Mammography - is it worth it?

[creekland]

The American Cancer Society released new screening guidelines today and now recommends that annual mammograms should be done at age 45 rather than 40. More here.

 

Hmm, since I never aged past 39 :coolgleamA: , I should be set for quite a while.

[Liz CA]

No, thermography is not considered as reliable as mammography. Maybe one day it will be but for now, it's more in the "alternative" category of medicine. An MRI is an alternative, but much more expensive. 

 

I wonder if it is not "considered" reliable because so few people are trained in interpreting it?

[ktgrok]

I wonder if it is not "considered" reliable because so few people are trained in interpreting it?

 

I'm wondering how much info it gives about deeper tumors. Everything I've read says it looks for changes in tempterature on the surface of the skin, perhaps it just isn't able to spot deeper tumors. 

 

That said, the new reccomendation is now to start mammos at 45, so I'm waiting until then :)

[MyHandsAreFull]

Breast MRI is more sensitive than mammography (meaning it finds more "stuff", often leading to biopsy--but a lot of that "stuff" ends up with a negative biopsy). It is clearly appropriate for a high risk population (most insurance companies define high risk as 20-25 % lifetime risk of breast cancer). It's probably not a great option for screening average risk folks (because of their lower pre-test probability of having cancer). It also has a role (sometimes) in troubleshooting questionable or discrepant findings on mammography/ultrasound.

 

Washington Post had a great interview with Dr. Kopans at Harvard where he pointed out that annual mammography beginning at age 40 clearly saves lives. Even the USPTF (the folks advocating every two year exams starting at age 50) have conceded that. The fight/debate is: is it worth the COST? (Meaning in terms of money, negative biopsies, anxiety/stress).

 

For me, I want my annual mammogram. But I respect other women's right to choose. If the stress and hassle of the whole process isn't worth it to them, they are welcome to skip it and I will not guilt or harass them. But if the medical societies come out and agree with USPTF then insurance will only pay for "start at 50 and do it every two years." I think that's wrong when there is clear evidence of a survival benefit to folks screening beginning at age 40.

 

I am a big fan of breast tomosynthesis ("3D mammography"), by the way. Some insurance covers, some doesn't. Emerging evidence suggests it truly finds more cancers with fewer callbacks and biopsies. It's not settled science or anything but it really looks promising.

 

My 2 cents...

[umsami]

Here's a good article from NPR talking about the different recommendations: http://www.npr.org/sections/health-shots/2015/10/20/450259578/ok-when-am-i-supposed-to-get-a-mammogram?utm_source=facebook.com&utm_medium=social&utm_campaign=npr&utm_term=nprnews&utm_content=2045

 

Seems like the American College of Radiology and the American College of Obstetricians and Gynecologist agree.

 

American Cancer Society is a little less frequent.

 

 

 

 

I'm a fan of breast tomosynthesis too.  My radiologist uses it.... my Dad's a retired radiologist and recommends it, etc.  But we also breast ultrasound with me because of breast density.  

[Word Nerd]

I'd have saved myself a lot of worry over nothing if I'd waited until 45—though to be fair, I had my first one because my doctor was concerned about a spot she found while doing a screening during a well-woman exam (which I don't go to every year to begin with).

[Greta]

Is there increased radiation exposure with the 3D/tomosynthesis scan?

[MyHandsAreFull]

Is there increased radiation exposure with the 3D/tomosynthesis scan?

At the moment,generally yes, but it is still less than the FDA allowed maximum for a regular four view mammogram. So, if your imaging center uses an old Mammo machine (especially analog) the tomo may actually be the same or less. They are working on/refining the machines and technique and so I think this is going to be less of an issue.

 

For myself, I have dense breasts and I think the evidence is accumulating that folks with dense breasts benefit the most from tomo. Honestly, the breasts that are mostly fat probably don't benefit as much because it's easier to see cancer in them.

 

Basically, most cancers show up on Mammo (and tomo) as white stuff. Dense stuff. Fat shows up as black. Glandular tissue shows up as white stuff. So if you have dense breasts (lots of glandular/fibrous tissue) it is harder to find cancer. Tomo makes it easier, because you can page through, slice by slice, looking for cancer.

[creekland]

But I respect other women's right to choose. If the stress and hassle of the whole process isn't worth it to them, they are welcome to skip it and I will not guilt or harass them. But if the medical societies come out and agree with USPTF then insurance will only pay for "start at 50 and do it every two years." I think that's wrong when there is clear evidence of a survival benefit to folks screening beginning at age 40.

 

I may be on the "other side" WRT wanting to deal with these, but we certainly have common ground here.  I don't think insurance companies should be able to decide when to pay for things.  It bugs me that insurance companies are for profit and seeing the salaries their CEOs make by "saving money for the company" is enough to...  :cursing:  At least now they need to be sure a percentage goes back to payments, but still...

[Greta]

At the moment,generally yes, but it is still less than the FDA allowed maximum for a regular four view mammogram. So, if your imaging center uses an old Mammo machine (especially analog) the tomo may actually be the same or less. They are working on/refining the machines and technique and so I think this is going to be less of an issue.

 

For myself, I have dense breasts and I think the evidence is accumulating that folks with dense breasts benefit the most from tomo. Honestly, the breasts that are mostly fat probably don't benefit as much because it's easier to see cancer in them.

 

Basically, most cancers show up on Mammo (and tomo) as white stuff. Dense stuff. Fat shows up as black. Glandular tissue shows up as white stuff. So if you have dense breasts (lots of glandular/fibrous tissue) it is harder to find cancer. Tomo makes it easier, because you can page through, slice by slice, looking for cancer.

Thank you for explaining this!

[umsami]

Saw this today and thought it was interesting re: false positives and such.

 

"Women who got a false positive were 39 percent more likely to get breast cancer over the next 10 years than women who simply got a negative result on a mammogram, Louise Henderson of the University of North Carolina-Chapel Hill and colleagues found."