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Jay K. Harness, MD: Mammograms are an important tool for screening for breast cancer and in
patients who have symptoms, mammograms are an important tool for making a diagnosis of
an underlying cancer. Now, we are very privileged here at Breast Cancer Answers, to have several
videos from frankly probably the world’s leading breast radiologists and mammographer,
Dr. Laszlo Tabar. So I would not be so presumptive to even begin to speak for Dr. Tabar, who
is I know has addressed this issue. But what I want to do now is sort of give you the surgeon’s
view about how effective mammograms are at detecting breast cancer.
Number one point I want to make is when we look at the lowering incidence of deaths from
breast cancer in the United States, the primary reason in the United States and other western
countries has been the use of screening mammography. It's number one and it is effective. But patients
unfortunately have the feeling that mammograms are 100% sensitive and 100% specific and that
is simply not the case. We have not yet invented a single technology that I would call the
holy grail of breast imaging. So mammograms are really important. Patient should be having
digital mammograms. I think film-screen mammograms are a part of our important history but the
contemporary standard in my view is clearly digital mammograms.
Digital mammograms are outstanding at finding fine little micro calcifications that can
suggest that a cancer is there. Now I have previously talked about micro-calcifications
and pointing out that not all, certainly not all, calcifications or microcalcifications
in the breast are breast cancer. But in fact some can be, and particularly if they are
branching and clustered, and a big fancy medical word called pleomorphic. So mammograms are
going to be very important for seeing micro-calcifications in my view for years to come. Now mammograms
work the best the more fat there is in the breast. The more fatty tissue replacing the
dense glandular tissue, the accuracy of mammograms goes away up. The more dense the breast is
the less sensitive mammograms are. In women who have fatty replaced breast, typically
seen in postmenopausal women, probably the accuracy of mammogram is up in the 90% to
95% range. You get down in women in their 40s, who have very, very dense *** or
then don’t have a lot of fatty tissue in the breast, probably then the accuracy of
mammograms could fall down potentially into the high 60% range or low 70% range. Cancers
on mammograms are white, the dense breast tissue is white and if you have white on white
you may not be able to see the breast cancer at all. Therefore ultrasound is an important
other tool and under development for the past few years has been ultrasound technologies
to scan the whole breast, analyze that, and to see potential areas, all of the cancer
that cannot be seen on a mammogram because the cancer can be white on white. These technologies
are not yet ready for prime time nor they are proved yet for screening, but certainly
if there is palpable lump in the breast and mammogram does not show anything, ultrasound
is mandatory at that point. Another technology being worked out in women who have very dense
breast is going to be using nuclear medicine isotopes, molecular imaging of all of the
breast. That is in trials going around right now. I am very optimistic about this technology,
but again it is not ready for prime time. Hopefully in the next year or so, it will
be. We need to lower the radioactive dose of the isotope down to a much lower level
before I think there will be widespread use. So what is the summary or the bottom line
of this particular video? Mammograms are really important in detecting breast cancer.
Mammograms are the not the be all and end all. The more fatty the breast is, the more
accurate they are. Conversely the more dense the breast is, the less accurate they are.
It is our number one weapon against breast cancer and just because they heard and I know
they do want to hear patients complaining to me does not mean you should not be getting
your mammograms and as I have said repeatedly here at Breast Cancer Answers, if there is
a palpable lump there, then more is needed than just
the mammograms.