While breast cancer screenings are considered a vital part of regular health care for women over 40, some women experience feelings of anxiety in the time leading up to a screening appointment.
Mammograms can help detect breast cancer in its early stages — even before a person may show signs and symptoms of cancer — when it is easiest to treat. Dr. Howard Schiffman, a diagnostic radiologist at San Diego Imaging – Chula Vista, affiliated with Sharp Chula Vista Medical Center, recently answered five questions about the importance of mammograms and the concerns some women may have about them.
- Why do some women dread mammograms?
Women may be deterred from getting a mammogram for many reasons. Certainly, there is a fear among those who have never undergone the procedure that it is painful. In my experience, the vast majority of women find the test less uncomfortable than they expected, and you are typically in and out of the room in eight to 10 minutes.
- Beyond the concern that the screening may be uncomfortable, what else affects a woman’s feelings about mammograms?
With all medical testing, it is human nature to be fearful of results and thus avoid any emotional upset leading up to the study. This results in a minority of patients adopting the “I'd rather not know” attitude. Mammography has additional psychosocial complexities. In women of some cultural backgrounds that we serve, it is frowned upon to discuss or acknowledge any problems related to reproductive organs. Many women consider their breasts a major component of their sexual identity and are afraid that any disease or disfigurement will result in loss of attractiveness. These are very difficult biases to combat and are constantly addressed, but change is slow and needs to come from the community and primary care providers.
- Is the fear of screenings and the related results unfounded?
For every 1,000 women coming to our imaging center for a mammogram, we will find a cancer in approximately five women. So, one way to look at this is that the chances are 995 out of 1,000 that a woman’s examination will be normal. And although the thought of breast cancer is scary, one’s chance of being totally cured is so much higher if we catch the problem early.
- What should a woman expect at her screening?
There are two basic categories of mammography examinations. A screening mammogram is for women who are not having any current issues or concerns about their breasts and are getting annual screening as part of their preventive health program. When we interpret a mammogram, one of the things that we evaluate are subtle changes from year to year. So, if a woman has a prior study with another health care provider, it is extremely important for us to have those studies to compare. If this is the woman’s first mammogram or we have her prior studies available, her examination will be read within the same or next workday. Both she and her health care provider will receive the results and recommendations within a week. We may wait up to two weeks to interpret her mammogram if we are waiting for her pictures from the other health care provider to arrive.
The second category of mammography is called a diagnostic mammogram. This study is for women who are having a current problem or concern about their breasts. This is usually a new lump, pain, nipple discharge, nipple retraction or a change in the breast skin. This examination requires a prescription from her health care provider detailing their assessment of the problem. Again, having prior studies for comparison is extremely important. During this visit, we will obtain as many mammographic images as needed and perhaps perform an ultrasound of the breast to evaluate the problem. The patient will receive the results of a diagnostic mammogram and recommendation that day from the radiologist while she is in our department.
- What should a woman be prepared to share with her health care provider before a screening?
I always encourage women to be honest with themselves and their providers when they schedule a mammogram appointment about the reason for the visit. If a woman has a concern about her breast, she should discuss this with her provider prior to the visit so that the appropriate study to address her issues can be scheduled and so that the radiologist can perform the correct studies to allay her fears.
For the news media: To talk with Dr. Howard Schiffman about mammography in honor of Breast Cancer Awareness Month (October), contact Erica Carlson, senior public relations specialist, at email@example.com.