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Monday, August 6, 2007

Mammograms and brest cancer

Mammogram - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Major Hospital has invested $400,000 in a digital mammogram machine that will provide state-of-the-art X-rays to aid in the fight against breast cancer.

After installation of the machine this week and training of personnel, the hospital will offer the upgraded mammograms locally.

Linda Skillman, radiology and women's imaging manager at Major Hospital, compared the new machine to the difference between a digital camera and one that uses film. She said the digital picture is stored in the computer of the machine and gives additional options to the technician reading the results of the mammogram.

"Film presents a very fixed image," Skillman said, "but the digital mammograms allow the technician to manipulate the data - he (or she) can change the brightness or contrast, zoom in to areas of concern."

Other advantages of digital mammography are a decrease in the number of breast biopsies needed, the ability to correct under- or overexposed films without repeating the X-rays, the ease of transmitting images from one physician to another and the ability to view large breasts with a single image.

Another reason the hospital decided to invest in the digital mammogram machine is that results from a trial sponsored by the National Cancer Institute suggested that for some women, the digital X-ray is more accurate. Skillman said women with extremely dense breast tissue, women under 40 years of age and pre- or perimenopausal women - those who are very close to menopause - might benefit from the digital mammograms. The American College of Radiology Imaging claims the digital mammograms could detect up to 28 percent more cancers of the breast than film X-rays.

Skillman said normally women who are under 40 years of age do not need a yearly mammogram, but those with a family history of breast cancer are an exception.

"It is also true," Skillman said, "that younger women have denser breast tissue, so the digital mammogram is a good choice for women under 40 with family members who have had breast cancer."

Earlier detection

National Cancer Institute Director Dr. Andrew vonEschenbach, said the digital mammogram demonstrated how new technology is allowing the earlier detection of breast cancer, especially in younger women. For women without high risk factors, however, the film and digital mammograms are considered equally effective by most researchers.

Skillman said women coming to the Women's Center on the third floor of the hospital for a mammogram won't notice a difference in the procedure. She said the machines look very much alike, and an accurate X-ray will still require compression of the breast.

"I know that many women hate the compression," Skillman said. "I know that there are some women who won't have a mammogram because they think the compression is so painful, but they need to understand that compression of the tissue is necessary to get accurate results."

A software program used with the new digital machine called Computer Aided Detection, or CAD, will serve as an extra pair of eyes for the technician reading the mammograms. This program highlights suspicious areas of the X-ray, pointing out sections that need more examination.

"Not that the technician would miss anything," Skillman said, "but the software helps the technician review any areas that might be considered suspicious."

Skillman added that patients will notice that mammograms take less time with the digital machines since the results can be read instantly without a wait for film to develop.

"Patients always are pleased when procedures take less of their time," Skillman said, "and this will allow us to do more mammograms in the same amount of time."

3,500 tests annually at Major Hospital

After the trials by the National Cancer Institute were published in the New England Journal of Medicine in September 2005, many hospitals decided to replace their film machines with digital, and Skillman said she is very proud that Major Hospital is among the medical facilities upgrading its imaging technology.

"Major Hospital wants to provide the best technology available for its patients," Skillman said.

The hospital performs 3,500 mammograms each year, and about 15 of those are for men. Skillman said a small number of men are indeed diagnosed with breast cancer, and as with women, early detection is the best way to provide a total cure.

The American Cancer Society suggests all women schedule a yearly mammogram after age 40.

Most mammograms are performed because of physician referrals, but Skillman said women who cannot afford the procedure or are uninsured may receive assistance through the Little Red Door Cancer Agency or a federal program aimed at fighting cervical and breast cancer.

Other than skin cancer, breast cancer is still the most common cancer found in women and is the leading cause of cancer death other than lung cancer. One in every eight women in the United States is likely to develop breast cancer in her lifetime, with more than 200,000 cases diagnosed each year, experts say. Forty thousand of those women are expected to die of breast cancer.

"We just want every woman to realize how important it is to get a mammogram," Skillman said. "They need to make the call to their doctors."

Inside Mammograms News

Mammograms are probably the most important tool doctors have to help them diagnose, evaluate, and follow women who've had breast cancer. Safe and highly accurate, a mammogram is an X-ray photograph of the breast. The technique has been in use for about thirty years.

Mammograms don't prevent breast cancer, but they can save lives by finding breast cancer as early as possible. For example, mammograms have been shown to lower the risk of dying from breast cancer by 35% in women over the age of 50; studies suggest for women between 40 and 50 they may lower the risk of dying from breast cancer by 25-35%.

Leading experts, the National Cancer Institute, the American Cancer Society, and the American College of Radiology now recommend annual mammograms for women over 40.

Finding breast cancers early with mammography has also meant that many more women being treated for breast cancer are able to keep their breasts. When caught early, localized cancers can be removed without resorting to breast removal (mastectomy).

Mammograms aren't perfect. Normal breast tissue can hide a breast cancer, so that it doesn't show up on the mammogram. This is called a false negative. And mammography can identify an abnormality that looks like a cancer, but turns out to be normal. This "false alarm" is called a false positive. To make up for these limitations, more than mammography is needed. Women also need to practice breast self-examination, get regular breast examination by an experienced health care professional, and, in some cases, also get another form of breast imaging, like ultrasound or MRI scanning.

4 Important Things to Know About Mammograms
1. They can save your life. Finding breast cancer early reduces your risk of dying from the disease by 25 - 30% or more. Women should begin having mammograms yearly at age 40, or earlier if they're at high risk.

2. Don't be afraid. It's a fast procedure (about 5 - 10 minutes), and discomfort is minimal. The procedure is safe: there's only a very tiny amount of radiation exposure from a mammogram. To relieve the anxiety of waiting for results, go to a center that will give you results before you leave.

3. Get the best quality you can.

If you have dense breasts or are under age 50, try to get a digital mammogram.
Bring your old mammogram films with you for comparison.
Have more than one radiologist read your study.
Ask if your center has CAD-computer aided detection-which calls the radiologist's attention to any possible areas of concern.
Make sure the doctor who referred you for the mammogram includes an explicit note when ordering the study (providing clinical correlations-e.g. "palpable mass in the upper outer quadrant, rule out abnormality").
Correlate your results with other tests you've had done, like ultrasound or MRI.
Discuss your family history of breast and other cancers-from both your mother's AND father's side-with your doctor.
4. It is our most powerful breast cancer detection tool. However, mammograms can still miss 15-20% of breast cancers that are simply not visible using this technique. Other important tools-such as breast self-exam, clinical breast examination, ultrasound, and MRI-can and should be used as complementary tools, but there are no substitutes or replacements for a mammogram.

Mammogram - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

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