Myths and barriers to mammography!Why you may think you do not need a mammogram? My grandmother and mother never had breast cancer, so I don’t have to worry about it.
Unfortunately, if you are a woman, and getting older, you are at risk for breast cancer. 70-80% of women who have breast cancer do not have family history of the disease. A woman with family history of breast cancer should talk to her doctor about getting checked more often. All women once they reach the age of 40 should consider a regular mammogram. I don’t need a mammogram unless I feel a lump or have symptoms.
The reality is, screening mammograms are for women with NO lumps or other symptoms. The best time to find cancer is before you can feel it. A mammogram can detect cancer as much as a year or two before you or your physician could feel it. Breast cancer found in its earliest stages offers the greatest chance of remission and survival. My monthly self breast examinations and regular check up with my doctor should be good enough for me!
Mammography can typically spot lesions one-fifth the size of those that can be felt by hand during self-examination or clinical breast examination by a healthcare professional. For example, an experienced examiner can feel a lump the size of a small pea. Mammography can find a lump the size of a grain of rice. Overall, mammography can pick up about 40% of cancers that are too small to detect by touch on clinical examination. If my doctor did not recommend a mammogram, I do not need one
In most studies, they have found that the reason women most frequently give for not having a mammogram would be whether their primary health care doctor suggested it. If your doctor does not suggest mammography and you are in the correct age group and if you have some risk factors, it will be up to you to raise the issue. I am too young for a mammogram
Although in screening programmes, the age of 40 or 50 is always mentioned, any person who has signs or symptoms suggestive of breast cancer needs appropriate evaluation, regardless of age. Even males with suspected breast cancer undergo mammograms. In addition, if breast cancer runs in your family and tends to occur early, you may need a different recommendation for mammography. Always consult your doctor or a radiologist. Why have a mammogram when it is not 100% accurate?
No test in medicine is 100% accurate. However, all results are interpreted with their limitations and limits of accuracy in mind. For example, the ECG (electrocardiogram) done for a patient with chest pain may be normal (rarely so) even if the patient is suffering from a heart attack. An exercise stress test for the heart may only pick up about 70% of those with narrowing (stenosis) of the heart blood vessels of more than half its diameter. The accuracy of mammography depends on the glandular density of the breast, skill of the mammographer who positions the breast, skill of the interpreting radiologist and well-maintained mammography and film processing equipment. Although it is not 100% accurate, it is capable of detecting lesions way before it can be felt, as small as a grain of rice. It can pick up approximately 40% of cancers which cannot be felt on physical examination. Mammography can miss some breast changes, most often in younger premenopausal women with dense breast tissue. The overall "false negative" rate for screening mammography is about 10% - in other words, 1 in 10 lesions may not show up on a mammogram. However, in fat replaced breasts, the accuracy exceeds 90% and can go as high as 95%. Mammography also has "false positive" findings. These may lead to biopsies that turn out to be negative or benign, and therefore, in hindsight, unnecessary. However, these biopsy procedures prove that a suspicious lesion is not cancerous. However, the limitations of mammography is known and in most centres, dense mammograms are followed by high-resolution ultrasound of the breast and any abnormality in the mammogram may also be additionally evaluated with further views and/or with high-resolution ultrasound, giving a better picture of what is the abnormality. This is particularly so, if the patient has been referred for a mammogram because of detected lumps or other changes in the breast – in the case of the diagnostic mammogram. With correlation of mammogram, ultrasound and the physical/doctor’s findings, accuracy is improved. Dr. Daniel Kopans, head of breast imaging at Massachusetts General Hospital agrees that there will be biopsies done for abnormalities that do not turn out to be cancer. However, radiologists are cautious because they do not want to miss cancer. Today, most biopsies can be done in the office setting using special needles to sample the lesion under imaging guidance. Surgical biopsy is not the only option available unlike previously and the trend is now to move to less invasive needle biopsies. Please see section on “What happens if I have an abnormal mammogram?” Despite its drawbacks, mammography remains the gold standard for detecting breast cancer and no other imaging modality measures up to it currently. In the meantime, because we know it is not perfect, research and development of new more precise techniques are being done. Ultrasound can replace the mammogram as a screening tool for breast cancer
The detection rate for cancer was quoted as 50% some years back with only a 10% cancer detection rate for lesions less than 1cm in size. Cancer detected rate in mammography is from 80-90%. Ultrasound is acknowledged to be useful in dense breasts and therefore patients with dense mammograms. Ultrasound today probably has a higher detection rate with the advent of newer, high resolution and new advanced technology ultrasound machines. Even so, the expert radiologists in breast ultrasound states it is premature to claim ultrasound can effectively replace mammography. More studies need to be done and methods to reduce the number of factors that influence the quality of ultrasound need to be addressed, especially that of dependence on the operator (person performing the ultrasound). Ultrasound depends on Operator skill and experience High quality ultrasound machine Patient factors: Breast architecture, breast size, location and characteristic of lesions, mobility of lesion, mobility of breast.
(In mammography, the breast is immobilised)
Ultrasound is best for focussed problem solving where a directed search is made. Therefore, it’s proven role is as an adjunct to the mammogram, in young patients or those with dense breasts and in certain rare circumstances where mammography is not possible. | 
