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Bill Klaproth (Host):  Mammography is the gold standard for breast cancer screening. The special x-ray for breasts can detect the lump long before you would be able to feel it and if it’s cancer, finding it early, is the key to becoming a survivor. Joining us to talk about the ins and outs of mammogram guidelines is Dr. John Beauvais with Columbus Community Hospital’s North Central Radiology. Dr. Beauvais, could you please start by explaining mammography for someone who may not be aware of what it is?

John Beauvais, MD (Guest):  Well mammography is an x-ray examination for screening for breast cancer. And it’s done in a special room in the x-ray department and the breast is imaged in two planes, a top to bottom and then a side to side plane while the breast is held in compression between two plastic paddles. We use the compression paddles to evenly distribute the breast tissue to make it so there’s not as much radiation exposure to the patient and to ensure that the patient holds still during the examination. And the compression is let up between each exposure to make it more comfortable for the patient.

So, a total of four images will be obtained then also generally a tomographic or 3-D image sequence will be obtained where the x-ray tube actually rotates. The breast is positioned the same, but the compression is held for slightly longer and the tube rotates to do the exposure for the mammogram.

Host:  And those critical views ultimately help you with detection.

Dr. Beauvais:  Yes. In the 3-D or what’s called tomography is a new examination that’s only been going on for about three years, but it has been found to be even more sensitive than the standard two dimensional images especially with women that have denser breast tissue. And it has become part of the standard of care at most hospitals now. We’ve been doing it for three years in Columbus.

Host:  Okay. Got it so, Dr. Beauvais, there are several organizations that release recommendations for mammograms. Which guidelines do you align with?

Dr. Beauvais:  Well we follow the guidelines of the Society of Breast Imaging and the American College of Radiology. They are basically the same guidelines. The alternative guidelines are from the US Preventative Services Task Force and then kind of an intermediate between the two is the American Cancer Society. So, we believe that mammograms should start at the age of 40 and continue yearly after that. That’s for a standard risk woman. Mammograms should be obtained until the woman is five to seven years from death based on a discussion between her and her doctor. The US Preventative Services Task Force guidelines suggest beginning at age 50 and going every two years to age 74 with inconclusive evidence in their mind for mammography after the age of 75. And they feel that imaging should begin at 50 and not at 40 like the American College of Radiology. But there are some problems with that.

The research has shown that the greatest amount of lives saved is for women diagnosed in their 40s. One in eight women will get breast cancer in their lifetime. It increases with age. One in 69 women will get breast cancer in their 40s, one in 42 women will get it in their 50s but the most years of lives saved occurs in women who are diagnosed in their 40s. The earlier that you diagnose breast cancer, the earlier treatment can begin and the better outcome that occurs. In total, one out of six breast cancers occurs in women in their 40s and that’s why the American College of Radiology and the Society of Breast Imaging set 40 as their age for starting mammography.

Host:  That’s how those recommendations and guidelines are determined then from all the stats and figures you were just saying.

Dr. Beauvais:  Yes, the research has shown that limiting mammography to women starting in their 40s or just screening high risk women in their 40s is going to miss a significant number of breast cancers. And that’s why we believe the ACR and the Society of Breast Imaging guidelines are the best guidelines to use.

Host:  Right. Got you. Okay so, just to go over that again. So, in general, women should start getting regular mammograms at the age of 40. And then how often, once they start at age 40, how often should they have a mammogram?

Dr. Beauvais:  They should have a mammogram every year. And the second and subsequent mammograms are even more important or as important as the first because what we look for oftentimes is a change from the previous study. It always distresses me when I see a woman comes in with a breast lump and she hasn’t had a mammogram for four years and this is something that we would have caught earlier and had better options for treatment and better success outcomes if they had been coming on a yearly basis.

Host:  And then how long should a woman continue to get annual mammograms?

Dr. Beauvais:  Under the recommendations from the Society of Breast Imaging and the American College of Radiology; mammography continues until a decision is made between the woman and her doctor that she has less than five to seven years to live based on her other health conditions. Based on that, some 90 year olds are still in great health and should be getting mammograms. But that’s the key to when they stop is it’s not based on a number like a cutoff number like the US Preventative Services Task Force say. It’s based on what’s your overall health like.

