Healing Strategies:
What to Subtract
What to Subtract
Healing Strategies:
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What to Add
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FAQ Diagnostic Imaging Techniques
How should I be screened for breast cancer?
In addition to physician exams and breast self-examination, there are primarily three
breast imaging techniques: mammograms (X-rays), ultrasounds, and MRIs (with
contrast dye). A newer technique, thermography, is still being studied.
In his chapter, "The Danger and Unreliability of Mammography: Breast Examination
is a Safe, Effective, and Practical Alternative," (The International Journal of Health
Services,Volume 31, Number 3 [2001] ), Dr. Epstein states, "Mammography
screening is a profit-driven technology posing risks compounded by unreliability. In
striking contrast, annual clinical breast examination (CBE) by a trained health
professional, together with monthly breast self-examination (BSE), is safe, at least as
effective, and low in cost." He goes on to say, "Mammography is not a technique for
early diagnosis. In fact, a breast cancer has usually been present for about eight
years before it can finally be detected. Furthermore, screening should be recognized
as damage control, rather than misleadingly as secondary protection."
(See Epstein, S., International Journal of Health Services 2001, in the MEDICAL
ARTICLES' IMAGING section, or go to: Dr. Epstein on Mammography.
Is there much radiation in mammograms?
UPDATE: In a March 2006 study, low energy X-rays used in mammograms were
found to cause approximately four times, but possibly as much as six times, more
mutation damage than higher energy X-rays. Since radiation risk estimates are
based on the effects of high energy radiation, this implies that the risks of radiation-
induced breast cancers for mammograms are underestimated by the same factor.
(See Heyes GH et al., Enhanced Biological Effectiveness of Low Energy X-rays and
Implications for the UK Breast Screening Programme, Br J Radio 2006.)
How reliable are mammograms in detecting breast cancer?
Although new mammography technology has increased the accuracy of detecting
breast cancer, it still remains more of a challenge to mammographically detect
breast cancer in women with non-fatty, dense breasts (common in women under
50). Has the advent of computer-aided mammograms helped to detect breast
cancer in women with dense breasts? A June 2006 retrospective study of malignant
tumors found better detection using computer-aided mammograms dependent
upon breast density types. For example, with lesser breast density, type 1, there was
an 84.85% accuracy rate in detecting malignancy, while for dense type 4 breast
tissue, there was a 69.70% accuracy rate. (See Obenauer S et al., Impact of Breast
Density on Computer-Aided Detection in Full-Field Digital Mammography, J Digit
Imaging 2006.).
If I have a lump in my breast and it turns out to be cancer, can the mammogram
spread it by compression ?
Dr. Robert Rosser, in his article, "Point of View: Trauma is The Cause Of Occult
Micrometastatic Breast Cancer in Sentinel Axillary Lymph Nodes," published in the
medical journal, The Breast (2000), cautions against compressing, squeezing, or
otherwise disrupting tumors that may result in trauma-induced micrometastases. He
calls these dislodged cancer cells "traumets."
Especially if a lump is known to be present at the time of the mammogram,
Dr. Rosser advises that the compression of the breast should be minimal to prevent
compression-induced traumets. While the risk of traumets may be small, if a patient
hasn't yet had a diagnostic mammogram, other non-compressing imaging
procedures may be considered.
Dr. Rosser suggests that the time between the mammogram and the surgical
excision of the traumet may determine whether an insignficant traumet will divide,
grow and progress to a real metastasis that may spread from the lymph nodes and
elsewhere if not removed.
(See Rosser, RJ, The Breast, The Breast 2000, in the MEDICAL ARTICLES'
IMAGING section.)
Other Imaging Procedures to investigate: Ultasound and MRI
How does an ultrasound compare to a mammogram and an MRI ?
Ultrasound (also called a sonogram), which does not use compression,
radiation, or dye, is generally useful for screening women with dense breasts. The
MRI, which uses a contrast dye, is similarly useful in women with dense breasts.
In a study assessing the accuracy of mammography, clinical examination,
ultrasonography, and magnetic resonance (MRI) imaging in the preoperative
assessment of the local extent of the breast cancer, ultrasound showed higher
sensitivity than mammograms for invasive ductal carcinoma in nonfatty breasts. (See
Berg WA et al., Diagnostic Accuracy of Mammography, Clinical Examination, US, and
MR Imaging in Preoperative Assessment of Breast Cancer, Radiology 2004.)
What is a Breast MRI?
Please go to this link for a full explanation.
What is a Breast MRI?
What if I feel a lump?
Update: In a May-June 2006 study, ultrasounds were found to be more accurate in
measuring palpable tumors (tumors that can be felt) than clinical exams or
mammograms. As determined by pathological exam, the maximal tumor diameter
was within 2mm of the pathologic tumor size in 45.2% of ultrasounds, 28.2% of
mammograms, and 14.5% of clinical measurements. (See Shoma A et al.,
Ultrasounds for Accurate Measurements of Invasive Breast Cancer Tumor Size,
Breast J 2006.)
