Breast Cancer and Mammograms - The Good, The Bad and The Ugly

Let’s Unveil Breast Health and The Mammogram Mission

About Breast Cancer and Mammograms: Early Detection and Beyond

‘Oh, My Goodness… a M-m-mammogram?! C’mon Doc, do I really have to?’

Many of us are reluctant to face the ‘booby trap of fear’, aren’t we? Enough to let you break out in nervous nellie sweats at the mere mention of going for a mammogram. Some immediately start bargaining with their doctor. And I totally get it!

And those scary stories from a ‘caring’ relative before your appointment don’t help either! Which, obb-viously (in Snape’s voice), does nothing but cause unnecessary stress and does more harm than good. That’s dangerous!

Fortunately, some clever ladies decided to ask for more opinions, though. They seek proper advice to make an informed decision, but… (yes, there's a big BUT),

Some of them plain out decide against a screening mammogram.

Until it’s too late!?

Every year, too many receive the unwanted diagnosis too late because of this, who could’ve been cured otherwise.

You see…

Breast cancer detected early enough can be cured in the easiest way with the least drama and trauma. Doesn’t that sound great?

So in this article, we’ll be looking at the whole debacle from the viewpoint of a seasoned mammographer (that’s meee ??) and with a wee bit of humour.?

Shall we?

This is what I’ll cover (just in short - I can write the size of a whole set of encyclopedias from the top of my mind on this topic!):?

• Tips for a more comfortable mammogram.
• Reasons and importance for getting regular mammograms.
• Different breast screening modalities (Sonar vs Mammogram vs MRI).
• Painful breast tissues.
• ‘I have a lump, now what?!’
• Most common breast lumps.
• Addressing common fears.
• General routine breast examinations.
• Male breast lumps.
• Tributes.

Why do I feel the need to write this?

Because I CARE and I hope you’ll care enough after reading this. About yourself, your friends and family members. And that you’ll find my tips and information helpful.

Remember, Google isn’t always your friend and I’ve found that many ladies don’t know where to look for legitimate information on the internet. Again, that can be dangerous.

My 5 Mammo-Hacks for Maximizing Mammogram Comfort

1. Mmm, most importantly…RELAX! Chillax.

Take a breath and count to 10! Easier said than done, I know.

BUT,?

If your chest muscles are relaxed, the examination will be a lot more comfortable. Especially the Pectoralis Major muscles that are running from your armpit across in front right underneath the breast and the compression plate won’t press on the tight muscle.?

Also, the ‘softer’ the chest muscles, the more tissue is shown in the image. If part of the muscle is included, you know that nothing of importance is missed behind. On the contrary, a tight muscle pulls the tissues backwards and a lesion close to the chest wall might be missed!?

1. Bring a fantastic attitude!

Many ladies arrive with a lot of antagonism… against the examination, the mammographer and the whole system, even. Out of fear of the examination, but mostly of the result.?

Believe me, it takes so much time, effort, energy, patience and persuasion to get through the mammogram.

To get them to the point of saying: ‘Is that it? Are we done already? But that didn’t even hurt!’ PHEW (wiping the sweat from my face)!! And Ladies remember, it’s for your own good, not for the pleasure of anyone else.

1. Caffeine’s the devil!!!

And something you would want to avoid a few days before your appointment. Like the plague! Or at least skip your morning coffee on the day. Unless you never struggle with tender breasts or you’re brave enough (a.k.a. addicted).

This isn’t only your normal morning cuppa coffee, though. It includes ordinary tea, green tea, energy drinks and CHOCOLATE! Yeah, I know. You see, caffeine mimics the effect of the hormone estrogen on the glandular tissues of your breasts, which can make them more ouchies.?

1. Timing is everything.

Your breasts are the least tender and swollen 10 to 12 days after your period (or midway between your hormone replacement). This calls for less tenderness and a much clearer (less dense) image.

