Talk to your doctor about breast health

Resolutions for 2010: eat better, get in shape, finish that novel, get an annual physical exam and talk to your doctor about breast health.  Breast health is an important topic for both men and women, especially with any family history of breast cancer.  The new US Preventive Service Task Force guidelines are controversial and recommend that mammograms not be used in routine screening until age 50.  The task force recommends that women in their 40’s utilize mammography as a screening tool only when recommended by their physicians.  Both the American Cancer Society and the American College of Radiology Breast Imaging Commission have released statements expressing disagreement with this new recommendation, because breast cancer is detected in 15% of women in their 40’s with screening mammography.  At present, insurance companies have not yet made changes in coverage for routine screening and physicians are unlikely to change their recommendations.  

If routine screening mammograms are detecting breast cancer early, why would the task force recommend that they be used a decade later?  The task force cites psychological harm (often anxiety associated with the workup of normal lumps), unnecessary imaging, false positives, over-diagnosis, over-treatment and radiation exposure as the “risks” that outweigh the benefits of routine screening mammography.

There are other imaging methods that are less widely known, including ultrasound, transillumination and infrared thermography.  Thermography is an especially promising technique as it results in zero radiation exposure and can be used by women of all ages, unlike mammography.  Ultrasound and thermography are the methods of choice for younger women as their breast tissue is usually too dense to reveal changes on mammography.  Thermography is a technique that measures slight temperature variations in breast tissue to detect the formation of new blood vessels, necessary for the growth of breast cancer.  Because thermography detects changes in vasculature, much smaller tumors can be detected than with mammography which detects tumors pea sized and larger.

Another technique under criticism is the self breast exam (SBE).  SBE, like screening mammography, is criticized for causing increased anxiety and unnecessary biopsies.  Because of this, many organizations and clinicians are recommending a more casual approach called “breast awareness,” which is more to the original point of the SBE.  The goal is to become familiar with the normal lumps and bumps, appearance, texture and monthly changes of your breast tissue for early detection of changes.  Most breasts have some lumps and bumps normally, but if it’s something new, painful or abnormal feeling, that may be cause for concern.  One technique to include in your breast awareness practice is breast massage.  Massaging towards your armpits stimulates lymphatic drainage and is a good technique for becoming familiar with the way your breasts normally feel.

With the controversial opinions about the latest Task Force guidelines and doctors on NPR calling self breast exams “useless,” it can be confusing to know the right action to take for your breast health.  Your personal physician and your own educated awareness should be your guides to if and when to use mammography.  Whatever resolutions you make for 2010 and however you decide to maintain your breast health, I wish you a healthy and happy new year.

This article was originally published in Tualatin Life in June 2011. The original text is presented here without editing or updates.