In addition, in another 2006 study, axillary ultrasonography was found to be helpful in
differentiating metastatic lymph nodes from normal lymph nodes. (See Wang YB et
al., Evaluation of the Ultrasonographic Features of Axillary Lymph Node Metastasis in
Breast Cancer, Clinical Oncology Institute, 2006.)
In the case of a palpable tumor, a mammogram is given in tandem with an
ultrasound, and many doctors and breast centers in the US resist doing an
ultrasound (no compression and no radiation) alone. Often, only persistence on the
patient's part will allow the patient to undergo an ultrasound alone.
A recent German study, cited below, suggests that ultrasound may be the
"preferred imaging procedure" for a palpable tumor ( a tumor which can be felt.)
During an ultrasound, the breast isn't compressed or exposed to radiation. Usually,
a mammogram is given in tandem with an ultrasound, and many doctors and breast
centers in the US resist doing an ultrasound alone. Often, only persistence on the
patient's part will allow the patient to undergo an ultrasound alone.
(See more literature on mammograms, ultrasound and MRI in the MEDICAL
ARTICLES' IMAGING section.)
Please consult your licensed health care practitioner before implementing any health strategy.
The information provided on this site is designed to support, not replace, the relationship that
exists between a patient/site visitor and his/her existing physician. This site accepts no
advertising. The contents of this site are copyrighted 2006 by Breast Cancer Choices, Inc.
Contact us for reprint permission. Website updated January 7, 2008.
How should I be screened for breast cancer?
In addition to physician exams and breast self-examination, there are primarily three
breast imaging techniques: mammograms (X-rays), ultrasounds, and MRIs (with
contrast dye). A newer technique, thermography, is still being studied.
In his chapter, "The Danger and Unreliability of Mammography: Breast Examination
is a Safe, Effective, and Practical Alternative," (The International Journal of Health
Services,Volume 31, Number 3 [2001] ), Dr. Epstein states, "Mammography
screening is a profit-driven technology posing risks compounded by unreliability. In
striking contrast, annual clinical breast examination (CBE) by a trained health
professional, together with monthly breast self-examination (BSE), is safe, at least as
effective, and low in cost." He goes on to say, "Mammography is not a technique for
early diagnosis. In fact, a breast cancer has usually been present for about eight
years before it can finally be detected. Furthermore, screening should be recognized
as damage control, rather than misleadingly as secondary protection."
(See Epstein, S., International Journal of Health Services 2001, in the MEDICAL
ARTICLES' IMAGING section, or go to: Dr. Epstein on Mammography.
- Please consider the data in this section of the FAQ comparing
mammograms, ultrasounds, MRIs and thermograms before rushing into
any single diagnostic procedure. PRINT OUT THE ARTICLES FOR YOUR
PATIENT PORTFOLIO.
Is there much radiation in mammograms?
UPDATE: In a March 2006 study, low energy X-rays used in mammograms were
found to cause approximately four times, but possibly as much as six times, more
mutation damage than higher energy X-rays. Since radiation risk estimates are
based on the effects of high energy radiation, this implies that the risks of radiation-
induced breast cancers for mammograms are underestimated by the same factor.
(See Heyes GH et al., Enhanced Biological Effectiveness of Low Energy X-rays and
Implications for the UK Breast Screening Programme, Br J Radio 2006.)
- Mammography Consideration: For Women Between 40 and 49
A 2006 study suggests that surgical removal of breast tumors in young
women may instigate angiogenesis (new vessel growth), by possibly
removing inhibitors of angiogenesis or promoting growth factors in response
to wounding, in dormant distant disease in approximately 20% of cases of
premenopausal node-positive women who have not had chemotherapy.
Women need to be advised of the risk of accelerated tumor growth and early
relapse before giving informed consent to mammography. (See Retsky M et
al., Does Surgery Induce Angiogenesis in Breast Cancer? Indirect Evidence
from Relapse Pattern and Mammography Paradox, Int J Surg 2005. Plus,
see correspondence in New England Journal of Medicine, February 16, 2006.)
How reliable are mammograms in detecting breast cancer?
Although new mammography technology has increased the accuracy of detecting
breast cancer, it still remains more of a challenge to mammographically detect
breast cancer in women with non-fatty, dense breasts (common in women under
50). Has the advent of computer-aided mammograms helped to detect breast
cancer in women with dense breasts? A June 2006 retrospective study of malignant
tumors found better detection using computer-aided mammograms dependent
upon breast density types. For example, with lesser breast density, type 1, there was
an 84.85% accuracy rate in detecting malignancy, while for dense type 4 breast
tissue, there was a 69.70% accuracy rate. (See Obenauer S et al., Impact of Breast
Density on Computer-Aided Detection in Full-Field Digital Mammography, J Digit
Imaging 2006.).
If I have a lump in my breast and it turns out to be cancer, can the mammogram
spread it by compression ?
Dr. Robert Rosser, in his article, "Point of View: Trauma is The Cause Of Occult
Micrometastatic Breast Cancer in Sentinel Axillary Lymph Nodes," published in the
medical journal, The Breast (2000), cautions against compressing, squeezing, or
otherwise disrupting tumors that may result in trauma-induced micrometastases. He
calls these dislodged cancer cells "traumets."
