Breast Cancer Awareness Month

By: Tara Erickson – ACHS Radiology Department

October is National Breast Cancer Awareness Month, with this being said I would like to remind all women that it is important to have a yearly screening mammogram. 

What is a Mammogram?  A mammogram is an x-ray of the breast.  Screening mammograms are used to look for breast disease in women who are asymptomatic: that is, those who appear to have no breast problems.  The goal of screening mammograms is to detection breast cancer early, before the start of symptoms.  Breast cancers that are found because they are causing symptoms tend to be larger and are more likely to have already spread beyond the breast.  In contrast, breast cancers found during screening exams are more likely to be smaller and still confined to the breast.  The size of a breast cancer and how far it has spread are some of the most important factors prediction the prognosis (outlook) with this disease.  Most doctors feel that early detection tests for breast cancer save thousands of lives each year, and that many more lives could be saved if even more women and their health care providers took advantage of these tests.  Following the American Cancer Society’s guidelines for the early detection of breast cancer improves the chances that breast cancer can be diagnosed at an early stage and treated successfully.  The American Cancer Society recommends women without breast symptoms at age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health.  Women with serious health problems or short life expectancies should discuss with their doctors whether to continue having mammograms.

The following are useful suggestions for making sure that you receive a quality mammogram:
• Try to schedule your mammogram at a time of the month when your breasts are not tender or swollen to help reduce discomfort and assure a good picture.  Try to avoid the week right before your period.
• On the day of the exam, don’t wear deodorant or antiperspirant.  Some of these contain substances that can interfere with the reading of the mammogram by appearing on the x-ray as white spots.
• Always describe any breast symptoms or problems that you are having to the technologist who is doing the mammogram.  Be prepared to describe any medical history that could affect your breast cancer risk—such as prior breast surgeries, hormone use, or family or personal history of breast cancer.  Also discuss any new findings or problems in your breasts with your provider before having a mammogram.
• If you are going to a facility for the first time, bring a list of the places, dates of mammograms, biopsies, or other breast treatments you have had before.  This is important so that your new images can be compared to your old ones.  If you can bring the previous with you or have them sent to the new facility before you appointment this will help in getting your results in a timely manner.
• If you do not hear from your doctor within 10-14 days, do not assume that your mammogram results are normal.  Please call your providers office.

What to expect when having a mammogram.
• You are required to undress from the waist up.  The technologist will provide you with a cape/wrap to wear.  If you have deodorant or antiperspirant on you will be provided with a wet wipe to remove the deodorant or antiperspirant.
• A technologist will ask you question regarding your medical history.
• A technologist will be there to position your breasts for the mammogram.  You and the technologist are the only ones in the room during the mammogram.  To get a high-quality mammogram picture, it is necessary to flatten the breast slightly.  The breast is compressed between 2 plates to flatten and spread the tissue.  Although this may be uncomfortable for a moment, it is necessary to produce a good, readable mammogram.  The actual breast compression only lasts a few seconds.  The entire procedure for a screening mammogram takes about 20 minutes.  You may feel some discomfort when your breasts are compressed, and for some women compression can be painful.  Try not to schedule a mammogram when your breasts are likely to be tender, as they may be just before or during your period.

Some women are worried about the amount of radiation that they are exposed to during a mammogram.  Modern mammogram equipment designed for breast x-rays uses very low levels of radiation, usually about a 0.1 to 0.2 rad dose per x-ray (a rad is a measure of radiation dose).  To put dose into perspective, a woman who receives radiation as a treatment for breast cancer will receive several thousand rads.  If she had yearly mammograms beginning at age 40 and continuing until she was 90, she will have received 20 to 40 rads.  As another example, flying from New York to California on a commercial jet exposes a woman to roughly the same amount of radiation as one mammogram.

