The breast mammogram for many years has been the standard for breast screening.
Recently, however, there have been questions raised about this procedure because of the low incidence of positive biopsy based on mammograms alone, which in most reports has been in the range of 20 percent positive biopsy.
The other question that is being raised is whether the radiation from mammograms increases risk of breast cancer.
For a woman to reach the best protocol for her own breast screening, she needs to know what alternate techniques are available. These are: breast ultrasound, breast scintimammogram and, more recently, the positron emission mammogram (PEM).
There is now also a resurgence of interest in breast thermography. The advantage of breast ultrasound and breast thermography is that there is no radiation exposure.
The nuclear medicine breast scintimammogram and positron emission mammography do use radioactive tracers and produce some radiation exposure but are, in my opinion, significantly beneficial in evaluating the breast.
For instance, years ago when I was reading several thousand mammograms per year, I also employed breast scintimammograms as an adjunct to ultrasound studies.
During that period of time, my positive predictive value for breast biopsy was 62 percent and my indeterminate was 12 percent. My negative biopsy rate was 26 percent, an almost 180-degree reverse from the average across the country where 80 percent of breast biopsies are negative.
The positron emission mammography (PEM) is better than the scintimammogram, because it has the ability to detect breast cancers as small as 0.5cm, whereas the scintimammogram is not very effective for cancers less than 1cm in size. These studies are particularly helpful in dense breasts where the standard mammogram is less accurate.
In my opinion, the ultrasound and the thermogram should be considered in women who are receiving hormone replacement therapy.
There is documentation of synergism between radiation and estrogen in the production of breast cancer first reported in Cancer Research: 31:166-8 February 1971, co-authored by Albert Segaloff and myself.
To me, what is not appreciated is that, with the intake of hormones, the breast tissue tends to grow, and the breasts become more dense, causing an increase in the amount of radiation required to obtain an adequate mammogram.
Therefore, the presence of extra hormones and increased radiation dose, in my opinion, is the reason for the reported incidence of breast cancer in some patients who have had mammograms.
My suggestion is to limit the number of mammograms in women with dense breasts and use ultrasound and thermography, which is growing in utilization as a screen for dense breasts.
Screening of the breast is important because there is good documentation that there is increased cure of breast cancer and survival if the cancer is detected and treated at a very early stage.
Mammography is good at early detection but is limited in women with dense breasts. Therefore, knowledge of the different methods of imaging the breast is, therefore, very important and the different methods should be employed.
It is important also for women to check their own breasts to determine if there is a developing lump, asymmetry, or if they have pain in the breast.
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