Who Needs Mammography?

Still another drawback of mammography is its price. The procedure is quite expensive which makes routine screening impractical for most women. Who then should undergo mammography?

If you belong to the high-risk group, that is, you are over 50 and have a personal or family history of cancer; it pays to have a mammogram annually. For women below 50, here are some guidelines from Dr. David E. Larson, editor-in-chief of the “Mayo Clinic Family Health Book”:

If you are younger than 40 years, you do not need mammography unless you develop a problem or are in a high-risk category.

If you are between 40 and 49 years and have a family history of breast cancer, have a mammogram once a year.

If you are between 40 and 49 years, have no symptoms or self-found lumps, and have no family history of breast cancer, have a mammogram once every two years.

If anything suspicious shows up after mammography, the only sure way to tell if it's cancerous or not is to have a biopsy. This can be done in two ways.

The fine needle aspiration biopsy (FNAB) is so named because the physician uses a thin needle to draw fluid from the lump. This fluid is analyzed for malignant cells afterwards. FNAB can be done in a physician's office with local anesthesia.

In surgical biopsy, the entire lump is removed in a hospital and examined by a pathologist. This is usually recommended if fluid cannot be taken from the lump or if the lump contains blood or malignant cells.

Between the two, FNAB is safer and more economical, but surgical biopsy is more accurate. In “The Best Treatment,” Dr. Isadore Rosenfeld of the New York Hospital - Memorial Sloan-Kettering Cancer Center said the needle technique sometimes gives "false-negative" results, making it less desirable than a surgical biopsy.

In 80 percent of cases, the lump turns out to be benign. But what if it's not? That's when surgery steps into the picture. This is often combined with radiation, hormone, or chemotherapy.

Women once dreaded the surgical approach since it disfigured them. Previously, this involved removing the entire breast together with the glands in the armpit and all the muscles and tissues of the chest wall - a procedure called radical mastectomy or the Halstead operation. This left the patient with less tissue covering the chest and a swollen arm that didn't function well.

Today's surgical techniques have been refined and are less mutilating. Depending on the size and location of the tumor, surgery may involve removing the breast and lymph nodes from the armpit (modified radical mastectomy), the breast alone (simple mastectomy), or the tumor alone (lumpectomy or partial mastectomy). The latter is usually performed if the tumor is small.

“Regardless of which procedure is done, lumpectomy or modified radical, the surgeon will remove and analyze the glands located in your armpit in order to determine whether the tumor has spread to involve them. This information has vital bearing on your subsequent treatment,” Rosenfeld concluded. (Next: Circumcision and cervical cancer.)

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