A Mammogram May not be Enough

By Dee Hughes, R.T. (R)(M)

​Many women get a negative mammogram report and think they are home-free. Unfortunately, approximately 15% of breast cancers diagnosed are not visible on the mammogram. Even so, mammography is still the gold standard for breast cancer screening, especially when combined with an annual clinical breast exam (by your healthcare professional) and monthly breast self examination.

When you have no known problems in your breasts, but have them checked annually to be sure no sign of cancer is present, this is called screening. If you have a problem area you or your healthcare provider can feel, then your tests would be considered diagnostic since you are looking for a cause of the problem or symptom.

For women at high-risk for breast cancer, many physicians are recommending additional, potentially more sensitive tests. For those women whose family background, genetics, or other factors signal a high level of concern, a growing number of physicians are suggesting magnetic resonance imaging, or MRI, which is typically the most sensitive form of screening. Unfortunately, this can be a costly exam, and not all insurance companies will pay for MRI as a screening exam. If your physician feels it is medically necessary, you need pre-approval from your insurance provider to insure your exam is covered.

Another commonly performed exam is ultrasound of the breast. Ultrasound is extremely useful when an abnormal area is felt in the breast or seen on a mammogram. It is operator-dependent and increasingly used for screening. Physicians also use ultrasound to guide them during a needle biopsy of breast tissue. It is typically covered by insurance, and is much less costly than MRI. Ultrasound should not replace mammography, but is a very useful tool in addition to mammography.

Women typically have breasts that are either primarily fatty tissue, very dense tissue, or a combination of the two. When women have primarily fatty tissue, the mammogram is generally very effective for screening for breast cancer. When women have very dense tissue, it is much more difficult for the radiologist to determine if there is an abnormal area that could turn out to be cancer.

Digital mammography is fairly new in the Cedar Valley. The mammogram is performed the same way; however the image is now acquired directly onto a computer monitor. This allows the radiologist to view the x-ray image more closely and zero in on suspicious areas. The biggest advantage of digital mammography is for women with very dense breast tissue. The computerized image can see through the dense tissue so much better. Dr. Douglas Duven of the Breast Care Center states, “Reviewing a digital mammogram is like the pictures you see on a high definition TV versus the old black and white TV. The clarity and sharpness of the images is incredible, allowing for a more complete review of the breast tissue.”

The good news is that with better screening and treatment, there has been nearly a 25% decrease in the mortality rate for women with breast cancer since 1994. As screening exams continue to improve, this number will increase. 

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