get your mammogram." That's something they recommend for women, age 40 and over, to start with that baseline, and go regularly thereafter.

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Recording: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life, you're listening to The Scope.

Interviewer: We're talking with Marjean Barnett, Director of Medical Imaging here at Teton Valley Hospital. Is there a lot of misunderstandings, do you think, with women as to how often they should get mammograms , when they should start? Do you feel that there's some confusion?

Marjean Barnett: I think there is, probably because the recommendations in the news change very frequently and there are national organizations that say, "Well, you don't need to start until you're 50 and you don't need to go more than every couple of years," but we sometimes will see a cancer appear that wasn't there just the year before.
I've seen a couple of cases of that just here recently. You really should get a baseline around 40 years old. Some of the more aggressive cancers occur in younger women, so if you're around 35 to 40 you need to be talking with your doctor about getting that baseline just to establish where you are.

Interviewer: So 40 is when women should really start worrying about it unless, I suppose, there's a family history of a particularly aggressive cancer then maybe earlier.

Marjean Barnett: That's correct, 40 is generally what's recommended. If you have family history like what's called a first degree relative would be a mother, a sister, a daughter, then you want to get your first mammogram earlier than the age at which they were diagnosed. Say if your mother was diagnosed at age 50 you definitely should have a baseline by the time you're 40, so ten years is a good window.

Interviewer: At 40 then how often after that?

Marjean Barnett: Usually yearly, our radiologist when they dictate the reports always recommend yearly.

Interviewer: Are there any disadvantages for a woman if she's like, "I really would like to start at 35," is there anything wrong with that?

Marjean Barnett: The only problem that might come up there is that younger women who are still producing a lot more of the female hormones estrogen and stuff, their breast tissue can be more dense which makes it more difficult to see clearly on a mammogram.

Interviewer: So it really doesn't make much sense because you're not going to be able to really see anything anyway.

Marjean Barnett: No.

Interviewer: Any final thoughts for our listeners? If there's one thing that they would take away and tell another woman what would you have that thing be?

Marjean Barnett: It's inconvenient at most. Some people think it's going to be horrible, but it's over quickly. It can save your life.

Recording: We're your daily dose of science, conversation and medicine. This is The Scope, University of Utah Health Sciences Radio.