Mammogram vs ultrasound
June 19, 2009 5:55 PM Subscribe
My girlfriend had a breast ultrasound 6 months back at doctor's request since doctor suspected a lump during breast examination.
At that time she was pregnant. The results came out normal.
(Benign)
They wanted to do a follow up ultrasound
after 6 months.
Since she just delivered a baby, i doubt they
might request her to go for mammogram.
She is in her mid 30's.
I read having a mammogram before 30's has some risks.
I intend to request the doctor to go for ultrasound examination
only ?
Am i making the correct decision ?
Can you pl. share your views.
The risk from a mammogram doesn't seem to be any different by age.
From the American Cancer Society's info on mammograms:
to put [mammography] dose into perspective, if a woman with breast cancer is treated with radiation, she will likely get a total of around 5,000 rads (a rad is a measure of radiation dose). If she has yearly mammograms beginning at age 40 and continues until she is 90, she will get a total of 20 to 40 rads. To put it another way, the dose of radiation that she gets during a screening mammogram is about the same amount of radiation from her natural surroundings (background radiation) she would average in a 3-month period.
The risk of her letting it go and not getting the mammogram outweigh the risks of getting one mammogram, IMO, even if the vast majority of lumps in women of her age are non-cancerous. IANAD. It doesn't even sound like they're wanting to do one though, just a follow up ultrasound.
posted by ishotjr at 6:03 PM on June 19, 2009
From the American Cancer Society's info on mammograms:
to put [mammography] dose into perspective, if a woman with breast cancer is treated with radiation, she will likely get a total of around 5,000 rads (a rad is a measure of radiation dose). If she has yearly mammograms beginning at age 40 and continues until she is 90, she will get a total of 20 to 40 rads. To put it another way, the dose of radiation that she gets during a screening mammogram is about the same amount of radiation from her natural surroundings (background radiation) she would average in a 3-month period.
The risk of her letting it go and not getting the mammogram outweigh the risks of getting one mammogram, IMO, even if the vast majority of lumps in women of her age are non-cancerous. IANAD. It doesn't even sound like they're wanting to do one though, just a follow up ultrasound.
posted by ishotjr at 6:03 PM on June 19, 2009
I forgot to include that one mammogram is usually only 0.1 to 0.2 rads per picture.
posted by ishotjr at 6:04 PM on June 19, 2009
posted by ishotjr at 6:04 PM on June 19, 2009
I would have thought that a mammogram wouldn't be performed if she is breastfeeding. IANAD, just an uninformed passer-by. Is the doctor you mention a regular GP, or a specialist? I would suggest she calls her OB to ask about the mammogram. Many doctors are (IMHO) unaware of the peculiarities of the lactating female body, and how it may affect other medical matters.
posted by Joh at 6:11 PM on June 19, 2009
posted by Joh at 6:11 PM on June 19, 2009
In making my own decision about routine mammograms, I found a book called Should I Be Tested for Cancer? very helpful.
I wouldn't feel that following up on a suspected lump found during pregnancy or lactation was a high priority; I think I remember during my own pregnancies reading that changes due to the pregnancy could cause the feeling of the breast to change. But it's been awhile.
The risks associated with mammogram and other screening tests include the possibility of false positives, causing emotional distress; the stress and expense of follow-up testing; and the possibility of unnecessary treatment. The book I mentioned was very helpful for me in weighing these various risks.
posted by not that girl at 6:26 PM on June 19, 2009
I wouldn't feel that following up on a suspected lump found during pregnancy or lactation was a high priority; I think I remember during my own pregnancies reading that changes due to the pregnancy could cause the feeling of the breast to change. But it's been awhile.
