Dr. Catherine Plzak

by Catherine Plzak

October is National Breast Cancer Awareness Month – the perfect time to discuss the importance of mammography. Because breast cancer is often detectable in its early stages when there’s a good chance for a cure, screening is essential to early detection. Most significantly, mammography can identify tumors even before they can be felt.

According to the Centers for Disease Control and Prevention, after non-melanoma skin cancer, breast cancer is the most common cancer among women in the United States. In 2012 (the most recent year numbers are available), 224,147 women in the United States were diagnosed with breast cancer, and 41,150 women died from the disease.

The American Cancer Society recommends women have yearly mammograms starting at age 40 and continue for as long as a woman is in good health. If a woman is at high risk for developing breast cancer, her doctor may recommend screening at a younger age, along with additional imaging studies. Talk with your doctor about your history and whether you should have other tests or start testing at an earlier age.

The Chestnut Hill Hospital Women’s Center provides breast cancer screening services including digital mammography, 3D mammography, breast ultrasound and breast MRI.

Screening and diagnostic mammography

A conventional screening mammogram is a low-dose X-ray test that creates images of breast tissue doctors can check for lesions or other abnormalities. The X-ray images make it possible to detect tumors that cannot be felt, and can find tiny deposits of calcium called microcalcifications that sometimes indicate the presence of breast cancer.

A mammogram used to check for breast cancer after a lump or other sign or symptom of the disease is called a diagnostic mammogram. Besides a lump, signs of breast cancer can include thickening of the skin of the breast, nipple discharge, or a change in breast size or shape; however, these signs may also be signs of benign or non-cancerous breast conditions.

Digital and 3D mammography, ultrasound and MRI detection

At the Chestnut Hill Hospital Women’s Center, women who undergo breast screening also have up-to-date diagnostic technology available with digital mammography, 3D mammography, breast ultrasound and breast MRI.

Digital images tend to provide doctors with better visibility of breast tissue. Through computer-aided technology, radiologists are able to enhance certain areas of the digital images to get a more precise picture of a patient’s condition. The digital images can also be stored electronically, and retrieved to share with other doctors if needed in the future. Breast tomosynthesis, also called 3D mammography, is a newer type of mammogram that produces a three dimensional image of the breast. By taking multiple images at different levels through the breast tissue, the radiologist has an even clearer picture of subtle changes in the breast. This is particularly helpful in dense breast tissue. Cancer detection is improved, and the need to return for additional mammogram films is reduced.

Breast ultrasound is best at helping to evaluate specific areas that are felt on an exam, or are seen on mammogram as abnormal. Breast ultrasound is not as good as mammogram for looking at the whole breast because of a high incidence of “false positives,” which means seeing changes that require further testing or even biopsy, and prove to be of no significance. Also, ultrasound cannot see most microcalcifications.

Breast MRI looks at the breast tissue in a different way and uses magnetic energy but no radiation. Though very good at finding small cancers, it also has a significant number of false positive findings. Breast MRI is most frequently used in combination with mammography in women with higher risk factors. MRI can also be helpful in breast cancer diagnosis and staging.

Through the Affordable Care Act, all marketplace health plans and many other private plans must cover breast cancer mammography screenings every one to two years for women over 40 without charging a co-payment or coinsurance. Women should contact their mammography facility or health insurance company for confirmation. In addition, Medicare pays for annual screening mammograms for all female Medicare beneficiaries age 40 or older.

Visit CHWomen.com to learn more about breast screening options. For more information on various breast diseases and conditions, the anatomy of breasts, other screening tools and more, visit www.chestnuthillhealth.com, choose the “Health Resources” tab and type “Breast Health” in the search box.

Dr. Catherine Plzak is a surgeon at Chestnut Hill Hospital and sees patients at the hospital's Women’s Center. Need a mammogram? Call 215-248-8400 to schedule an appointment at either our Chestnut Hill or Blue Bell locations.