According to Connie Busch, lead mammographer at Trinity Health, one of the most heartbreaking things to face is when a 40-year-old woman comes in for her first mammogram, has no family history of breast cancer and Busch is the first one to discover that the woman has cancer that has spread too far and too fast. Busch has to be the one to deliver the life-changing news to the woman.
A study on the value of screening recently published in Cancer, the scientific journal of the American Cancer Society, found that most deaths from breast cancer occur in unscreened women. To maximize mortality reduction and life-years gained, initiation of regular screening before age 50 should be encouraged, the researchers in the study said. Regular screening increases the likelihood of detecting non-palpable cancers and annual screening further increases that likelihood relative to biennial screening. Detecting and treating breast cancer in younger women may further increase the disease-free life years saved.
Busch said the results of the study mean that the breast cancer found in younger women is not being found early enough and the women are dying at an earlier age. The study proves the validity of getting mammograms, she added.
Connie Busch, lead mammographer at Trinity Health, stands next to a mammography machine in an exam room at Trinity Health-Medical Arts. She encourages all women to get mammogram screenings for breast cancer starting at age 40.
"Women at higher risk (for breast cancer) are younger women because the cancer found in them is more aggressive, grows faster and is harder to treat," Busch said. "Women who are post-menopausal, those cancers grow at a slower rate and are much easier to treat."
There has been some controversy on how old a woman should be before getting a mammogram, Busch said. The use of mammograms to prevent breast cancer deaths, according to the study, has been controversial since the United States Preventive Services Task Force's misguided proposal in 2009 to limit screening to women ages 50 to 74 years. Busch said the American College of Radiology and the American Cancer Society disputes those recommendations. They recommend that women get mammograms starting at age 40, continuing every year with no upper age limit, she said.
"From our experience here (at Trinity), we have diagnosed a good number of women in the 35- to 40-year range," Busch said.
Some women who start screening at an early age come in because they have family members who had breast cancer in their 50s, Busch said. Women who have a first-degree relative (mother, daughter, sister, for example) who had breast cancer should start mammograms 10 years younger than when their relative was diagnosed, she said, "Just because you're at a higher risk of developing breast cancer."
A lot of what keeps women from getting mammograms is fear, Busch said. They think a mammogram hurts, people are modest and there's the fear of finding something wrong, she added. Many of the women who come in for their first mammogram leave saying it wasn't as bad as they thought, Busch continued.
Busch said mammograms done in 1988 to how they're done in 2013 are like night and day. Digital technology put mammograms into high definition, especially in women who have high-density breast tissue. Digital technology outshines the mammograms of years ago, Busch said. She explained that before digital imaging, the film screen image of the breast was black and white with a hundred different shades of gray in between, but in the digital image there's still black and white but with thousands of shades of gray.
"That makes it easier to find the cancer," Busch said.
Trinity has had digital technology in mammograms since 2006 and were the first facility in the state to have it, she said.
Newer technology involving a 3-D image of a mammogram is also available, although it's not at Trinity yet, Busch said. A digital mammogram will take slices through the breast, she said, but 3-D will take thin slices of the breast. The exam is similar to how mammograms are done now with the 2-D image, but the machine switches the camera to 3-D in the compression stage, Busch continued. With the 3-D imaging, the woman would be in the compression stage longer and receive more radiation, she added. The 3-D imaging is also not yet covered by insurance, Busch noted, and too cost prohibitive to offer to patients at this point, but they would like to offer it.
Busch encourages first-time mammogram patients to talk to a relative or family friend who has had a mammogram recently and ask about their experience. Women who don't have mammograms are also the ones who don't have any kind of screening done or do any preventive health measures, she added, so it's hard to convince them to come in.
The mammography department at Medical Arts offer long appointment times and can work around peoples' work schedules, Busch said. They can do screenings from 7:30 a.m. continuously through 6 p.m., she added, and can also schedule a mammogram on a Saturday if a person's work schedule doesn't fit with any of the other times.
"It's a very fast exam, a relatively benign procedure," Busch said. "You're in and out in a short time, and the information gathered from it is valuable."