Are There Alternatives to My Annual Mammogram?

Each October hundreds of unlikely pink makeovers—NFL football shoes, the White House lit up at night, Kate Hudson’s hair, to name a few—remind those of us over 40 to schedule our annual mammograms. Although it’s nearly impossible not to get the message, nearly a third of all women over 40 have not had a mammogram within the past two years. Even among women whose health insurance takes cost out of the decision, around 29% are skipping their annual mammogram. Often the reason is simply the difficulty of fitting the test into their busy lives, but some women genuinely dread the discomfort or anxiety they experience.

So, is something else available? After all, an Internet search produces hundreds of posts describing “natural alternatives.” The short answer is—mammograms are the best way to detect breast cancer early, while a lump is still too small to be felt by a woman or her doctor. Sometimes we recommend other studies that give us more information in addition to—not instead of—a mammogram. I would like to offer you some information about these, as well as a caution about some procedures that we do not recommend.

Mammography: The American Cancer Society and the American College of Obstetricians and Gynecologists both recommend annual mammograms beginning at age 40. For women at high risk we may recommend earlier mammograms or additional tests. Your mammogram facility should be certified by the Food and Drug Administration. (We are). Digital mammograms offer some advantages over film mammograms including the ability to adjust the image to see certain details more clearly, as well as the ease of sending your mammogram electronically to the radiologist for reading and to store all your mammograms in your electronic medical record.  Sparks & Favor uses digital mammography.

Breast Ultrasound (sonography): The ultrasound uses sound waves to examine the breast tissue.  It helps the radiologist examine more closely an area of concern found on the mammogram, especially in women with dense breast tissue. It can help the radiologist differentiate a possible tumor from a simple cyst. It does not replace your mammogram. The radiologist decides whether you need this additional test after viewing your mammogram.

Magnetic Resonance Imaging (MRI): If a woman has a significantly higher than average risk for breast cancer based on certain factors, her physician may recommend MRIs in addition to mammograms. At Sparks & Favor we will refer you to a breast cancer specialist if you are in this risk group. Right now, there is no scientific evidence that MRIs are an effective breast cancer screening tool for women of average risk.

Clinical Breast Exam (CBE): A clinical breast exam is the exam performed by your health care professional at your annual well-woman visit. CBE is recommended for all women over 40 in addition to the annual mammogram.  For younger women who are not in a high risk group and do not yet need annual mammograms, the clinical breast exam gives your doctor a chance to help you develop breast self-awareness.

Breast Self-Awareness (BSA):  This term has replaced our traditional discussions of Self Breast Exam. Breast self-awareness involves becoming familiar with the normal appearance and feel of your breast tissue so that you can be alert to changes. Although women’s physicians have moved away from recommending monthly self-breast examination, many women feel more comfortable with this routine. This is absolutely fine, but it does not replace having mammograms beginning at the age your doctor recommends.

Breast Thermography: This tool produces images of heat and blood flow patterns within breast tissue. The Food and Drug Administration warns that it has no evidence to support claims that thermography can replace mammograms or find breast cancer sooner than mammograms can. In fact, the FDA has issued warning letters to companies who attempt to make these claims. Here in the Birmingham area, several providers offer thermography. Beware of claims about its effectiveness and alert to the likelihood that your insurance will not cover the procedure. Read more from the FDA.

Nipple Aspirate Test:  This test uses a breast pump to obtain fluid from the nipple which is then tested for cancer cells. The FDA states it “has no evidence to support claims that nipple aspirate tests, when used on their own, are an effective screening tool for any medical condition, including the detection of breast cancer or other breast disease.”

A final word: We want your annual mammogram at our office to be as convenient, comfortable, and anxiety-free as possible. Unfortunately, mammograms do not find all breast cancers, and they occasionally find suspicious areas that turn out not to be cancer. For you that means a call-back for extra studies and the anxiety that causes.  Fortunately, less than 10% of women receiving mammograms are called back for additional studies. And, if you get a call-back, keep in mind that less than 10% of these extra visits find a cancer.  (American Cancer Society).

So schedule your annual mammogram and enjoy the rest of your fall with peace of mind!