“When it comes to screening mammography there are two groups of women: One in which Mammography works well and has saved thousands of lives, and women in whom it doesn’t work well at all”… Dr. Deborah Rhodes, Preventative Health Expert, Mayo Clinic, from her TED Women, 2010 Talk.

Which group are you in? Don’t know? You’re not alone. Today we’ll share information that can change how you get screened for breast cancer.

Breast cancer kills half a million women worldwide each year. And billions have been invested into medical research to help stop breast cancer from taking the lives of even more women.
Yet if you’re like me—until now, you may not have known the truth about some important facts about breast cancer that could, potentially save your life!

Mammograms, especially after the age of 40 have long been the primary recommendation of the National Cancer Institute as a means of detecting cancer before symptoms appear.
And many women, including yours truly, have followed this advice for years, thinking that this test—the mammogram would be the best test –otherwise it wouldn’t be recommended right?

Not so fast—maybe not.

breastcancerscreeningDid you know that the breast has been called by some medical experts as the most political organ in the United States? What does this mean you may ask?

Well for starters, health care is not just about keeping you healthy. It’s tied into a system that is also a big business. And there may not be any more big business than women’s breasts.

Now before you think this article is about another subject, let me explain further. Women not only control the dollars in the economy when it comes to making purchasing decisions in terms of their home environments. But we also control quite a bit of the $$$ that flow when it comes to health care decisions. And if we’ve been taught for years that the way to ‘beat cancer’ is to go regularly for our annual mammograms, especially after a certain age—most of us follow this advice—without questioning.

But the care you have access to within a health care environment sometimes has more to do with political and economic forces, then what’s actually best for your health.

For example, in Dr. Deborah Rhodes in her Technology, Entertainment, Design (TED) Talks, presentation says that it cost the United States approximately 4 billion dollars to convert from traditional film based mammography machines to the new digital devices.

Yet in studies, one of which was funded by taxpayer dollars at a cost of 25 million dollars to you—it was found that digital mammography was really no better at detecting tumors than traditional mammography, and had even worse results in older women.

Digital mammography was however, better for one group of women: Those who were under 50 years of age, and premenopausal, and those who had dense breasts. But the stats, even for digital mammography to identify cancers in women with dense breasts are still fairly dismal. Digital mammography may still only detect about 60% of the tumors in these women with dense breasts.

“What it ultimately boils down to is that mammography can’t reliably find tumors in dense tissue, so if you have dense tissue you need something else, “ says Dr. Deborah Rhodes.

So let’s take a moment to share a few more details about a doctor who wants you to know the truth, and understand more about the benefits, risks, and limitations of the annual mammogram.

Dr. Deborah J. Rhodes, M.D. Is an Internist and Expert in Managing Breast Cancer Risk. Director of the Mayo Clinic’s Executive Health Program, Rhodes is collaborating with Michael O’Connor a nuclear physicist along with other Mayo Clinic Radiologists to study a new gamma camera for breast imaging. Rhodes’ presentation at the TED Women’s 2010 conference was one which was both eye opening and frightening.

Why? Because Rhodes’ discussed a new tool that can find more than 3x more breast cancers. Trouble is most of us haven’t heard about it and may not have access to it even though this new technology may detect cancers years before they show up on traditional mammograms. You can watch Dr. Rhodes’ presentation in it’s entirety by going to the end of this article and then clicking on the video play button.

One more thing before we move on. How many of you are asked when you visit a health care provider to fill out a medical history form? All kinds of questions are on this form. Name, address, age, weight, height, medical history. Medical history of your relatives: Mother, father, sister, brothers. And you may have also been indoctrinated into the belief that family history was the most important risk factor for breast cancer.

Hold on….you may want to even sit down for this next one. There is another, even greater risk factor than family history that may determine whether or not you or someone you love will be diagnosed with breast cancer.

And that risk factor is…the denseness of your breasts!