1. I feel that I might be repeating, sort of, but…

Try not to arrive rushed, overly stressed or sick for your appointment. Which is a recipe for a not-so-pleasant experience for all parties involved.

Why Routine Mammograms Are Your BFFs and Your Breasts' Best Bodyguards

• Quick for cure

As I mentioned earlier, early detection is key. Routine screening mammograms are the answer (at one to two yearly intervals) to find them small. Mammograms are saving so many lives every single day. Remember, early lesions are easily treated and even cured these days.

• There are different types of breast cancers, though.

They all look, react and grow differently. They’re also detected in different grades and stages. Their biology is different. And there’s no one-size-fits-all approach to the treatment either.?

Fortunately, most types of breast cancer grow slowly, can be detected early and small during routine screening tests and are curable. You see them long before you can feel them.

But then there are the more aggressive fast-growing types. Fortunately, they’re scarce, but they can grow into a palpable lump within a few months. Many times these are hereditary and both breasts might be affected (the other side can even be diagnosed at a later stage).?

That’s why many young women with a very strong family history opt for bilateral mastectomies as a precaution (like actress Angeline Jolie did).

Not-so-fun fact: A lump is about 2 cm in size before you can feel it in dense, lumpy type of breast tissue!?

Battle of the Boob Scans: Sonar, Mammogram or MRI?

You might be wondering why you can’t just have a sonar scan instead. And what about an MRI scan? Or why we include a sonar routinely with a mammogram.

Well, even though mammography is still worldwide recognized as the gold standard for detecting breast cancer, it has its limitations. The same with sonar and MRI. They’re all complementary modalities.

In the practice where I’ve worked for 21 years, we always included a routine sonar with the mammogram. Since the arrival of tomosynthesis (3D imaging) on newer machines, it replaced the sonar in those clear and totally ‘see-through’ fatty (no offence) types of breast tissues.

Lemme explain…

• In the cases where the breast tissues are very dense, the sonar is the more sensitive and accurate examination.
• However, it can’t show everything. Certain types of microcalcifications could be the first sign of early cancer. DCIS (Ductal Carcinoma In Situ) is seen by some as a precursor of cancer. The malignant (cancerous) cells are still in the ducts and haven’t yet grown enough to break out and infiltrate the surrounding tissues to form a growth (non-invasive breast cancer). High-grade DCIS is very dangerous, though and is handled as such. These microcalcifications are too small and fine to be seen on sonar (or MRI) but are clearly seen on mammogram images. Benign types of calcifications on the other hand are very commonly seen and only a trained and experienced eye will know the difference.
• Sonar is a great and safe examination for young or pregnant ladies, as there’s no radiation involved. There is still too much glandular activity in the breast going on up to the age of 40 and should preferably not be exposed to too much X-ray radiation.
• Most breast biopsies can be done with sonar guidance with great accuracy. The microcalcifications on the other hand need to be biopsied under stereotactic guidance inside the mammogram machine and specific coordinates.
• An MRI scan (a costly and lengthy examination) can’t be used as a screening tool alone, as it also has limitations. There are specific cases when an additional MRI examination is routinely used in correlation with a mammogram and/or sonar, as indicated.

Painful Breast Tissues: The Great Squeeze Debate

Fibroadenosis is a big word, right? But all it means is swollen, painful, but healthy breast tissues. As normal as can be. Mostly young women with healthy hormone levels are plagued the most, but it can occur at any age (remember the caffeine lecture above before your next appointment).

A gynaecologist gave us the little ‘recipe’ of Evening Primrose oil to be taken in combination with Vitamin B6 and Omega-3 for relief. All in capsule/tablet form. But it isn’t a quick fix, though and might take a while.?

Lumpology 101: What's Up with Those Breast Bumps?

I can’t tell you how many times I’ve heard this: ‘I have a lump, now what?!’. Usually from someone who either never had a mammogram before or is much more than 2 years overdue. Completely freaked out.