The risks associated with mammogram and other screening tests include the possibility of false positives, causing emotional distress; the stress and expense of follow-up testing; and the possibility of unnecessary treatment. The book I mentioned was very helpful for me in weighing these various risks.
posted by not that girl at 6:26 PM on June 19, 2009
You're weighing the emotional distress of waiting for test results vs the emotional distress of, um, cancer. Get the mammogram. (While not perfect, it's a much better test than ultrasound.)
posted by ruwan at 6:38 PM on June 19, 2009
posted by ruwan at 6:38 PM on June 19, 2009
ruwan, I don't want to derail, but I refer you to the book, or to other similar resources. I modified my mammogram schedule after learning that my risk of developing breast cancer during my 40s is about 1%, but the false positive rate on mammograms--which has been climbing--means that a woman who gets an annual mammogram during her 40s has something like a 55% chance of a false positive during that decade. It's not negligible, and it's worth taking into account in decision-making.
The OP isn't talking about a routine mammogram, however, given that his girlfriend has actually had a lump. On reflection, I would probably say to him and his girlfriend that if the doctor recommends a follow-up ultrasound, that's probably sufficient and I wouldn't personally push for a mammogram. But if the doctor recommends a follow-up mammogram, I wouldn't necessarily refuse it. In terms of radiation exposure, it's negligible as ishotjr says, and except for the possibility of false positives, I don't know of any other risks associated with mammograms.
Of course, I'm not a doctor. I'm just a person with breasts who reads a lot, has had plenty of mammograms, has been pregnant twice, and tries to make informed decisions.
Congrats on the baby, by the way, tom 123!
posted by not that girl at 6:45 PM on June 19, 2009
The OP isn't talking about a routine mammogram, however, given that his girlfriend has actually had a lump. On reflection, I would probably say to him and his girlfriend that if the doctor recommends a follow-up ultrasound, that's probably sufficient and I wouldn't personally push for a mammogram. But if the doctor recommends a follow-up mammogram, I wouldn't necessarily refuse it. In terms of radiation exposure, it's negligible as ishotjr says, and except for the possibility of false positives, I don't know of any other risks associated with mammograms.
Of course, I'm not a doctor. I'm just a person with breasts who reads a lot, has had plenty of mammograms, has been pregnant twice, and tries to make informed decisions.
Congrats on the baby, by the way, tom 123!
posted by not that girl at 6:45 PM on June 19, 2009
REGULATORY GUIDE 8.29 is the U.S. Nuclear Regulatory Commisions guide on radiation exposure. The above is mostly meant for people who receive much large radiation doses but it covers how they calculate the risk of developing cancer from low level radiation doses (a mammogram) and what assumptions are built into it.
Apendix section 6-10 gives you a general what is happening, what we think will happen, how we estimate the danger involved and where we get our data from.
Using the NRC estimation that a 1 rem/ 0.01 Sv dose has a risk of 4 in 10,000 developing a fatal cancer, a mammogram comes out to a risk of 28 in 1,000,000 (a 0.7 mSv dose) chance of developing a fatal cancer.
The above estimation is probably extremely conservative ( it overestimates the risk of developing fatal cancer) however, since low level radiation doses are extremely hard to study "The uncertainty associated with this risk estimate does not rule out the possibility of higher risk, or the possibility that the risk may even be zero at low occupational doses and dose rates."[Appendix section 8]. This on top of the fact that the 4 in 10,000 chance of developing fatal cancer includes doses to vital organs means we are probably overestimating the risk by several magnitudes.
So the question becomes is a 28 in 1,000,000 chance of developing fatal cancer worth the risk of proper identification of something that the doctors are going "hmmm we need to look into and monitor this because it could turn out to be bad"?
posted by metex at 6:54 PM on June 19, 2009
Apendix section 6-10 gives you a general what is happening, what we think will happen, how we estimate the danger involved and where we get our data from.
Using the NRC estimation that a 1 rem/ 0.01 Sv dose has a risk of 4 in 10,000 developing a fatal cancer, a mammogram comes out to a risk of 28 in 1,000,000 (a 0.7 mSv dose) chance of developing a fatal cancer.