But wait, in almost 50 years on this earth I have yet to be asked on a medical history form, about the denseness of my breasts. In fact, after several mammograms, and yes, I have copies of my reports which incidentally do mention breast density, not one doctor ever discussed with me how this “density” should impact my future medical care.

Almost every physician when going over my medical history takes a cursory few seconds to reiterate the fact that I have no family history of cancer. But NO ONE Mentioned this very important factor about the DENSENESS of my breasts !

You also have copies of your previous mammogram reports don’t you? Of course you do because you’ve been following our HospitalSoup.com conversations about how important it is for YOU to keep copies of your own medical records, including previous copies of ALL lab results, scans, reports, MRI’s etc.

But if you’re late to the party—and you don’t yet have your medical records, make today the day that you start getting copies.
Yes, it is important, yes it is necessary, and Yes, it’s like insurance.
The time to get copies of all your medical records is BEFORE you need them.

So although the annual mammogram has been the primary advice for women towards early detection of breast cancer, did you know there are serious limitations with mammography and it has everything to do with the denseness of your breasts?

If you’re like me—your doctor may not have informed you. And today we’re going to change that.

First, let’s review the technology:

Mammogram:

A mammogram is basically an x-ray of a woman’s chest from two angles. It involves a small amount of radiation exposure but the benefits of finding a breast cancer early are thought to outweigh the potential risks. . But this technology has other limitations.

What Your Doctor Doesn’t Tell You:

Breast density is one of the greatest risk factors for breast cancer. According to Dr. Deborah Rhodes, “Breast density is a stronger risk factor than having a mother or sister with breast cancer.”
Did you know that? If you didn’t, you’re not alone. Ninety-five percent of women don’t know that breast density increases their risk of breast cancer.

What Is Breast Density:
Breast density is the measure of breast composition in terms of relative amount of glandular tissue, connective tissue and fat.

Quick Note About Breast Density: It’s easier to detect tumors in the breast if the breast has more fat.
The more fat in the breast—the less dense the breast is and therefore the easier it is to detect tumors on a mammogram.

According to Dr. Rhodes, two thirds of pre-menopausal women in their 40’s have dense breasts, and if you have dense breasts, mammography does not work well.
One third of women have breast tissue that is dense following menopause.
Again, let’s review, in a dense breast, the tumor and the dense breast tissue both are the same color—and differentiating between the two can be difficult or even impossible.

Detecting a tumor while it is still small is vitally important to your health: Why? Because if you can detect a tumor while it is still small, you are more likely to survive.

Tumor size < 1 cm = survival rates which exceed 90%

As Tumor size increases, survival rates drop off dramatically

So in order to save our own lives and the lives of women worldwide, we must have better methods of detecting tumors while they are smaller.
And we must use alternatives other than mammography if we are to properly screen women with dense breasts.

Traditionally, radiologists do not disclose a woman’s breast density during a mammogram. They limit the assessment on the radiology report to ONLY whether masses (tumors) have been detected. If they do discuss density instead of being specific about the amount of density on a mammogram exam, the radiologist may not provide any concrete measure of the density.

Only one state, Connecticut, requires that women are provided with notification of their breast density following a mammogram. That leaves you and I, quite literally, “in the dark” about making decisions that are prudent for our medical care.  

If you have a mammogram and you do not know the denseness of your breasts it’s like buying a house without knowing how much interest you will pay on your mortgage.
Leaving this information out of the report is like telling only half of the story.

When you make medical decisions impacting your health and your risks do you want only half of the story—or would you like the whole truth?

You’d think physicians and medical professionals in the field of radiology would be “on board” with full disclosure of this information to you– wouldn’t you? Negative again. In fact, Dr. Rhodes, described how she was “stunned” when attending a 2010 conference in Chicago with 60,000 breast imaging professionals who were heatedly debating whether or not women should be told about their breast density.

