An acquaintance of Mary Murray,
M.D. was diligent in receiving yearly mammograms, which always came back negative for breast cancer.
Yet during one self-examination, the
woman discovered a lump about the size
of a half-dollar. By that time, it had progressed to the lymph nodes. Ultimately,
a mastectomy was necessary.
It’s just one scenario, but it’s the perfect example of why Murray stresses the
three facets to detecting breast cancer:
annual mammograms beginning at age
40, self-exams once a month and an
annual clinical exam beginning at age 25.
“Mammograms can be falsely negative
about 15 percent of the time. That means
there is actually something in there even
though the mammogram says there
isn’t,” says Murray, the breast surgical
oncologist for Akron General Medical
Center. “That’s why the clinical exam is
so important on top of that. We like to
catch all (breast cancer) as early as we
can.”
Smart Business spoke to Murray
about what women can do to ensure
early detection of breast cancer.
How important is it to maintain regular
mammograms?
The general recommendation is to start
getting them at the age of 40 and every
year after that. In the past, they’ve said
every one to two years, but I firmly
believe every year women should have
one every year. If you skip one year, you
could miss a tumor from the year before.
By the time we see a tumor on the mammogram, it’s approximately 1 centimeter
in size, which is about the size of an eraser on the tip of a pencil. The year before,
it was half that. It doubles every year, so
if someone skips a year, it’s going to be
two to three times the size the next year.
By the time a woman feels a mass on a
self-breast examination, it’s usually the
size of a nickel to a quarter. You can see
it’s real important because a screening
mammogram is the earliest way to
detect a lesion before it even becomes
palpable.
What are the survival rates for discovering
breast cancer in a mammogram as opposed
to a self examination?
If you catch it early, when it’s still very
small and it hasn’t spread to lymph
nodes and blood vessels, it’s called Stage
One, which has a 95 percent to 99 percent survival rate. At that point, it may
be about completely curable.
People who find them during a self-exam; usually, they’re the size of a half-dollar. Those people tend to have a
poor prognosis. By that time, it has gotten to such a large size that it has been
able to invade blood vessels. When it
has access to the blood vessels, it can
land in any other part of the body. As far
as a prognosis at that point, at the latest
stages you’re looking at a survival rate
of 50 percent or less. When it becomes
that advanced it’s almost impossible to
cure.
How can women with dense breasts ensure
they are doing all they can to detect breast
cancer?
When we’re looking at mammograms,
the things that are abnormal show up
white, but the dense breast tissue also shows up white. Fat tissue shows up as
gray, so it’s easy to see those abnormalities. But with the denser breasts, you
can’t tell by feel or touch.
A study out of Toronto, recently published in the New England Journal of
Medicine, studied more than 1,100
women in Toronto over a 25-year period. They found women with denser
breasts have five times the risk of
women that have a more fatty breast. Of
all the women diagnosed with breast
cancer, about one in six have dense
breasts.
When people have dense breasts, it’s
almost impossible to read on a mammo-gram and it can mask cancers. It’s like
looking for a polar bear in a snow storm.
These women are often diagnosed later.
If someone comes into my office with
dense breasts, I will use a Gail Model
risk score.
How does that help detect breast cancer?
It helps classify a woman’s risk for
breast cancer. It helps stratify women as
far as the risk, then from that model you
can recommend chemo prevention to
help stop the tumors from growing or
even forming. That can reduce a
woman’s risk of breast cancer up to 50
percent.
If a woman has a higher Gail Model
risk score and she has dense breasts and
I can’t read the mammogram, I’ll order
an MRI. That’s something that is not
clear-cut in the literature, but the
American College of Radiologists have
put out guidelines that suggest women
with higher risk scores should have an
MRI. Not everyone follows that, but I
think it’s a good idea that these women
get them. It’s the most sensitive test you
can have in picking up breast cancers.
Most of the time, if you have breast cancer, an MRI will pick it up.
MARY MURRAY, M.D. is the breast surgical oncologist for
Akron General Medical Center. Reach her at (330) 670-9700.