More on mammograms and breast cancer risk

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Kudos to Cape Town doctor Martinique Stilwell, for tackling the controversial and sticky subject of breast cancer risk in last week’s Mail & Guardian. Her article is a breath of fresh air – and not least because she reminds us, here in South Africa, that very often less can be more. South African women are still very much in need of clinic services near to their homes where they can talk to, and be examined by, well trained, caring community nurses. Meanwhile, the debate about how much screening should be offered to women under 50 – aside from those with particularly high risk due to BRCA mutations – rages on. Here at Bay Breast Care we don’t recommend that you postpone mammogram screening until over 50, especially if you have “dense” breasts – firm breasts are always popular, but the density of breast tissue vs fatty tissue makes this breast more difficult to visualise on a mammogram. Patients at high risk may need additional ultrasound screening and perhaps even Magnetic Resonance Imagery (MRI). Radiologist Dr Sandra Basson, who trained in Germany, says that high-risk women there have scans on a six monthly basis, alternating MRI scanning with mammography to keep the mammo exposure to a minumum whilst still providing good and frequent screening that would be able to catch even a fast growing cancer in an early stage. The good news is that for Medical Aid patients, there is more acceptance these days of other methods, including the notoriously expensive MRI procedure, and this means a better service for those who need it. On the other hand, if your risk is average, keep things simple – you neither need nor want to have expensive, uncomfortable procedures that don’t add to either your peace of mind or your span of healthy life. Martinique Stilwell’s article is a timely reminder to women to become aware of our true breast cancer risk. Those who over-estimate their risk experience needless anxiety whilst those who under-estimate can be too blasé about the need for regular screening and a healthy lifestyle. To calculate your risk, use a breast cancer risk calculator. The first part gives you the basic risk, the second part refines that with a few more details on lifestyle. A word of warning: for some women, the calculations aren’t accurate. The risk will come out too low if you have a BRCA mutation, and it may be too high for women who consume large amounts of phyto-oestrogens on a regular basis – for example, soya beans and soy products. More research is needed on that. However for most of us the calculator will work well and give a much better result than a...

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Medical schemes make screening mammography more accessible

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Good news  for members of medical schemes – certain medical aids are now approving and reimbursing Screening Mammography without requiring a referral from your doctor.  Mammography plays an essential role in detecting breast cancer at an early stage, up to two years before you or your doctor would be able to feel an abnormality in the breast tissue, but it’s taken quite a while for medical aids to allow this. Booking yourself in will simplify the process, especially for busy people who aren’t keen to spend needless time in doctors’ waiting rooms! When you arrive for your Mammo screening, X-Ray Department staff will ask for your doctor’s details (GP or Specialist) so that they can send a report on your X-Ray or scan.  If your X-Ray indicates further management, the medical specialist in the X-Ray department will discuss this with you and explain what you should do – and will contact your doctor to let him or her know what’s happening. By the time you see your own doctor, he or she will have the pictures and the report, and will be ready to help you decide on the next step.  If all is well, your doctor will still get a report from the X-Ray Department and will thus know that everything is in order. By easing the process in this way, medical aids are encouraging their members not to delay their regular Mammo screening (for more information on Screening Mammography and who should be screened, see our article). Port Elizabeth radiology firm Drs Visser, Erasmus, Vawda and Partners  believe that the medical aids have taken “a step in the right direction” with this new provision, because it helps to promote screening mammography and thus the early detection of breast cancer. Here at Bay Breast Care, we agree!  If you have any queries,  check http://www.bayradiology.co.za for contact details of your nearest X-Ray Department. Meanwhile, it’s a good idea to call your medical aid, to find out if they are supporting this pro-screening  initiative. If they are, they deserve a pat on the back; if they aren’t, go right ahead and tell them it’s not good enough. If we women are ready to put our breasts on the table – literally! – then the least we can expect is that our medical aids will help us with an easy and cost effective process. If you’ve never had a mammogram before, check out this video from BUPA in the UK which gives you some idea of what to expect: http://www.youtube.com/watch?v=2t_lW_PICl4...

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What do I do when I have an abnormal mammogram?

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Mammograms, along with a healthy lifestyle, regular breast examination, and ultrasound, can help you and your doctors to become aware of what’s going on deep in the tissue of your breast.  Many women dislike mammograms and it’s hardly surprising. Since puberty, most of us have been protecting, covering and supporting our breasts, and the self-consciousness of youth often re-emerges when we submit to unceremonious uncovering and squashing from different angles! However, radiographers in today’s hospitals and clinics have specialised post-graduate mammography training, and they know how to help you relax as they expertly scan your breasts including the “tail” of breast tissue that lies under the armpit. If the radiographer sees something untoward, she will take care not to stress you but will explain that there is something on the mammogram that’s not clear, and which requires more attention. It’s likely that a further examination will follow, using ultrasound which can show up tissue abnormalities that might not be easily seen on the the mammogram. She will then call in a radiologist, who is a medical specialist in the field of hi-tech imagery, for an opinion. There is nothing much to be done in this situation but keep breathing deeply and calmly… Remember that mammography, if undertaken as a routine part of your normal health care, is a method of surveillance – keeping watch. Although obviously everyone hopes for an “all clear” every time, breast tissue is complex, often dense; and there are many aspects that change over time. Most changes are harmless, but there would be little point in going to the trouble of a mammogram if we don’t take advantage of the specialist opinion that’s available along with the procedure. At one end of the spectrum of concern the radiologist might note a change which is obviously harmless (such as small areas of calcium deposit that are common as we get older), or perhaps a larger benign growth which has been noted on an earlier mammogram and shows no sign of unhealthy change. At the other end of the spectrum, a mammogram will occasionally reveal a very obvious cancer spot – and this is precisely why we went there, to take charge of that possibility. In between these extremes, there is a range of “doubtful” lumps and bumps which may be uncertain because of their shape or position, or perhaps because there is no track record from previous mammograms to confirm that they’re harmless. Your age and previous mammography relevant: if you are 50+ and an abnormality is seen for the first time, you will be advised to take further action, but the same finding in a younger patient might merely be noted for future reference. The...

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