View Point

Friday, May 15, 1998

Mammography need not
be stressful experience

Doctors want to speed up
process of diagnosing illness to reduce
anxiety for women

By Scott Grosskreutz, M.D.

AT its May 7 meeting, members of the Professional Education Sub-Committee of the American Cancer Society discussed Diane Chang's April 20 piece, "Mammograms do save lives; however..."

Her column covered the anxiety she experienced during her mammogram and raised a number of important issues, which should be addressed.

Breast cancer screening can be a stressful and anxious experience for some women, although it doesn't have to be.

Anxieties may occur because of comments overheard during mammography, fear of radiation or delays in getting the results of the study. Some women are also concerned because they know the mammogram is not a perfect test.

First, women should know that the benefits of mammography far outweigh the tiny theoretical risks of radiation.

Second, screening mammography is performed without a physician in attendance. Patients may hear such comments as, "These views look OK," or "We will need to get additional images."

They should be aware that the technologist is only concerned with getting a good study, and is not assessing the study for the presence of cancer. (Technologists should take care to educate their patients that they are talking about the quality of the study and not about any abnormalities on the mammogram.)

Finally, about one in 10 breast cancers is hidden on the mammogram, usually because the surrounding dense breast tissue obscures them.

Many of these "hidden cancers," however, can be detected on the physical examination. For this reason, monthly self breast exams and annual physical examinations of the breasts by a physician or trained nurse are recommended by the American Cancer Society, in addition to yearly mammography starting at age 40.

If an abnormality is detected on the physical exam or screening mammogram, then further evaluation is indicated.

Currently, the American College of Radiology endorses the use of diagnostic problem-solving breast evaluations, so that all of the additional imaging breast work-up can be obtained at the same appointment, if requested by a patient's doctor.

This work-up most often includes a diagnostic mammography where additional images are monitored by a radiologist.

There are also a number of newer breast imaging tests available -- breast ultrasound, scintimmammography and breast MRI -- which can help detect cancers hidden on mammography.

If a biopsy is indicated, tissue sampling through the skin is often an option, if the patient and her doctor request this procedure in advance. Most often, these tests are performed on different days.

For example, if a patient has a screening mammogram and a possible mass is seen, she would be called back for a diagnostic mammogram on another day to help localize the mass and determine its shape.

Then she might have another appointment for an ultrasound to determine if the mass is a cyst or solid.

Finally, a biopsy might be needed on yet another day, which might be weeks or even months after the screening mammogram. Many patients complain that they find these long delays stressful.

Diagnostic problem-solving breast evaluations can often complete the work-up in a single visit.

In the past, insurance companies sharply curtailed or denied reimbursement if more than one breast study was performed in a single day.

Currently, an educational effort by the doctors of the Hawaii Society of Breast Imaging is under way to encourage single-visit imaging evaluations in accordance with national standards of care.

Here are some other suggestions regarding breast cancer screening:

A patient should not hesitate to ask her doctor or surgeon for a thorough physical examination of any breast lump she palpates.

If a patient has sensitive breasts, she should try scheduling her mammogram at a time of the month when her breasts will be least tender. For example, try to avoid the week right before a menstrual period; this will lessen the discomfort.

A patient shouldn't wear deodorant power or cream under the arm, as it may interfere with the quality of the mammogram.

If a patient changes medical facilities, she should ask for her old mammograms to bring with her to the new facility, so they can be compared with her new mammogram.

Patients should ask if it's possible to obtain diagnostic breast evaluations where they receive their medical care. Women should also ask if their health insurance companies encourage or discourage such evaluations when selecting their health insurers.

If a patient does not hear from her physician within 10 days after her mammogram, she should not assume her study was normal. Confirm this by calling the physician.

In closing, those of us in the medical field certainly can sympathize with the anxiety that some people feel about breast cancer screening. The American Cancer Society is always available to answer any questions at 1-800-ACS-2345.

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Dr. Scott Grosskreutz is chairman of radiology at
Hilo Medical Center on the Big Island and is a member of the
professional education subcommittee of the
American Cancer Society-Hawaii chapter.