mammogram

RECENT POSTS

What You Really Need To Know About Dense Breasts

From left: 1) a breast of normal density showing fat (white), fibrous tissue (pink) and glands within the rectangle, while a cancer is present (circle). This illustrates the fact that cancer can occur in breasts of any density; 2) an extremely dense benign breast without any fat, composed of pink fibrous tissue and minimal amounts of glands; 3) an extremely dense breast involved by cancer (infiltrating haphazard small glands), in contrast to Fig 2, but very similar in appearance, demonstrating the subtle similarities. (Courtesy Michael Misialek)

From left: 1) a breast of normal density showing fat (white), fibrous tissue (pink) and glands within the rectangle, while a cancer is present (circle). This illustrates the fact that cancer can occur in breasts of any density; 2) an extremely dense benign breast without any fat, composed of pink fibrous tissue and minimal amounts of glands; 3) an extremely dense breast involved by cancer (infiltrating haphazard small glands), in contrast to Fig 2, but very similar in appearance, demonstrating the subtle similarities. (Courtesy Michael Misialek)

By Michael Misialek, M.D.
Guest Contributor

Reading the pathology request on my next patient, I saw she was a 55-year-old with an abnormality on her mammogram. Upon further investigation I discovered she had dense breasts and a concerning “radiographic opacity.” The suspicion of cancer was high based on these findings and so, a breast biopsy had been recommended. As I placed the slide on my microscope and brought the tissues into focus, I immediately recognized the patterns of an invasive cancer. Unfortunately the suspicion had proven correct.

Just a few patients earlier, an almost identical history had prompted another breast biopsy. This time the results were far different, a benign finding and obviously a sense of relief for the woman. Every day these stories unfold; the never ending workup of abnormal mammogram findings. Both radiographically and microscopically, it can be challenging at times sorting out these diagnoses, particularly in the face of dense breasts.

But what, exactly, are dense breasts and why are they suddenly in the news?

Breast Tissue 101

Breast tissue is actually made up of three tissue types when viewed under the microscope. The percentage of each varies between patients. There is fat, fibrous tissue (the supporting framework) and glandular tissue (the functional component). This is what I actually see under the microscope. Cancer can occur in fatty or dense breasts. It can be toughest to assess when the background is dense.

Biopsy, considered the gold standard in diagnosis, may even prove difficult to interpret when in the background of dense breasts. Dense breasts can hide a cancer, making it more difficult to detect both by mammogram and under the microscope.

Breast density has taken a lot of heat recently. A new study published in the Annals of Internal Medicine found that not all women with dense breasts and a normal mammogram warranted additional screening, as was previously thought. Understandably this report has received much attention. The authors found nearly half of all women had dense breasts. This alone should not be the sole criterion by which additional imaging tests are ordered since these women do not all go on to have a cancer. Clearly other risk factors are at play.

Confusion All Around

This is confusing for patients and doctors alike, especially when it seems as if screening guidelines are a moving target. Recently, the American College of Physicians issued new cancer screening guidelines: among these was mammograms, being recommended every two years. This too is getting a lot of press.

The American College of Radiology, American Cancer Society, Society of Breast Imaging and American College of Obstetricians and Gynecologists recommend yearly mammograms beginning at age 40. Continue reading

My Right Breast: One Man’s Tale Of Lump And Mammogram

Journalist B.D. Colen chronicles  his own mammogram experience both in prose and in photos he took during the procedure. ((c) B. D. Colen, 2014)

Journalist B.D. Colen photographed his own mammogram during the procedure. ((c) B. D. Colen, 2014)

By B. D. Colen

It began with an itch I just had to scratch. Doesn’t every adventure begin that way?

I was lying in bed reading on a Saturday evening, and without even looking I idly scratched a spot on the right side of my chest –- at that point I had a chest, not breasts. As I did, my fingers rode over a small something, a little like a speed bump about an inch below and two inches to the left of my right nipple.

I stopped reading and started poking. And prodding. And pushing. And feeling. And manipulating. And panicking.

“That’s a lump!” I thought, and suddenly I had a right breast. With a lump in it.

I spent Sunday attending to the usual chores and pleasures, with a good deal of poking and prodding added in. There was absolutely no question that something was dwelling there, beneath my AAAA right breast. But what was it? And what was I worried about? After all, I’m a man, and men don’t…Well, yes, men do get breast cancer. In fact about one in every thousand men will develop breast cancer during their lifetimes. Granted, that’s barely worth mentioning compared to a woman’s one-in-nine chances, but it still means that the possibility was indeed real that something ugly and malignant was barely hiding beneath my skin.