Especially if a lump is known to be present at the time of the mammogram,
Dr. Rosser advises that the compression of the breast should be minimal to prevent
compression-induced traumets. While the risk of traumets may be small, if a patient
hasn't yet had a diagnostic mammogram, other non-compressing imaging
procedures may be considered.
Dr. Rosser suggests that the time between the mammogram and the surgical
excision of the traumet may determine whether an insignficant traumet will divide,
grow and progress to a real metastasis that may spread from the lymph nodes and
elsewhere if not removed.
(See Rosser, RJ, The Breast, The Breast 2000, in the MEDICAL ARTICLES'
IMAGING section.)
PREVENTING ANY POSSIBLE TRAUMETS FROM BECOMING REAL METS
Take home questions to ask yourself:
1. If other reliable imaging procedures are available, should do you want to
risk having a mammogram if the compression during the mammogram is
more than minimal?
2. If you've already had a mammogram, can you shorten the time
between the mammogram and surgery date to minimize the chance of
traumets before they can become real "mets" (metastases)?
Other Imaging Procedures to investigate: Ultasound and MRI
How does an ultrasound compare to a mammogram and an MRI ?
Ultrasound (also called a sonogram), which does not use compression,
radiation, or dye, is generally useful for screening women with dense breasts. The
MRI, which uses a contrast dye, is similarly useful in women with dense breasts.
In a study assessing the accuracy of mammography, clinical examination,
ultrasonography, and magnetic resonance (MRI) imaging in the preoperative
assessment of the local extent of the breast cancer, ultrasound showed higher
sensitivity than mammograms for invasive ductal carcinoma in nonfatty breasts. (See
Berg WA et al., Diagnostic Accuracy of Mammography, Clinical Examination, US, and
MR Imaging in Preoperative Assessment of Breast Cancer, Radiology 2004.)
What is a Breast MRI?
Please go to this link for a full explanation.
What is a Breast MRI?
What if I feel a lump?
Update: In a May-June 2006 study, ultrasounds were found to be more accurate in
measuring palpable tumors (tumors that can be felt) than clinical exams or
mammograms. As determined by pathological exam, the maximal tumor diameter
was within 2mm of the pathologic tumor size in 45.2% of ultrasounds, 28.2% of
mammograms, and 14.5% of clinical measurements. (See Shoma A et al.,
Ultrasounds for Accurate Measurements of Invasive Breast Cancer Tumor Size,
Breast J 2006.)
In addition, in another 2006 study, axillary ultrasonography was found to be helpful in
differentiating metastatic lymph nodes from normal lymph nodes. (See Wang YB et
al., Evaluation of the Ultrasonographic Features of Axillary Lymph Node Metastasis in
Breast Cancer, Clinical Oncology Institute, 2006.)
In the case of a palpable tumor, a mammogram is given in tandem with an
ultrasound, and many doctors and breast centers in the US resist doing an
ultrasound (no compression and no radiation) alone. Often, only persistence on the
patient's part will allow the patient to undergo an ultrasound alone.
A recent German study, cited below, suggests that ultrasound may be the
"preferred imaging procedure" for a palpable tumor ( a tumor which can be felt.)
During an ultrasound, the breast isn't compressed or exposed to radiation. Usually,
a mammogram is given in tandem with an ultrasound, and many doctors and breast
centers in the US resist doing an ultrasound alone. Often, only persistence on the
patient's part will allow the patient to undergo an ultrasound alone.
- Ultraschall Med. 2004 Dec;25(6):411-7.
Re-evaluating the role of breast ultrasound in current diagnostics of
malignant breast lesions
Hille H, Vetter M, Hackeloer BJ. Praxis fur Gynakologie und Geburtshilfe,
Hamburg.
CONCLUSIONS: Breast ultrasound should be the preferred imaging
procedure in the case of a palpable lump, leading to a definitive
diagnosis itself or with an additional consecutive core needle biopsy.
For women without symptoms, breast sonography should be mandatory
and complementary to mammography in the case of breast density
grade II (BI-RADS) or more.
(See more literature on mammograms, ultrasound and MRI in the MEDICAL
ARTICLES' IMAGING section.)
When weighing the safety of all three mainstream procedures
(mammography, MRI
and ultrasound), we must consider the radiation toxicity of the
mammogram and the chemical toxicity of the contrast dye in the MRI
procedure. Of the three mainstream procedures, only ultrasound is non-
toxic. Thermograms are being used more widely
but are still being evaluated for reliability. Each patient needs to study each
method before making an informed decision.
Please consult your licensed health care practitioner before implementing any health strategy.
The information provided on this site is designed to support, not replace, the relationship that
exists between a patient/site visitor and his/her existing physician. This site accepts no
advertising. The contents of this site are copyrighted 2006 by Breast Cancer Choices, Inc.
Contact us for reprint permission. Website updated January 7, 2008.
| Breastcancerchoices.org Innovative Research and Patient Advocacy |