Host:  And then on the opposite end, thinking of people who would start to get mammograms earlier; what about women who may have a history of breast cancer in their family? When should they start to get mammograms?

Dr. Beauvais:  Very good question. What we consider a significant family history is a first degree relative, that’s mother, daughter, or sister who has a diagnosis of breast cancer before menopause. And if you have one of those risk factors, then you should begin mammography ten years before that person in your family developed breast cancer. So, say your mother developed breast cancer at the age of 42. Instead of beginning screening at age 40; you begin screening at age 32, that’s ten years before your mother got it. There are other certain situations that now with genetic testing and stuff you might hear about the BRCA 1 and 2 genes or people that have an estimated cancer risk of greater than 20% in their lifetime. Those women should start annual mammography at the age of 30. There are some rare cases particularly in kids that have had Hodgkin’s Disease or lymphoma who’ve had irradiation to their chest that the recommendations are that they start eight years after the radiation stopped but not before the age of 25.

So, in general, you start at age 40 but if you have a significant family history, you begin ten years before that person in your family got it or at age 40 whichever is earlier.

Host:  So, we know that mammograms are the gold standard for breast cancer screening. Do you believe there is still value in breast self-exams which some are calling ineffective?

Dr. Beauvais:  I think anything that can be done is helpful. So breast self-exam, physician exam, and yearly mammography are all part of the equation when it comes to screening for breast cancer. The studies will show that up to five to ten percent of cancers will show up on exam, physical exam before they show up on mammography. So, it’s all part of the whole package in screening for breast cancer and it also makes women also aware that I should be paying attention to my breast health and doing the exam and getting my mammograms. So, I do believe that there is value in both physician exam and self-exam.

Host:  Right, so speaking of women paying attention to their breast health; are there additional steps a woman can take to manage her breast health?

Dr. Beauvais:  Now I think the major things that have shown to be of proven value is the screening mammography on the yearly basis, being in touch with your self-exam and regular check ups with your doctor.

Host:  Got you. And then is there any harm from getting a mammogram at all? I know there’s radiation involved any thoughts on that?

Dr. Beauvais:  It is a form of radiation but the amount of radiation is very small it’s about or equal to backround radiation we monitor the amount of radiation that occurs during the examination and there are limits set by the mammography quality standards act. Which we adhere to and you know give us limits on the amount of radiation that we use but the risk of radiation induced harm is much less than the risk of getting cancer. The main thing that you hear talked about is the anxiety that’s produced by a false positive result. Not everything that we see or everything that we biopsy turns out to be cancer. So, there will be some false positives. And what we try to do here at Columbus Community Hospital is expedite the process, so women don’t have to wait long for their results. The get the results of their mammogram usually the day of the examination and if we need to do extra images or do a biopsy; we usually do them the day of the examination or at the very least, the next day or two. And that way you can get the results back from the pathologist within three or four days of your mammogram.

At larger hospitals and at breast centers, a lot of times, they don’t schedule their biopsies for several weeks down the road and so understandably the women have anxiety as they have to wait for that result.

Host:  Yeah that speeding getting test results is very important. So, as we wrap up Dr. Beauvais, it sounds like what you are saying is for a woman with normal risk profile, make sure you start getting your mammograms at age 40 and then make sure you do it yearly. Is that right?

Dr. Beauvais:  Now that’s exactly true. If you are to the screening and the earlier you get diagnosed, the better your treatment options and the better the success of the treatment. Mammography is the only modality that is shown at this time proven to save lives. So, that’s what we do and that’s the screening guidelines we utilize.

Host:  Dr. Beauvais, thanks so much for your time. We really appreciate it.

Dr. Beauvais:  Thank you.

Host:  That’s Dr. John Beauvais. And for more information on the Breast Care Services offered at Columbus Community Hospital or to learn how to schedule a mammogram please visit, www.columbushosp.org and if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Columbus Community Hospital Healthcasts from Columbus Community Hospital. I’m Bill Klaproth. Thanks for listening.