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We're closing out Breast Cancer Awareness Month with a final word from Dr. Olga Mengin, a board-certified radiologist and the medical director of breast imaging for UCHealth Memorial in Colorado Springs. Dr. Mengin is also fellowship trained in breast imaging.
For anyone who knows they need a mammogram but is hesitant to get one, Dr. Mengin says it’s important to know you're not alone if you feel stress or fear.
“Stress about a mammogram is extremely common, and we just have to look at it as the big picture. Is it stressful to go into a medical clinic? Yes, we all know that; none of us like to go in for that (a mammogram) because we don't know what we might learn.”
Knowing you have breast cancer is half the battle, but for some, it's the fear of learning that, and that’s what might keep them away, says Dr. Mengin.
“There's also the stress of, ‘what then? I got through my mammogram. What happens next? What if I get called back?’ We try to tell everyone 1 in 10 women are going to be called back because not all breasts look the same. Everyone has a unique pattern, and sometimes we can't see something as well as we would like. So 1 out of 10 women is going to get called back from their mammogram. The majority of those women, once we get extra images and possibly an ultrasound, they're done, they’re OK. Just a small percentage of those women (who get called back) are then going to need a biopsy, but even the biopsies are mostly benign. So only a small percentage of women who need a biopsy will actually be diagnosed with breast cancer.”
Dr. Mengin says there is also the fear that the mammogram will be a painful experience. “If you’re worried that it might hurt, I recommend just trying to relax as much as you can. We have wonderful techs here (at UCHealth) who will guide you through it. They are as gentle as they can be, but they also want to get great images.”
For others, there may be a fear of radiation exposure, but Dr. Mengin says the dose is extremely low.
“People in general are scared of the concept of radiation. Radiologists actually have to take a lot of physics classes and take exams on physics and specifically on radiation. We always look at imaging that uses ionizing radiation, and how that might affect people long term. Mammograms and X-rays are some of the lowest radiation studies we do. In fact, it's so little it's a lot less than the normal background radiation that you get over the course of a year living anywhere. In Colorado, we actually get more background radiation because we are at a high altitude. There's also radon exposure, so a mammogram is essentially a drop in the bucket. I like to tell patients it's all about risks and benefits. You have radiation exposure throughout your life and you get very little radiation from a mammogram, but the benefit of a mammogram is enormous. So you get immense benefits from screening and early detection of cancer diagnosed, and you take a teeny tiny risk. In fact, these tiny amounts of radiation are felt to be negligible in terms of how it affects us.”
The most important part of raising awareness about breast cancer and getting women to have their annual mammograms all boils down to saving lives, and it’s a topic that Dr. Mengin is passionate about.
“Cancer and the whole point of diagnosing breast cancer is to catch it early because early (detection) means treatable. I like to tell patients in the grand scheme of life, it's like going over a speed bump. Yes, it's not fun to go over a speed bump; You have to slow down - you don't want to jolt everyone, but in the long run, when you look back at that speed bump, that's what it was, just a speed bump. We want women to go on with their life, live a long and healthy life, enjoy their children, their grandchildren, their great-grandchildren, and when you think of it that way, one little mammogram is absolutely worth it.”
BONUS TOPICS WITH DR. MENGIN
Question: White women are diagnosed with breast cancer at higher rates, but black women are more likely to have bad outcomes when diagnosed. Can you elaborate on this and your recommendations for women of color?
Answer: Healthcare disparity has been a topic of discussion in recent years. Many studies have been done on just part of our population. Recent studies have shown that although specifically black women have lower rates of breast cancer than non-Hispanic white women, their mortality rates - in other words, their likelihood to die from breast cancer - are higher. There are a number of reasons that this is the case. One of them is that we feel we're not doing as good of a job screening these women, and so diagnosis is happening later. Another reason is that black women are more likely to have what's called triple-negative breast cancer. This is a more aggressive type of breast cancer. Because of these reasons, even though a black woman has a lower likelihood of having breast cancer, she is more likely to die from it. The new recommendations are for all black women to have a formal risk assessment by the time they are 30. There are other groups as well that this is recommended for, like women who have Ashkenazi Jewish ancestry because of genetic factors. So with these populations, we recommend a risk assessment, which just means let's talk about your family history, let's talk about your risk factors and let's find out when you should start screening. The current recommendation for them is also to start screening by age 40 unless they have these risk factors. Black women are also slightly more likely than white women to have breast cancer in their 40s, so they are having cancer earlier and a more aggressive form of cancer.”
Question: Is thermography an effective screening tool, and what does the FDA say about thermography?
Answer: Thermography is an interesting concept. It essentially is an infrared image of the body so it gives you the surface temperature of the skin. For breast tissue, not all cancers are just under the surface of the skin. In fact, many of them are in the deeper tissue because just under the surface we have our subcutaneous fat, which is a layer of tissue where we typically do not see breast cancer. We need to get into the fiber glandular tissue to see a malignancy. So, thermography is not particularly helpful. In fact, it has no studies to support it as a way to identify breast cancer. The FDA has approved thermography as an adjunct screening. In other words, it can be used because it does not cause any harm. However, it is not FDA-approved as a screening tool for breast cancer. It has been a problem for some patients because it's presented … as a screening tool, and it has been confusing for patients. I think patients like the idea that it's a whole body scan because it seems holistic. However, the FDA has put out a warning because it's so misleading. The FDA actually has a warning against thermography because so many have presented it as a screening tool when in fact it is not. It can only be used as an adjunct, and that's because it is not felt to not cause harm. But it does not have data to support its use for screening for breast cancer in any way, there are no studies to support it, so we do not recommend it.”
Question: Is it necessary to continue self-breast exams, if you are keeping up with your annual mammogram?
Answer: If you're coming in for a mammogram once a year, it’s important to remember nothing is perfect. A mammogram is not perfect either, especially when you have dense breast tissue. A self-breast exam will help you find things that are superficial but you will know - if you're used to doing your breast exam - all of your own little lumps and bumps. I can't tell you how many women we've had come in who feel their own cancer. It is an extremely important thing to do, and we recommend that women do it once a month. If it's a woman who's menstruating, the best time to do it is right at the end of the menstrual cycle. That's when the breast tissue is what I like to call the calmest, or the least hormonally active. So, your breast tissue is going to be the most uniform, and you're the most likely to feel something worrisome if it's there rather than it being obscured by all the hormonally active glandular tissue. I recommend doing that breast exam right after the end of your period. You can even do it on the last day if that's easier, or the first day after it stops. If a woman is post-menopausal, pick a day. It can be the first of the month or the 15th of the month, just do it every month like clockwork. It is very important as an add-on to your mammogram because you're only doing a mammogram once a year and cancer can develop in the breast in between a mammogram.”
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