According to the Cancer Association of South Africa (CANSA), it’s far better to have an early-stage diagnosis, as it results in better breast cancer treatment and long-term survival. The only way to get an early diagnosis? Checking your breasts regularly at home, and making sure you attend your scheduled mammograms. But there are so many mammogram myths that scores of women are opting out of this practice. An informal survey amongst women who are hesitant to go even though they have the means to go shows that the top reasons include thinking it’s painful, having fear of radiation and being afraid of that Big C diagnosis.
Plus, skipping just one screening can increase a woman’s risk of dying from breast cancer, per a study of half a million Swedish women.
Since mammograms are essential, we’ve broken through a few of the myths and addressed them, courtesy of the radiologists at SCP Radiologist Practice and Dr Lizanne Langenhoven, who specialises in the treatment of breast cancer. Here’s what you really need to know about mammograms.
Myth #1: Mammograms are too painful
Many women still rely on their mother’s experience with early mammograms which were painful. Mammography machines have progressed exponentially since the early days, so the level of discomfort experienced during the procedure is now significantly reduced. Modern technology and digital equipment allow us to use less compression and still obtain quality imaging. Also, the amount of pressure is different for each individual, depending on the breast size and composition. Pressure is often manually adjusted so speak to your mammographer if you experience any discomfort.
Myth #2: Mammograms mean exposure to cancer-causing radiation
A mammogram uses relatively low-dose radiation. The total dose is approximately 0.5 mSv (2D mammogram). To put that into perspective, we are exposed to 3.0 mSv of background radiation from our natural surroundings per year. Radiologists also strictly follow what’s known as the ALARA principle – to always apply radiation “as low as reasonably achievable”. Clearly, the benefits of this screening tool vastly outweigh the actual low-dose radiation.
Myth #3: You don’t need a mammogram if you go for thermography
At present, thermography cannot substitute mammography but may be used as complementary screening. Dr Langenhoven cautions that thermography is not all it is cut out to be. In order for the cancer to give off heat signals, it has to be significant in size. Mammography on the other hand can detect changes in the breast before they progress to cancer. A mammogram therefore picks up the disease course much sooner than thermography.
Myth #4: Ultrasounds are safer
“Mammography is our workhorse. We look for masses, calcifications, and architectural distortion,” says Dr Langenhoven. “Ultrasound is a supplementary investigation used to further evaluate morphology, blood flow, consistency of masses, and lymph nodes that are abnormal on a mammogram.” Tomosynthesis, a type of X-ray, is also supplementary, used to further evaluate architectural distortion seen on a mammogram. They all work together. With denser breasts mammography is less sensitive, which is when we add the supplementary investigations to improve the sensitivity of detection.
Myth #5: I can’t have a mammogram I have breast implants
Yes, you can, is the short answer. If you have breast implants the compression and positioning are adjusted. The amount of pressure is equivalent to sleeping on your stomach. Modern technology means there is a very low risk of implant rupture or damage. It is usually combined with ultrasound for better evaluation of the implants.
Myth #6: If am diagnosed with breast cancer I am going to die anyway. So I would rather not find out
Perhaps the biggest and most harmful myth of all. The truth is that we’re in a period of time where 90% of women with early breast cancer can be cured of their disease, says Dr Langenhoven. “In the same way we don’t drive cars from the ’50s, our treatment is no longer ancient either!” she remarks.
“The good news is that our understanding of the different subtypes of breast cancer has improved significantly over the past few years! We no longer follow a one-type-fits-all approach and many women may even safely be spared chemotherapy in a curative setting,” she says.
“As with everything else in life, it is easier to address a ‘small’ or ‘early’ problem than it is to address a much larger problem! I’ve seen breast cancer diagnosed at a size of 2mm on a mammogram – meaning that treatment is tailored to a very low-risk situation. In short, the earlier we become aware of an existing problem, the sooner it can be addressed and with much less invasive treatment.”
Added to that, the side-effect profiles of our new drugs improve the quality of life during treatment. And the fact that we now identify and treat four distinct subtypes of breast cancer means that we can target the specific growth pattern at play and avoid unnecessary treatment. In short, modern medicine means your chances of dying of breast cancer are reduced. But screenings are still the champion in our fight against breast cancer.
Different screenings for breast cancer
“When you consider that around 90% of women find their own breast lumps, it is a very important part of the screening process,” says Dr Langenhoven. “Although 80 percent of these lumps are not malignant, there are cases where women owe their lives to their own self-examination.”
A mammogram involves breast imaging using low-dose X-rays to form a 2D image. The advantage? It often reveals abnormalities undetected in a clinical breast examination. Four images are taken, two of each breast. The breast is lightly compressed for less than 1 minute during the examination to improve diagnostic accuracy.
This is a form of 3D mammography and uses X-rays as well as sophisticated software to create a 3D image of the breast. It is considered better at detecting cancer and reducing false positives in dense breast tissue. It is invaluable in problem-solving and is used in combination with 2D mammography.
Ultrasound is a supplementary investigation used to further evaluate morphology, blood flow, and consistency of masses and lymph nodes that are abnormal mammography. It uses no radiation but rather real-time imaging, using sound waves to create an image. It’s a slightly longer process and is also valuable in problem-solving. It is used in combination with a mammogram not in place of it.
The digital MR image uses strong magnetic fields and radio waves but no radiation. You will receive an intravenous injection and then lie on your stomach, in an MRI ‘tunnel’ for around 45 minutes. An MRI for breast screening is usually used for problem-solving, high-risk screening and for women who have breast implants.
Your doctor might recommend a breast biopsy when a suspicious area is found in your breast, like a breast lump or other signs and symptoms of breast cancer. It is also used to investigate unusual findings on a mammogram, ultrasound, or other breast examination.
Thermography is a test that uses an infrared camera to detect heat patterns and blood flow in body tissues. Digital infrared thermal imaging (DTI) is the type of thermography that can be used to show these patterns and flow in the breasts.