But it isn’t necessarily a problem and not all ‘lumps’ are bad news. Unfortunately, contrary to the common belief that friendly lumps ‘move’ and bad lumps are fixed when you feel them, you can never be sure just by feeling.?

And remember, a lesion is either benign or malignant from its origin. A friendly lump can’t turn bad and vice versa.

Most Common Benign Breast Lumps:

• The cyst saga: bubbly bumps and beyond

A breast cyst is a completely harmless water ‘bubble’ within a milk duct or milk gland that forms due to normal hormone cycles and fluctuations. The smaller cysts can form over time and can get bigger every month. They can usually disappear by themselves as well.?

But others can suddenly pop out as a big(ish) very tender ‘golf ball’. They’re usually inflamed and can easily be drained under sonar guidance with a fine needle and syringe… and voila!?

• Fibroadenoma: The friendly intruder unmasked

Commonly known as the movable ‘breast mouse’. This is the most commonly found benign breast lump and usually stops growing at the age of 40. When they ‘die’, they can sometimes calcify, looking like a little popcorn on a mammogram image.?

It doesn’t need to be removed at all unless it grows rapidly and causes too much discomfort. But it should always have a biopsy under sonar guidance to confirm.

• Swollen glandular tissue

Your breast consists of different types of tissues that feel different. These are glandular tissue (milk glands), fatty tissue and fibrous tissue (milk ducts, blood vessels and ligaments). Like each woman’s breasts look different, the tissues on the inside differ too. It can either be very dense, moderately dense or not dense at all.

The breast glands are influenced by hormonal fluctuations and can swell up and get tender at times, while it has no effect on the other types of tissues. The more glands in the breast (dense breasts) in relation to the amount of fatty tissues, the bigger that reaction. And it can swell so hard in some areas that it can feel like a lump!

• The 'axilla lumps' mystery

Sometimes we find islands of breast tissue high up under the arm (called accessory tissue) that can also react to the hormones and swell up, feeling like a lump. Remember, where there’s breast tissue, there can be breast cancer too.

The lymph glands can also swell up into a (sometimes painful) lump in the axilla when there’s an infection or inflammation in the vicinity like a small cut on your hand.

But it can also be a cancerous glad, either a metastasis from breast cancer or Lymphoma and should always be investigated and confirmed a.s.a.p!

• Male breast lumps

Yes, men can get breast cancer even though it’s a scarce finding. They do have a small amount of (dormant) breast glands behind the nipple, And yes, they can get a mammogram as well (but only the side view).?

Fortunately, most breast lumps in men are because of a benign condition called gynecomastia where swelling of one or both breasts occurs due to certain chronic medications. It can be hard and painful but can subside when the doctor adjusts and tweaks the medication.

5 Most Common Fears:

I can assure you with all I am that a mammogram really isn’t harmful. At. All (don’t look at me like that, it’s a promise!).

Please hear me out…

The benefits outweigh any risk factors by far.

You see, mammography facilities (meaning all safety aspects, apparatus, radiation, etc.) are under strict quality assurance by the medical ‘watchdogs’ like the FDA in the US and all other local governments worldwide.?

They’re monitored regularly and will be shut down immediately if they don’t comply with the strict standards.?

Each facility does its own daily, weekly and monthly quality insurance tests and a comprehensive yearly quality assurance regime. And has a bunch of files to present at any surprise visit by the authorities.?

But I see you, I hear you and I feel you. So let me address some of those fears and hopefully debunk a few myths in the process:

1. ? Pain

Where there’s pain, you’re either too tense, you’re in a painful period of fibroadenosis and your breasts were sore before or the position isn’t correct (the latter can be blamed on the mammographer).

After radiation therapy for breast cancer in the instance where the patient had a lumpectomy (only the lump or part of the breast removed), that breast can be swollen and very tender for a long time, even up to 2 or 3 years (but it gets better with time).

2. ? Radiation

With the new generation of digital technology, the (already low) radiation is about 50% less than before. And less than what you receive on a long-haul flight! My logic? Wouldn’t all air hostesses and captains get cancer then (but that’s just me)?

