Earlier this week I had the opportunity to speak to Dr Nancy Cappello, a determined advocate for the right of American women to make informed decisions about their health. Nancy, who was awarded a PhD in educational administration by the University of Connecticut in the mid-1990s, has just published an article entitled “Decade of ‘normal’ mammography reports — the happygram” in the Journal of the American College of Radiology. The ‘happygram’ refers to a screening mammogram with the good news that a woman is cancer-free.
Nancy writes that in late 2003 her annual screening mammogram was reported as normal, just as had been reported in the decade previously. However, at her routine gynaecological examination six weeks later, her doctor felt a ridge in her right breast and ordered both a diagnostic mammogram and an ultrasound. While the mammogram yielded nothing, the ultrasound revealed a 2.5-cm mass that was later verified as stage IIIC breast cancer. When Nancy questioned her doctors about what had happened, she was told she had dense breast tissue and that was why the tumour was invisible to the X-rays.
Nancy was stunned to discover “My radiologist knew that I had dense breasts. My doctor knew that I had dense breasts. The only person who did not know was me: the woman with the dense breasts.” She turned to the scientific literature and discovered that there was a wealth of information: 40% of women have dense breast tissue; breast density is a strong predictor of mammographic failure; ultrasound can detect early-stage invasive cancers; and dense breast tissue is associated with higher risk of cancer.
Haunted by her doctors’ response that it was not standard protocol to inform their patients about the risks of dense breasts, Nancy turned to the state legislature. Within a few years Connecticut had implemented legislation that not only required insurance companies to pay for whole-breast ultrasound as an adjunct to mammography, but radiologists were obliged, by law, to inform patients about their breast density. Nancy and her husband Joe launched a website called AreYouDense.org, as well as a not-for-profit organisation by the same name to serve as an advocate for breast density notification laws.
With Nancy Cappello’s leadership, another 12 states have enacted similar legislation, while the FDA is looking to update the Mammography Quality Standards Act of 1992. Research evidence shows that in Connecticut there’s been a significant increase in the detection of mammographically occult cancers using ultrasound, a fitting tribute to a remarkable woman.
This just begs for an instrument that does both radiology and ultrasound…..
Ultrasound and mammography, with spatial matching of the information. Probably the ideal match in screening of dense women with a normal family history.
and radiologists who are more informed and informative about breast density!
Early detection of breast cancer is an extremely complex subject. It is my understanding that many women under the age of 40 do possess breast dense tissue. Hence, the unreliability of mammography. In that age group.
It is well-known that mammography is far from perfect, but at this point in time it’s the best tool we have to detect breast cancers early.
The reliability of mammography increases after the age of 40, because in many instances the tissues forever reason become less dense. This of course is not preclude women over the age of 40 or 50, for that matter, having dense breast tissue.
I’m not a radiologist, but ultrasound obviously plays an important role in certain diagnostic problems.
There is a disturbing trend underfoot, to delay mammography to age 50, and then every few years.
The United States preventive services task force, recommend that mammography should begin at age 50, and then every two years later.
The United States preventive services task force`s mammographic guidelines have been widely discredited by the American Cancer Society, the American Medical Association, American radiology Association, and many other learned bodies.
The unfortunate truth of the matter, is with all our imperfect diagnostic tools, many women are going to die from breast cancer.
Until we find a breast cancer marker, a blood test that can pick out cancers that will surely kill, if left untreated, and those that will do no harm. If left alone..
My own daughter was informed on her 50th birthday that she had a widespread invasive carcinoma involving most of her left breast. All previous mammograms had been negative, and if it had not been for an astute Dr. who ordered an MRI, she would probably not be alive today.
Dense breast tissue can occur at all ages. women under 40 are prone to have dense breast tissue,HENCE ROUTINE MAMMOGRAPHY IS NOT USUALLY RECOMMENDED BEFORE 40.
ULTRA SOUND, AND MRI ARE BOTH USEFUL TOOLS, WHEN USED WITH DISCRETION.
THESE 2 VIDEOS**SUMMARIZES A SOMETIMES DIFFICULT DIAGNOSTIC SITUATION. MAMMOGRAPHY IS CERTAINLY FAR FROM PERFECT, BUT IT UNDOUBTEDLY SAVES MANY WOMEN`S LIVES
IAN GRANT-WHYTE MA MD (CAMBRIDGE)
http://www.youtube.com/watch?v=g84IpPSIPSI&feature=youtu.be (July 2013)
Over reliance on negative Mammography can sometimes be a great mistake.