Unimaginable really. That one of the most heated arguments during a professional conference about breast imaging was how Medical Imaging Professionals want to keep this information — your Breast Density Under Wraps! Why would anyone think that keeping information from a patient about their medical care is sound advice? Some of these imaging professionals think that telling women about their breast density will only needlessly worry us about things we can’t do anything about anyway, given that breast density is predominantly determined by genes and race. Sound familiar? What century are we in anyway? So not only our own doctors aren’t telling us about this, but a group of other medical imagine professionals are censuring the information we receive about our own bodies? “Don’t worry your pretty little head about things like this…”

If you are as angry about this as I am then and if you think this needs to change in your state, please leave a comment after the article and share your comments!

Connecticut is the only state with laws mandating a disclosure on a woman’s breast density every time she gets a mammogram. It is important that a woman is made aware of all her risks for breast cancer so she better manage her lifestyle and make appropriate decisions regarding treatments that may aggravate her risks such hormone replacement treatment or HRT: a type of therapy often taken by menopausal women to stave off uncomfortable menopausal symptoms. These have been proven to increase breast density and even prevent involution or the natural decrease of a woman’s breast density which comes with age.

A Better Option

In her talk at Technology, Entertainment, Design (TED) Talks, Dr. Deborah Rhodes discussed the limitations of mammography as well as the successes and how after years of study under the Mayo Clinic with a team of physicists: they have found a better alternative to mammograms for women with dense breasts that is three times more effective with about the same radiation exposure as what one would receive with a traditional digital mammogram. This new technology is called Molecular Breast Imaging or MBI technology.

MBI versus Mammograms

“The problem with breast density is that it’s truly the wolf in sheep’s clothing,” Dr. Rhodes points out. “Both the tumor and dense breast tissue appear white on a mammogram.” Basically, the data she presented shows that mammograms are actually only able to detect early stage tumors about 40% of the time.

This means if you have dense breasts you may have a 60% chance of NOT having your tumor detected on an annual mammogram. Think that’s not important information to have?

MBI uses a gamma camera which forms images from the rays emitted by gamma radio-emitting radioisotopes which will be injected into the patient’s system. The images formed from the scan are more accurate and tumors appear as black dots. In a study done in 2004 funded by the Susan G. Komen Foundation, 1000 women with dense breasts were screened using both mammograms and MBI. The difference was stunning with MBI detecting 83% of tumors while the mammogram results showed only 25%.

Dr. Rhodes asked the audience to explore their options and be more informed about more advanced screening technologies.

“It is time for us to accept both the extraordinary successes of mammography and the limitations,” she said, “We need to individualize screening based on density.”

Rhodes does not profit from the Molecular Breast Imaging technology, nor will she if it becomes widely available.

Tips that women can implement now include:

  1. Know Your Breast Density: Read your Mammography reports, get and keep copies of these reports, and when you go for a mammogram, ask in advance that the Radiologist give you your Breast Density in writing on the report. (I know I won’t personally be using any imaging center who will not agree to provide me with a written opinion on my breast density from now on.)
  2. Remember to always schedule your mammogram during the first two weeks of your cycle if you are premenopausal. Breasts are less dense during this time and also less sensitive.
  3. If you have changes in your breasts that are persistent—even if you have recently had a normal mammogram, be assertive, and insist on follow up or alternative imaging.
  4. If you have dense breasts you may want to ask for an MRI every other year until MBI or better technologies are available. The statistics for finding a tumor using either regular or digital mammography are not good for women with dense breasts. So discuss options with your doctor and be assertive in your conversations with medical professionals.
  5. Pass this information on. If doctors and medical professionals are not going to give you this information, then do your friends, family and neighbors a service and make sure that everyone you know understands the limitations of mammograms for women with dense breasts. This could be the difference between life and death, so help get this message out.
Dr. Deborah Rhodes MD: Powerful Tool on Detecting Breast Cancer

 

More Information on Molecular Breast Imaging at the Mayo Clinic