I Hate Mammograms
My search for a better way to detect breast cancer
I parted my hospital robe and carefully propped my right breast onto a chilly shelf, pressing my ribs against the mammography machine. I inhaled slowly, trying to relax. As the plates pressed down, my breath stopped, and my eyes watered.
We would never do this to a man’s balls, I thought, once the tortilla press released my breast. We can send men to the moon, but we can’t create a better way to find breast cancer?
Ask any radiologist and they will tell you that the mammogram is the gold standard for detecting breast cancer. That’s largely because of the volume of randomized control trial data in support of mammography’s effectiveness, including over the long-term, says Dr. Bonnie Joe, chief of breast imaging at the Department of Radiology and Biomedical Imaging at the University of California, San Francisco. “The mammogram is the only one proven, in these trials, to save lives from cancer.”
It’s also because mammography can detect calcifications in the breast, a potential sign of cancer. “To compete with mammography is almost impossible, because it works so well,” says Dr. Avice O’Connell, professor of imaging sciences and director of women’s imaging at the University of Rochester.
That god-awful compression is key. “When you compress the breast, you reduce its motion,” explains Dr. Jean Kunjummen, director of the Breast Imaging Center at Emory University Hospital Midtown. “Even breathing can cause blurry images, and then you don’t find the small [early stage] cancers.” The smaller the cancer, the better the chances of treating it, says Dr. Kunjummen. “Size matters.”
Compression also reduces the amount of radiation that’s needed during the screening because it’s easier to “see” through a flattened breast.
Mammography may be queen, but there are other options — though all carry significant drawbacks. Ultrasound, for example, has a high false positive rate. Molecular breast imaging (MBI), in which a radioactive tracer is injected intravenously, then viewed with a gamma camera, exposes the entire body to radiation, not just the breasts. The dose is too high (30–40 times higher than mammography) to do annually.