There are 2 kinds of risk factors for breast cancer; the ones that you cannot change and the ones that are lifestyle-related.  The ones that you cannot change are; gender, age, family history, personal history, race and ethnicity, and menstrual periods.  The ones that you have control over (lifestyle-related) are; having children, birth control hormone therapy after menopause, breastfeeding, alcohol, being overweight or obese, and physical activity.
Risk factors you cannon change:
• Gender – Simply being a woman is the main risk factor for developing breast cancer.  Men can develop breast cancer, but this disease is about 100 times more common among women than men.
• Aging – Getting older increases your risk of getting breast cancer.  About 1 out of 8 invasive breast cancers are found in women younger than 45, while about 2 of 3 invasive breast cancers are found in women age 55 and older.
• Family history – Breast cancer risk is higher among women whose close blood relatives have this disease.  Having a first-degree (month, sister, or daughter) with breast cancer almost doubles a woman’s risk.  Having 2 first-degree relatives increases her risk even more.  Although the exact risk is not known, women with a family history of breast cancer in a father or brother also have an increased risk of breast cancer.  Less than 15% of women with breast cancer have a family member with this disease.  Than means that most (85%) women who get breast cancer do not have a family history of this disease.
• Personal history – A woman with cancer in one breast has an increased risk of developing a new cancer in the other breast or in another part of the same breast.
• Race and ethnicity – White women are slightly more likely to develop breast cancer than are African-American women, but African-American women are more likely to die of this cancer.  In women under 45 years of age, however, breast cancer is more common in African-American women.  Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer.
• Menstrual periods – Starting menstruating early (before age 12) and/or went through menopause later (after age 55) slightly raise your risk of breast cancer.
Lifestyle-related factors:
• Having children – Women who have not had children or who had their first child after age 30 have a slightly higher breast cancer risk.
• Birth control – Recent oral contraceptive use: Studies have found that women using oral contraceptives (birth control pills) have a slightly greater risk of breast cancer than women who have never used them.
• Hormone therapy after menopause – Use of combined (estrogen and progesterone hormones) post-menopausal hormone therapy increases the risk of getting breast cancer.  It may also increase the chances of dying from breast cancer.  This increase in risk can be seen with as little as 2 years of use.  Large studies have found that there is an increased risk of breast cancer related to the use of combined hormone therapy.  Combined hormone therapy also increases the likelihood that the cancer may be found at a more advanced stage.  A women’s breast cancer risk seems to return to that of the general population within 5 years of stopping treatment.
• Breastfeeding – some studies suggest that breast feeding may slightly lower breast cancer risk.
• Alcohol – Consumption of alcohol is clearly linked to an increased risk of developing breast cancer.  The American Cancer Society recommends that women have no more than 1 alcoholic drink a day.
• Being overweight or obese – Being overweight or obese after menopause has been found to increase breast cancer risk.
• Physical Activity – Evidence is growing that physical activity in the form of exercise reduces breast cancer risk.  In one study from the Women’s health Initiative, as little as 1 ¼ to 2 ½ hours per week of brisk walking reduced a woman’s risk by 18%.

Signs and Symptoms of breast cancer
If you are experiencing any of these signs or symptoms (no matter what age) please contact your provider as soon as you can.  They may or may not be signs of cancer.

• Swelling of all or part of a breast (even if no distinct lump is felt)
• Skin irritation or dimpling
• Breast or nipple pain
• Nipple retraction (turning inward)
• Redness, scaliness, or thickening of the nipple or breast skin
• A nipple discharge other than breast milk

Sometimes a breast cancer can spread to lymph nodes under the arm or around the collar bone and cause a lump or swelling there, even before the original tumor in the breast tissue is large enough to be felt.  Swollen lymph nodes should also be reported to your doctor.

Most insurance companies will cover the cost of a screening mammogram.  The best way to find this out is to call your insurance and see how much and how often they cover mammograms with your plan.  If you ask the technologist performing your mammogram they do not know as there are a lot of different insurance companies and different plans they can not remember them all.  If your insurance doesn’t cover or you don’t have insurance there are programs out there that can help with the cost.  For example for Adair County residents Adair County Home Care has a program called National Breast and Cervical Cancer Early Detection Program (NBCCEDP).  Stephanie Claussen is in charge of this program.

Not everyone reading this is a woman but please remind those women in your family to have their yearly mammogram.  Most facilities will send a reminder letter the next year but also hearing it from your family really shows them that you care about their health.
Breast Cancer: Early Detection
American Cancer Society
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