War on Breast Cancer: What you need to know about mammograms
In The Network Journal’s second of two consecutive articles on breast cancer, Dr. Annette M. Brown, an attending radiologist at Long Island College Hospital in Brooklyn, N.Y., talks about what women, especially African-American women, need to know about mammograms.
TNJ: Why are mammograms so important?
Dr. Brown: You want to find breast cancer while it’s still confined to the breast. Once it’s left the breast, we lose control over treating it most successfully. Mammograms are one of our best tools for finding smaller tumors.
TNJ: How often should women have mammograms?
Dr. Brown: While breast cancer is higher overall in Caucasian women, it’s higher among Black women under 55 years old. We don’t know why, although a small study now indicates that Black women are four times as likely to have a mutation in the p53 gene that suppresses breast cancer. So whereas the current recommendation is for women to start having annual mammograms at 40, I think African-Americans should have their first, baseline mammogram at 35.
TNJ: What do you say to women who say, “I examine my breasts regularly? Isn’t that enough?”
Dr. Brown: You want to detect cancers before they’re large enough to feel, and for that you need a mammogram. Monthly breast self exam (BSE), done a week after one’s period, is a good way for women to get familiar with their breasts, so that they’re more likely to notice any changes (e.g., if the nipple has changed shape) and that can spur them in for a mammogram.
TNJ: Surely well-educated career women are careful about coming in for mammograms?
Dr. Brown: Education has nothing to do with it. I treated a lot of upscale Black women in private practice and sometimes they’re worse at getting their exams.
Dr. Brown: Different reasons. Sometimes women tell me, “There’s no family history,” as if that means they don’t have to worry. But family history is only one risk factor. Some feel if they don’t face it, it will go away. Not true. What you don’t know can hurt you. And some are seriously misinformed. There’s one celebrity who tells women they don’t need mammograms; an ultrasound found her cancer. With few exceptions, ultrasound is for diagnosis after the anomaly has been found. [Editor’s note: The American College of Radiology is now studying ultrasound’s usefulness. For more information, call 215-717-2769 and ask about the Breast Ultrasound Screening for High Risk Women trial.
TNJ: With all the advances, studies indicate that mammography misses 17 percent of tumors. Why is that?
Dr. Brown: Mammography is perhaps the most difficult area of radiology. The breast has no definitive anatomy and every breast is different, so it’s really difficult for doctors to be sure about what’s “normal.” So doctors and hospitals are finding ways to double-check mammograms. Here at LICH, for example, I sit down with my fellow radiologist every Wednesday to review films. There are some facilities where doctors have to read 20 or 30 arbitrarily pulled cases of a fellow radiologist, then they see if they agree with the original conclusions.
TNJ: How important is it to keep track of our mammograms?
Dr. Brown: Mammograms are a girl’s best friend. Women should know where their films are. Either keep a list of where you’ve had every mammogram done or [even better] keep your original mammogram yourself (not a copy). Then know where it is. A lot of women can’t remember where they put their films!
TNJ: Why is the previous mammogram so important?
Dr. Brown: If this is the first time I’m looking at your mammogram, I have nothing to compare it against. So if I see a little something there, I don’t know if it’s important or not.
TNJ: What do you say to businesswomen who point out that there are rarely convenient hours for mammography testing?
Dr. Brown: You can’t tell me your job is more important than your life! You won’t be around to make deals if you’re sick. When we put our jobs or money ahead of our health, I think our priorities are in the wrong order.