Again, after many comprehensive studies, no harm was found. And after carefully weighing up the pros and cons, mammograms remain the #1 trustworthy modality for detecting early breast cancers.

According to The Handbook of Mammography, screening mammograms can reduce mortality by up to 40%.

3. ? When boob bombs go boom (a.k.a popping a breast prosthesis)

In ‘our’ practice, thousands of ladies with breast implants have received mammograms over the years with safety.?

The key is to tell the mammographer in detail before the examination if you have any concerns (i.e. if you had trauma to your breast, you feel a lump/bubble, if the shape/position of the breast changed in any way OR if they’re older than 25 years or younger than 2 years).?

In any of these cases, it’s best to start out with a sonar scan to determine if there is any rupture of the implant, wall weakening or any free silicone seen.

4. ? Tissue damage with compression

The compression itself should at most be a bit uncomfortable. There is no evidence pointing at any harm done.?

The newer generation mammogram machines have an Opcomp? mechanism where the compression action stops automatically at the point of n optimum amount of compression.

Any compression less than that is useless and you won’t be able to see through the overlying tissues (think of a bag of marbles: If you hold the bag up, it all lies in a bundle where some hide behind the others, but if you put it down flat, they spread out and you can see them all).?

The same with dense breast tissue where small lesions and microcalcifications can hide and have to be spread out ("the better to see, my child.")

Anything more than the optimum amount is unnecessary.

5. ? What about a power outage?

Don’t fret my dear friend, there are 2 different mechanisms to release the compression manually. Phew!

General Breast Examinations

The following breast examinations are of utmost importance. And... with that said, it’s important to also bring any previous mammogram and sonar images, CDs and reports you have for comparison.

That’s the only way to detect slight changes, to monitor the size of a lesion and the amount and shape of microcalcifications.

• Self-examination

This one is important for both men and women. You have to feel your breasts at least once a month (there are many tutorials on the internet on how to do it correctly).?

Do it at least 10 to 15 days after your period (for those who have them), or otherwise, just pick a date and stick to it.

The value lies in you getting to know the normal look, feel and lumpiness of your own breasts and you’ll easily notice a difference.

• Breast sonar/ultrasound

This is a very helpful examination for men, young people and during pregnancy. And an important addition to a mammogram in dense breasts.

• Mammogram magic: inside the breast snapshot

The standard is to have one baseline mammogram no younger than 35 and then routine screening mammograms every 1 to 2 years from 40 onwards. This, however, differs from country to country and is revisited from time to time.

Those with a strong family history should start with annual mammograms, restricted mammograms or sonars (for those too young) 10 years before the age at which the youngest relative was diagnosed.

• Gyno grand tour

Yep, your gynaecologist will examine them clinically as well during your routine visit.?

Now that was a mouthful, wasn’t it?! But before you go…

My 2 Cents for You

I want to give tribute to every single mammogram patient, to every breast cancer survivor, to every brave woman who fought and to those who lost. I’m rooting for you all the way!

Remember, health is wealth and you’re worthy of it. Take care of yourself!?

Prevention is always better than cure, but early detection is also worth gold!?

And… a healthy lifestyle will not only help prevent breast cancer in the first place but many other unwanted health conditions as well.?

?

Conclusion:

So tell me, are you going to use the ostrich technique or are you going to make the best health choice of your life and have your routine checks??

Remember, we’re built for childbirth for crying out loud (just on the inside)! Those few seconds of discomfort can’t begin to compare.?

And talking about children… don’t we owe it to them? Our health choices impact our families directly and more so do our bad choices, which can have devastating consequences.

SO JUST…GET…A…MAMMO, mkay?!

Please, if you have any questions whatsoever, I’m here to help as far as I can. And if you’d like a list of my references for this article, I’ll send them your way.

So ping me an email: [email protected] and let’s connect! I’d love to read your 2 cents down in the comments as well.

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