20:04 PM

Diagnosing the Headlines With Dr. Naomi Robertson

By Naomi Robertson, PharmD, MD, Envision Radiologist

In this edition of Diagnosing the Headlines, Dr. Robertson answers important questions surrounding mammograms and Breast Cancer Awareness Month.

October is Breast Cancer Awareness Month and a reminder for everyone that routine screenings and early detection can help save lives. We look at important facts, such as symptoms to look for, risk factors for breast cancer, when to schedule screenings and new imaging trends.

Diagnosing the Headlines is a series that aims to provide expert insight on important healthcare topics that have captured headlines and to unpack the key takeaways that are the most important to patients and clinicians.

At what age should women start getting regular mammograms?

The American College of Radiology recommends women begin yearly screenings starting at age 40. Some women should start earlier if they have a higher-than-average risk of breast cancer. Your healthcare provider can review your medical and family history to determine your risk factors and discuss what screening you should have.

What are some risk factors?

Signs and symptoms of breast cancer:

  • New lump or mass in breast or armpit
  • Changes in shape or pulling in of the nipple
  • Nipple discharge, crusting or oozing from or around the nipple, including blood
  • Changes in skin texture, pitting, redness, flakiness, or itchiness of the skin or nipple 
  • Changes in shape or size of the breast
  • Breast pain

If you have any of these symptoms, seek medical care right away.

How often should a mammogram be scheduled?

Screening mammograms are a tool used to find early breast cancer when it is small, easier to treat and before it is large enough to cause any symptoms. The United States Preventive Services Task Force (USPSTF) recommends that women who are 50 to 74 years old and are at average risk for breast cancer get a mammogram every two years. However, studies show that having regular mammograms can lower the risk of dying from breast cancer. It is believed that yearly mammograms can be more beneficial in helping women detect and treat breast cancer.

The American Cancer Society (ACS) and American College of Radiology (ACR) both recommend that women begin with annual screening. One difference between ACR and ACS recommendations is that the ACS states that women, ages 55 and older, may switch to biannual screening or have the option to continue with annual screening. The ACR, however, continues to recommend annual screening regardless of the patient's age. Members of these different groups and societies meet to discuss and update recommendations/guidelines based on their interpretation of the data including risks and benefits. Each comes to a consensus on screening recommendations. No recommendation is "better" than the other. Particularly, in terms of frequency of screening, I recommend annual mammograms, in keeping with the ACR. 

What are some things that one can do to prevent breast cancer?

Some major risk factors for breast cancer include age, sex at birth, inherited genetic mutations, family history of breast cancer, race and ethnicity, breast density, some benign breast conditions, age at first menstrual period and age at start of menopause. These risk factors are non-modifiable and cannot be changed. There are a few risk factors that patients can potentially control, such as excess weight and alcohol use.

Being familiar with the way your breasts look and feel is important. This will help you notice if there are changes so that you can see a healthcare provider right away.

Are there any new imaging trends that patients should be aware of? What should they know about 3D mammography or the use of AI?

Mammograms are used as the main screening and diagnostic tool to find or detect breast cancer. There are two types of mammograms: 2D (conventional) and 3D mammograms (tomosynthesis or digital tomosynthesis). X-rays are used to create images or mammograms of the breasts, which are reviewed by a radiologist. Mammograms can show abnormal calcifications or masses which may be cancerous or noncancerous (benign).

2D mammograms show two-dimensional images of the breasts. 3D mammograms use a newer technique that allows the radiologist to look at the entire breast in multiple slices or layers. Both expose the breasts to very low radiation. The dose of radiation to the breasts may be slightly lower, equal to or slightly higher with 3D mammograms compared to 2D mammograms.

Multiple studies have shown that 3D mammography finds more breast cancers and has fewer false alarms than 2D mammography, reducing the need for being called back for follow-up imaging.

Ultimately, what do you want patients to know?

Ultimately, I would like patients to know that mammograms save lives and that the best way to find breast cancer early is by getting screened. It is important that women talk to their doctor or healthcare provider about their risk factors for breast cancer, when they should begin screening and what imaging tests they should have.

Author Bio

Naomi Robertson, PharmD, MD, joined Envision Physician Services as a diagnostic radiologist in October 2022 at HCA Northwest Hospital. Dr. Robertson received her PharmD degree from Florida Agricultural and Mechanical University and completed her medical degree at the University of Miami Miller School of Medicine. That was followed by a diagnostic radiology residency with a specialized focus on breast imaging and a neuroradiology fellowship at the University of Miami/Jackson Memorial Hospital.