The following day, I already had an appointment with my primary care physician about something else, and when we were finished I said, “So, Sam, I seem to have this lump in my right breast.”

(Photo c. B.D. Colen, 2014)

(Photo (c.) B.D. Colen, 2014)

Suddenly, my normally garrulous physician grew serious. “Let’s take a look,” he said, asking me to lie down on the examining table. He had me show him where I thought the lump was and I instantly isolated it – I’d already felt the damned thing enough times to be able to go right to it.

He felt it, felt around it, poked and prodded, and in less than a minute said, “You’re right, there’s something there.” Then, without further kidding – which I’d expect from him – and without any “Well, it’s probably nothing, but let’s be sure,” he sat down at the computer and started typing. “I’m putting in an order for a ultrasound and a mammogram,” he said. “For tomorrow.”

Mammowhat?! Mammogram? Me? But I’m a man! And at 67? Is this some really, really weird dream I’m about to wake up from? How in God’s name were they going to do a mammogram when there’s practically no mam on my chest?

But into the rabbit hole, through the door marked “Women (almost) Only” I went. Though not before Googling “male breast cancer” and convincing myself that I was going to die: Family history? Check. Average age of 68? Check. Sometimes Google is not your friend.

The nice woman down in radiology scheduled me for 10 the next morning, and told me that I shouldn’t worry. “It’s probably nothing,” she assured me. I thought, “That’s probably what you tell all the guys.”

I don’t need to tell any of you who are women what a painful, essentially degrading experience having a mammogram is. I’ve since read the jokes advising women to prepare for the procedure by placing a breast on the edge of their freezer and slamming the door on it – and that is pretty close to the reality. Continue reading

Daily Rounds: Stop Texting Now! Mammogram Mixed Messages; Innovation Chief Snapshot; The ADHD Gene; A New Nurturing Planet?

Mass. texting while driving ban begins Thursday – BostonHerald.com “The new law also prohibits scanning the Internet on a phone or mobile device while driving and bans anyone under 18 from talking on a cell phone while driving. Violators will face fines ranging from $100 for a first offense and up to $500 for repeat offenses. The ban still applies when drivers are at a stoplight.” (bostonherald.com)

Mammogram Benefit Is Seen for Women in Their 40s – NYTimes.com “The study’s conclusions contrast with those of a report last year by the United States Preventive Services Task Force, an independent group that issues guidelines on cancer screening, questioning the benefit of screening women younger than 50.” (The New York Times)

New 'Innovation' Chief Comes From 'Model' Health Care System – Kaiser Health News Dr. Richard Gilfillan was just appointed the new acting director of the Center for Medicare and Medicaid Innovation. "It is one of the most important positions in HHS because almost all of the reform of the delivery system potential hinges on this innovation center. It is as key a position as there is," said Gail Wilensky, who ran the Health Care Financing Administration — now CMS — from 1990 to 1992.” (kaiserhealthnews.org)

Kids with ADHD more likely to have missing DNA – Boston.com “Children with attention deficit hyperactivity disorder are twice as likely to have missing or extra chromosomes than other children — the first evidence that the disorder is genetic, a new study says.” (Boston Globe)

New Planet May Be Able to Nurture Organisms – NYTimes.com It might be a place that only a lichen or pond scum could love, but astronomers said Wednesday that they had found a very distant planet capable of harboring water on its surface, thus potentially making it a home for plant or animal life.” (The New York Times)

DIY Mammogram Math: 1 in 20,000 Odds

Remember that flare-up of The Mammogram Wars? Last November, an independent government panel recommended that women should start getting annual mammograms at age 50 instead of 40, incurring backlash from the breast cancer community and others.

Now, the latest New England Journal of Medicine offers a deeply reasonable article called “Lessons from the Mammography Wars” about how such issues should be handled, including these highly useful stats that might help many of us make our individual mammogram decisions:

For women between the ages of 40 and 49 years, the false positive rate is quite high, and the expected benefits are quite low: more than 1900 women would need to be invited for screening mammography in order to prevent just one death from breast cancer during 11 years of follow-up, at the direct cost of more than 20,000 visits for breast imaging and approximately 2000 false positive mammograms. Conversely, for women between the ages of 60 and 69 years, fewer than 400 women would need to be invited for screening in order to prevent one breast-cancer death during 13 years of follow-up, while accruing approximately 5000 visits and 400 false positive mammograms.6 In short, as the risk of breast cancer increases, the benefits of mammography increase, whereas the relative harms become progressively less significant.

Continue reading