Imagine trying to pick a white marble out of a field of snow.
That’s the kind of difficulty a radiologist might have looking for a tumor on a mammogram.
The challenge, Kingston radiologist Dr. Thomas Bednarek says, is that cancerous tumors show up as white on mammograms. So do harmless cysts. So does fibroglandular tissue, which is the dense, non-fat tissue that many women have in abundance.
So, while mammograms may work very well for finding tumors in breasts that are mostly fat, because fat shows up as gray, they don’t necessarily work so well for detecting cancer in the 40 percent of women who have dense breast tissue.
Fortunately, there are other tools. Women with dense breasts routinely have ultrasound tests in addition to mammograms at Vision Imaging in Kingston, where Bednarek works. If still further information is needed for a diagnosis, a smaller group of women go on to have an MRI (magnetic resonance imaging) test as well.
But not every woman is so fortunate.
“I’ve had women tell me they’ve been having mammograms for 10 years, and nobody ever told them they had dense breasts,” Bednarek said.
That can be dangerous, said State Rep. Karen Boback, R-Harveys Lake, pointing out that if a woman doesn’t even know she has dense breasts, a possible cancer might not be discovered when it is small and easily treatable.
Boback happily reported last week that the House Health Committee voted unanimously on Wednesday to pass Senate Bill 358, which would require radiologists to inform women about their breast density so they will be aware they may need more testing than just a mammogram.
Earlier this year a similar bill, authored by Sen. Bob Mensch and co-sponsored by Sen. Lisa Baker, R-Lehman Township, and Sen. John Yudichak, D-Plymouth Township, was approved in the state Senate. The House version of the legislation was introduced by Boback, who is hopeful the full house will vote on it and pass it as early as this month.
The bill has the potential to save women’s lives or perhaps to spare them the harsh treatments needed when cancer is discovered later rather than sooner, Boback said.
“It’s a very important piece of legislation,” Baker agreed, noting she has had ultrasounds herself and is eager to see them become more commonplace for women who could benefit.
If readers feel strongly about the issue, Pat Halpin-Murphy of the Pennsylvania Breast Cancer Coalition urges them to contact their state representatives. A sample letter is available at www.pabreastcancer.org, she said.
What do tests show?
The female breast is so unique, Bednarek said, it carries as much detail as fingerprints or dental records. “No two women have the same mammograms.”
Inside the complex mix of fat, connective tissue, milk ducts, lobes and lobules, unfortunately, cancer can sometimes raise its ugly head. It’s not just one type of cancer, either. There are about 20 different kinds of cancer that can affect the breast.
“Some behave fairly innocently; they’re not galloping off to kill someone. Others are aggressive,” he said.
Shaking his head at “so many things that can go wrong,” Bednarek said, “I often look heavenward to the maker and say, ‘What were you thinking?’ “
But, he said, while “the face of breast cancer is manifold” and detecting it is “a daunting challenge,” when it’s caught early there is a 99.9 percent chance of a cure.
A need for tests
That’s why the radiologist becomes impatient when he hears that U.S. Preventative Services Task Force recommends that women delay scheduling regular mammograms until age 50, rather than age 40.
“They said you don’t need one between ages 40 and 50, yet that’s when 20 to 25 percent of malignancies develop,” he said. “Did they get it backwards?”
The task force also recommended mammograms every other year instead of every year — which makes him angry because a fast-growing cancer doesn’t need that much time to manifest itself.
Likewise, he thinks the recommendation that women stop getting routine mammograms at age 74 doesn’t make sense for everyone. “This is what I would say. If a woman has severe heart problems and renal failure, no, you probably don’t have to take her out of the nursing home to get a mammogram. But if she’s in good health, she should ask herself if she’s likely to live at least five more years. If she wants those to be healthy years, she should get the mammogram.”
Both the American Cancer Society and the American College of Obstetricians and Gynecologists recommend most women start mammograms at age 40, earlier for women with family history or other risk factors.
“Listen to them,” Bednarek said.
One of the arguments the task force had against more frequent mammograms was that they led to increased stress and a greater number of biopsies for women who learned the suspicious area was not cancer after all.
“What woman wouldn’t be immensely happy to hear that?” asked Bednarek, who also believes it’s worthwhile for at-risk women to be tested to see if they have a genetic mutation that increases the chance of breast cancer.
“Forewarned is fore-armed,” he said.