first mammography? what age?

[naturalmama]

Hello,

my mother thinks i should get my first mammography now even though i have no health concerns now, because she says it is good for doctors to be able to compare my normal breast to anything unnatural in the future. i am 30 years old and have no family history. i eat a vegetarian diet, don't drink cows milk, and try to eat as natural and as healthy as i can. what do you all think?

[Becky N.]

Hi there! I'm a mammography tech. (semi-retired so maybe I can help ya out a bit. I do know that ACR and ACS guidelines don't reccomend any screening for asymptomatic females w/no family history until at least 35. Depending on who you ask, the consensus is generally 35-40 for the first screening, then between 40-50 either every year or every 2 years, then annually after 50.
Some things to keep in mind:

Younger women generally have denser breast tissue, which makes the films much more difficult to read and obtain an accurate diagnosis from. This gives younger patients a much higher false-positive rate. The false-positive rate for mammography is VERY high to begin with.

Although older women get breast cancer more often, the cancers in younger women tend to be more aggressive (if they are estrogen-dependent tumors)

If you are concerned about radiation, keep in mind that it's effect is cumulative- it adds up throughout life. Mammography is low-dose now, but still radiation all the same.


If I were you- I'd defintely wait- probably another 10 yrs! Be hyper-vigilant about doing your breast exams at the same time each month and do not hesitate to investigate any lumps or changes you may feel. I've seen quite a few women w/br CA that were in their 30's - the youngest being 23, but they are few and far between, and all of them felt their lumps on breast exams. Would have mammography detected it earlier? For some of them, yes- but hindsight is 20/20. The few cases of br. CA that screening in women under 40 would catch does not justify mass screening of all women in that age group, in MY opinion. I think Dr. Mercola's web site has an article on this, too-www.mercola.com

Best of luck!

[Natashka]

I am 31 and at this point plan to start at 40. I have family history of premenopausal breast cancer. I have investigated the issue and am glad to hear that Becky has same advice!
I assume you are a mom and a bf one so this puts you in a lower risk category (first pregnancy before 30 and bf, the longer the safer). Please be vigilant and get very, very familiar with your breasts, do not rely too much on the diet being protective. Although there is evidence it is, it's not overwhelmingly so. Rembrandt's Saskia had advanced cancer early in life and she surely did not eat artificial foodstuffs.

[scribblerkate]

So cool that your first response was from a tech! Listen to her!

You know, there have been a lot of reliable studies coming out lately questioning the usefulness of mammography, especially for some of the reasons she mentioned in her post. The CDC and others have really been focusing on this issue. Mammography is most useful and reliable over 50, I believe.

If you have some risk factors, then you may want to discuss them with your health care provider and weigh the pros and cons of having a screening done. Otherwise, I wouldn't worry about rushing into it. My mother had bc, and my aunt died of liver cancer, so I am high risk but have chosen to wait quite a while before having one done. (I'm 32 now.)

I have heard there are researchers working on a couple of different tests for bc which may prove more reliable in detecting it. I heard this on Talk of the Nation about a month ago, but don't remember much. If anyone knows more, I'd love to hear about it.

[Becky N.]

Threre are a lot of new techniques being investigated, but thus far, nothing to replace mammography as a mass screening tool. Ultrasound can be very helpful for women with very dense breast or fibrocystic breast disease, as ultrasound will tell you if a lesion is solid or fluid filled. Mammography will not. Ultrasound is generally ordered as a follow-up to a mammogram, but in my opinion, for women with dense breast tissue, it should be used all the time. Mammography just does not image dense breasts well- the breast tissue obscures any possible masses unless you have a really excellent imaging system and a super radiologist.
One thing I heard about at a conference recently that sounds promising is called ductual lavage- a very thin catheter is inserted into one of the milk ducts through the nipple, then "washed" out with fluid to obtain a sample of the cells that hang out in the ducts. Since the most common BC is intraductal, theoretically, if you had very early stages of malignancy, the sample would contain some of those malignant cell. This could technically be used as a screening tool someday, and not require the interpretations of radiologists whose opinions often differ. I don't know how fun having a catheter put in a milk duct would be, though!!

MRI can be helpful, too, though I don't know a lot about it. I know that it is the only way to image the entire breast in a woman who has breast implants. It's the only way you can see the tissue behind the implant against the chest wall.

Thermography detects malignant areas in the body by measuring the amount of heat coming out of the tissue. Malignant cells typically grow rapidly and demand a large vascular supply to support themselves, generating more heat than normal tissue. That's about all I know about that! Not done at many centers at this point.

It always ticks me off when they have these little bits on the news about how there's some new technique to replace mammography. They talk for 30 seconds about it and fail to mention that it's not approved by the FDA, only available in two hospitals in the nation, not appropriate for screening, etc etcetc.
Then every patient the next day wants to know if we have the new equipment they saw on the news.

Mammography has its many limitations and is definitely not a pleasant exam- and believe me, I've worked with some techs that are a little bit on the sadistic side. However, it really is our only way to image very early breast cancer. It's the only radiographic modality that can image the very fine calcifications that form along the ducts when cancer first takes hold. It doesn't stop breast cancer or reduce the rate, but it can detect it a lot earlier, and that's what saves lives. There's a huge difference between a stage I tumor that only requires a lumpectomy and minimal radiation and a more advanced tumor that has spread to the lymph nodes, requiring possible mastectomy, radiation, and chemotherapy. I've seen it many, many times and lost a co-worker that waited too long to get a lump checked out.

Cancer is scary and everywhere anymore. In my opinion, our entire environment is toxic and affecting us all on a cellular level. Our air is polluted, our water is polluted, our food full of additives, our household products full of chemicals. All you can do is live the healthiest life possible. I think some people are more succeptible than others- how else can you explain the 90 year old woman who has lived on a diet of red meat and cigarettes, while the 30 year old organic-eating health nut dies of cancer?
There's so many variables living in this world- environment, genetics, diet.

Sorry for the long post!! I love talking about medicine but hate working in the field! I didn't realize how much I wrote....

Becky

[scribblerkate]

Thanks, Becky!

That was very informative. I think the ones they talked about on NPR were MRI and maybe thermology?

Hmm, maybe you could do a career switch? Health education would let you talk about health all the time. Also, I used to work in health care publishing. You could become a health care journalist, and once again get to talk (okay, write) about health care all the time.