Doctors study effectiveness of new screening methods for breast cancer - Cancer He@lthLINK

New technologies do not replace need for self-exam and mammography

The field of breast cancer screening is rapidly evolving. Today, women have access to more types of screening than ever before. Digital mammography is being offered in additional to traditional film X-rays and the new computer-aided detection (CAD) gives doctors an extra tool in diagnosing early cancers.

“Digital mammography is changing the way doctors review mammography. ”

While these new tools are helpful to doctors, they don’t replace the traditional screening methods of self-breast exam and mammography.

Computer-aided detection a safety net
CAD is a special computer system that can evaluate mammograms, helping doctors determine whether a mass or cluster of calcifications looks suspicious. While it doesn’t replace a doctor’s diagnosis, this technology provides a second computer evaluation in addition to the doctor’s review.

The CAD system produces a visual report called a mammograph that identifies areas of potential concern. The radiologist then re-reviews the mammogram in light of the findings of the CAD mammograph to develop a final diagnosis.

Digital mammography gives clearer pictures
While the study reported that digital mammography has not shown statistically significant differences in cancer detection, I feel that it does have some benefit. Digital mammography is changing the way doctors review mammography. Digital pictures are processed immediately so doctors don’t have to wait for X-rays to be processed. Digital images are clearer. A doctor will review the digital photo on her computer and has the ability to manipulate the image, enlarging it and zooming in on a particular spot. Doctors can also make the image darker or lighter, getting a better look at something that appears suspicious.

The digital system also makes it easier for doctors to store images, compare them from year to year and share them for a second opinion or further evaluation. Doctors can exchange images with each other immediately via the computer. There’s no need to wait for X-rays to be mailed or couriered to another doctor’s office.

Self-exams still recommended
While all this new technology is helpful, it doesn’t replace the need for self-examination of the breast and mammography. The new modalities provide a safety net that gives doctors confidence that fewer instances of cancer will be missed.

Although the study didn’t find that breast self-exam are effective in reducing breast cancer mortality, I still urge all women to do them monthly. I’m a big supporter of the self-breast exam. Many women don’t like to do a self-exam, but I feel that no one knows her breast like a woman. My advice to all women is to get comfortable with the monthly self-exam. Many instances of breast cancer are caught because a woman felt a lump during a breast exam.

Here are my suggestions. Do it:

In the shower while the breast is soapy, the hand will glide more easily.
On the fifth day of your menstrual period, there’ll be the least amount of hormonal changes in the breast.
If in menopause, any day of the month is fine, but be consistent.

The self-exam is important because the breasts can undergo many hormonal changes during the month as they prepare to do their job during pregnancy. Some women are more prone to lumpy and tender breasts and experience fibrocystic changes. I have seen a lump literally appear or disappear in the course of an hour. I call these “busy breasts.”

If you notice that the lumps and bumps vary from month to month, they’re usually nothing to worry about.

Screening mammograms needed
My second piece of advice to women is to get a screening mammogram. Data shows that mammograms help detect cancers early, which mean more of a chance for cure.

Ultrasound and MRI good for high-risk women
Some women may be recommended to go for an ultrasound or MRI, but it’s really not clear whether these tools are all that helpful in diagnosis. They can be helpful, however, for women in high-risk categories.

Some women may be called back after a screening mammogram for additional tests. While this can be frightening, it doesn’t necessarily mean breast cancer is suspected. Sometimes, doctors want to see additional pictures to further hone in on a lump or calcification that may look suspicious. In most cases, callbacks aren’t cases of breast cancer.

Early detection is still the best chance of cure, so be sure to do your monthly self-breast exam, get a mammogram and see your doctor yearly.

Teresa Ponn, MD, is associate director for breast surgery at the Yale-New Haven Breast Center.

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