Mammograms
Sought By Most Women Over 40
The majority of women
in the US are getting their first screening mammogram for
breast cancer at age 40, as recommended by health experts, according
to a new report in the medical journal Cancer.
The American
Cancer Society guideline for screening mammography
states that women 40 years of age and older should have a screening
mammogram every year.
The National
Cancer Institute guideline for screening mammography
states that women in their 40s and older should have a screening
mammogram on a regular basis, every one to two years.
Access
To Mammograms Not Always Easy
However, certain women
- particularly those who are poor, lack insurance, or do not speak
English - are failing to get the imaging tests by 40, the researchers
say.
The findings are a
follow-up to a study published last year by the same group that
found only 16 percent of women who have their first mammogram
return at the correct annual interval for follow-up mammograms.
Taken together, the
two studies give women good marks for an initial mammogram but
not for follow-up screenings, says James A. Colbert, lead author
of the latest study.
Colbert and his colleagues
looked at more than 72,000 women who got screening mammograms
at Massachusetts General Hospital in Boston between January
1985 and February 2002.
"From that we selected
a subpopulation of 940 who we found had a first mammogram between
January 2000 and February 2002," says Colbert, a research assistant
in the division of surgical oncology at the hospital.
The fact that 60 percent
of the women had their first mammogram by the end of their 40th
year is "considered very good," Colbert says.
However, according
to the new study, some women fell short of the recommended guidelines.
For instance, African-American women began screening
at a median age of 41 years, about 0.7 years later than white
women, the researchers found. And Hispanic women began screening
at a median age of 41.4 years, 1.1 years later than non-Hispanic
women.
Women without private
health insurance began screening even later - at a median age
of 46.6 years, or 6.3 years later than women with private health
coverage. And non-English speaking women began screening at
a median age of 49.3 years, or nine years later than the English-speaking
persons, the study found.
The last to get their
first mammogram were women who lacked private insurance and
did not speak English. They had their first screening at a median
age of 55.3 years.
In the study published
last year, the researchers found the median time for return
for a follow-up screening for women who had a mammogram in 1996
was 1.3 years. And about 25 percent failed to return by three
years. Only 16 percent of the women who had a mammogram at the
hospital in 1996 had five subsequent screenings during the next
five years.
The new study was
not designed to tell why the rate of the first screening
mammogram was lower for those who did not speak English
or did not have health insurance, Colbert says. "We hypothesize
that it is due to a communication problem," he says.
Lack
of Access a Concern, Expert Says
The new study's findings
ring true with Dr. Melvin Silverstein, a breast surgeon at USC's
Norris Comprehensive Cancer Center and chief of the breast service
at the USC/Los Angeles County Medical Center, a county hospital
that serves many poor patients.
Dr. Silverstein sees
a wide spectrum of patients. The women who get mammograms at
the Norris Center tend to get their cancers detected early because
they don't miss their screenings.
At the county facility,
Silverstein often sees women who have skipped their annual mammograms
and, as a result, may have their breast cancers diagnosed at
a later stage.
"They are people who
have to work, who can't take a day off" to get a screening mammogram,
he says.
"It's a very good
study," Dr. Silverstein says of the latest research. "It points
out that some groups of women are doing a good job - that is,
English-speaking, well-insured, affluent women."
What is needed,
Dr. Silverstein and Colbert agree, is a way to get the message
out to all women about the necessity of beginning mammograms
at age 40, and getting follow-up screenings annually.
"At Massachusetts
General, the staff spends two hours a day on the phone to remind
patients about their mammogram appointments," Colbert said.
If a woman's hospital
or HMO does not do that, he says, one way to remember is
to schedule the annual mammogram on or near the same date each
year. Or pick a date that is easily remembered, such as
a day before or after a birthday.
Always consult your
physician for more information.
Online
Resources
(Our Organization
is not responsible for the content of Internet sites.)
American
Cancer Society
American
Society for Clinical Oncology
Centers
for Disease Control and Prevention (CDC)
National
Cancer Institute
National
Institutes of Health (NIH)
National
Women's Health Information Center
Susan
G. Komen Breast Cancer Foundation |
November 2004
Mammograms
Sought By Most Women Over 40
Access
To Mammograms Not Always Easy
What
Is a Mammogram?
Online
Resources
What
Is a Mammogram?
A mammogram is an
X-ray exam of the breast. It is used to detect and diagnose
breast disease in women who either have breast problems such
as a lump, pain, or nipple discharge, as well as for women who
have no breast complaints.
The procedure allows
detection of breast cancers, benign tumors, and cysts before
they can be detected by palpation (touch).
Mammography cannot
prove that an abnormal area is cancer, but if it raises a significant
suspicion of cancer, tissue will be removed for a biopsy. Tissue
may be removed by needle or open surgical biopsy and examined
under a microscope to determine if it is cancer.
Mammography has been
used for about 30 years, and in the past 15 years technical
advancements have greatly improved both the technique and results.
Today, dedicated equipment, used only for breast X-rays, produces
studies that are high in quality but low in radiation dose.
Radiation risks are considered to be negligible.
The recent development
of digital mammography technology shows promise for improved
breast imaging.
Digital mammography
provides electronic images of the breasts that can be enhanced
by computer technology, stored on computers, and even transmitted
electronically in situations where remote access to the mammogram
is required.
The National Cancer
Institute describes the following types of mammograms:
screening
mammogram
A screening mammogram is an x-ray of the breast used to detect
breast changes in women who have no signs of breast cancer.
It usually involves two x-rays of each breast. Using a mammogram,
it is possible to detect a tumor that cannot be felt.
diagnostic
mammogram
A diagnostic mammogram is an x-ray of the breast used to diagnose
unusual breast changes, such as a lump, pain, nipple thickening
or discharge, or a change in breast size or shape.
A diagnostic mammogram
is also used to evaluate abnormalities detected on a screening
mammogram. It is a basic medical tool and is appropriate in
the workup of breast changes, regardless of a woman's age.
X-rays of the breast
are different than those used for other parts of the body. The
breast X-ray does not penetrate tissue as easily as the X-ray
used for routine X-rays of other parts of the body.
The breast is compressed
by the mammogram equipment to spread the tissue apart. This
allows for a lower dose of radiation. Compression of the breast
may cause temporary discomfort, but is necessary to produce
a good mammogram.
The compression only
lasts for a few seconds for each image of the breast. A breast
health nurse or X-ray technologist usually takes the X-rays,
but the resulting films are read and interpreted by a radiologist,
who reports the results to your physician.
A mammogram may show
calcifications, tiny mineral deposits within the breast tissue.
One type of calcification
is called macrocalcifications, where the coarse calcium deposits
may indicate degenerative changes in the breasts such as aging
of the breast arteries, old injuries, or inflammations.
Microcalcifications
are tiny (less than 1/50 of an inch) specks of calcium. When
many microcalcifications are seen in one area, they are referred
to as a cluster.
Masses, which may
occur with or without associated calcifications, and may be
due to different causes, include:
cyst
- a non-cancerous collection of fluid in the breast. It cannot
be diagnosed by physical exam alone nor by mammography alone.
Either breast ultrasound or aspiration with a needle is required.
If a mass is not a cyst, then further imaging may be obtained.
benign breast
conditions - masses can be monitored with periodic
mammography, but others may require immediate or delayed biopsy.
Always consult your
physician for more information. |
