Thursday, July 20, 2017  

Still Haven’t Had That Mammogram? A Radiologist Takes On The Excuses


one of the most important things I’ve learned about healthcare has very little to do with medicine, technology or clinical innovation. Instead, it’s based on the simple idea that better health begins with better information.

By Sharon J. Outten, M.D.
Radiologist; Medical Director Radiology Dept., Riverside Tappahannock Hospital Peninsula Radiological Associates

After more than two decades as a radiologist, I can tell you that one of the most important things I’ve learned about healthcare has very little to do with medicine, technology or clinical innovation. Instead, it’s based on the simple idea that better health begins with better information. For that reason I’m very gratified to have the opportunity to be part of the conversation on mammography and early detection.

During the years I’ve been practicing I’ve probably heard every excuse imaginable as to why a woman would choose not to have a mammogram as part of her overall approach to breast health. Maybe nothing quite as strange as the student’s old standby about homework eating dogs, but close. Some of the reluctance is valid, however, and I’d like to take a closer look at some of the obstacles that can appear on the road to preventive care in general and earlier breast cancer detection in particular.

It’s not convenient

A mammogram takes about 15 minutes. Add a little travel time, checking in and getting ready and we’re talking about maybe an hour out of your day. Generally that’s only going to be one hour a year. The other thing to keep in mind is that you don’t need to go through the process of getting a referral for a mammogram. When you schedule a mammogram with us we only need your primary care doctor’s name so we can report the results.

And to add to the convenience, there’s no reason why you have to go very far from home. At Riverside I work with full field digital mammography and utilize MRI for individuals who are diagnosed as high risk. We also have a computer aided detection (CAD) system that further helps radiologists detect any abnormalities in the image. This is all state-of-the-art technology, so people in this area don’t have to travel for mammograms. It’s another reason why the inconvenience and “I don’t have time” excuses don’t stand up very well.

I dislike the whole experience

Let’s be real here. Getting a mammogram isn’t your idea of a day at the beach. It’s not mine either. But there’s nothing that says it can’t be a more pleasant experience. I practice in an attractive, new mammography suite where my colleagues are trained and committed to reduce even the mild discomfort factor as much as possible. Because the equipment operates so quickly to obtain an accurate digital image, the breast compression time is reduced. So again, it’s not a rollicking good time, but not bad at all and getting better.

I can’t afford it

Because of its long record as an effective tool for early detection in the fight against breast cancer virtually all health insurance plans cover a mammogram in full or in large part. For women without health insurance and at very low income levels, the Tappahannock Regional Free Clinic offers a Well Woman Check-Up that includes mammograms and Pap tests provided at no cost. Uninsured women who meet the age and income qualifications can also receive free or reduced cost breast and cervical cancer screenings through the state health department’s Every Woman’s Health program in which Riverside Tappahannock Hospital and Riverside Walter Reed Hospital participate.
Our hope is that healthcare reform will make breast cancer screenings even more accessible – and believe me, breast cancer is a bipartisan disease. It doesn’t care how you vote, so mammograms are a good example of why it would help to take politics out of healthcare.

What about harmful radiation?

The levels of radiation used in screening mammography – which is a type of x-ray procedure – are extremely low, and the very quick images we obtain reduce the exposure even more. It helps to keep in mind that most of our exposure to ionizing radiation, the form of energy waves used in an x-ray, come from natural sources.

For example, the amount of radiation required for a mammogram is just about what you would receive just being outside for the day or making a flight on a commercial airline. Virtually no procedure is without risk, but in the case of mammography, the benefits far outweigh any potential concerns.

I don’t have a family history of breast cancer

For many women who develop breast cancer the only known risk factor is being a woman. In general, risk factors can include everything from alcohol consumption, obesity, environmental exposures and age to an early menstruation and a late menopause, as well as certain genetic mutations. So not having a personal or family history of breast cancer is a good thing, but it represents only one of numerous potential risk factors.

Isn’t there a debate about the value of mammography?

Over the past five years in particular there have been some different opinions in the scientific community as well as some different interpretations of available data on the relationship between early diagnosis and the mortality rate from breast cancer. As a physician and a woman I support a healthy public debate about any health issue. But I also think that it is critical to have the facts, and this is what we know:

  • Breast cancer killed an estimated 40,000 women last year and is the second-leading cause of death among women, exceeded only by lung cancer.
  • Early detection of breast cancer with screening mammography means that treatment can be started earlier in the course of the disease, possibly before it has spread.
  • Results from randomized clinical trials and other studies show that mammograms can help reduce the deaths from breast cancer among women ages 40 to 70.
  • The five-year survival for breast cancer is 98 percent when it’s caught early and 23 percent when it’s not.

Over the course of the years that I’ve been practicing radiology, the increasing level of screening mammography that we’ve been fortunate to achieve has resulted in a marked and uncontestable improvement in the overall health and wellbeing of American women. It’s also led to guidelines by the American Cancer Society, the federal government’s National Cancer Institute and most major health organizations that recommend that women who are not at higher than average risk for breast cancer get yearly screening mammograms starting at age 40 and continue so for as long as they are in good health.

Keeping in mind that any health decision is a personal one that involves weighing risks and benefits, I strongly support that recommendation. And I encourage you, wherever you choose to go, to have regular screening mammograms if you’re within the recommended age range.

Sometime in the future there very well may be a cure for breast cancer or a preventive measure. What we have now is that hope along with the very real value of early detection. And while mammography, as with any screening procedure, has limitations, it is the most widely available and most effective tool we have to detect breast cancer earlier, when it’s more curable.