The above estimation is probably extremely conservative ( it overestimates the risk of developing fatal cancer) however, since low level radiation doses are extremely hard to study "The uncertainty associated with this risk estimate does not rule out the possibility of higher risk, or the possibility that the risk may even be zero at low occupational doses and dose rates."[Appendix section 8]. This on top of the fact that the 4 in 10,000 chance of developing fatal cancer includes doses to vital organs means we are probably overestimating the risk by several magnitudes.
So the question becomes is a 28 in 1,000,000 chance of developing fatal cancer worth the risk of proper identification of something that the doctors are going "hmmm we need to look into and monitor this because it could turn out to be bad"?
posted by metex at 6:54 PM on June 19, 2009
In general, do what the doc recommends in this case. If they want to start with mammogram, fine -- since, if it's negative, nothing further needed. And as mentioned above, the physical risk of mammogram is essentially nil with respect to radiation. In this case, I'd think wanting to get follow-up on a previous lesion would generally be reducing stress, not causing it.
On the other hand, if you go back and the doctor recommends only ultrasound, moot point.
At any rate, I hope it all works out well. And congratulations on the baby!
posted by davidnc at 7:26 PM on June 19, 2009
On the other hand, if you go back and the doctor recommends only ultrasound, moot point.
At any rate, I hope it all works out well. And congratulations on the baby!
posted by davidnc at 7:26 PM on June 19, 2009
Just to clarify, I'm not suggesting mammograms while breastfeeding is a radiation risk, but simply that a lactating breast is full of milk, and much denser, so possibly a mammogram will be less useful. But this is wild speculation on my part. I know my own OB did not seem interested in doing a manual breast exam while I was breastfeeding, because it would be hard to detect lumps in full, lumpy breasts.
posted by Joh at 8:31 PM on June 19, 2009
posted by Joh at 8:31 PM on June 19, 2009
"This study examined the data of nearly 2 million breast cancer screenings and found that of 2,000 women screened regularly for ten years, one will benefit and avoid dying from breast cancer, but ten healthy women will have needlessly undergone mastectomies, radiation and sometimes chemotherapy, and another 200 will have endured a false alarm and follow-up tests and biopsies."
"The breast cancer screening information that American women receive from health insurance plans and hear from the media is exactly as Dr. Gøtzsche and colleagues described. The information is universally one-sided — women never hear the evidence or balancing information about the downsides. And they’re never told that not having a mammogram can even be a reasoned option. "
"The rate of false positive diagnosis after ten screenings was 50% in the United States and 20% in Norway."
The NHS literature states that a mammogram “involves a tiny dose of radiation, so the risk to your health is very small.” But, as the doctors pointed out, the rate of overdiagnosis was 30% in randomised trials of screening and 50% in observational studies. They concluded that it was misleading to reassure women they would only be exposed to tiny doses of radiation when significant numbers of healthy women will be put at risk with much larger doses in radiotherapy.
posted by IndigoRain at 9:00 PM on June 19, 2009 [5 favorites]
"The breast cancer screening information that American women receive from health insurance plans and hear from the media is exactly as Dr. Gøtzsche and colleagues described. The information is universally one-sided — women never hear the evidence or balancing information about the downsides. And they’re never told that not having a mammogram can even be a reasoned option. "
"The rate of false positive diagnosis after ten screenings was 50% in the United States and 20% in Norway."
The NHS literature states that a mammogram “involves a tiny dose of radiation, so the risk to your health is very small.” But, as the doctors pointed out, the rate of overdiagnosis was 30% in randomised trials of screening and 50% in observational studies. They concluded that it was misleading to reassure women they would only be exposed to tiny doses of radiation when significant numbers of healthy women will be put at risk with much larger doses in radiotherapy.
posted by IndigoRain at 9:00 PM on June 19, 2009 [5 favorites]
I have a history of breast cancer in my family and even my doctor did not recommend a mammogram until 3-4 months after I stopped breast feeding. Not because of radiation doses, but because the changes in the breast tissue from pregnancy and breast feeding make the detection of a lump awfully difficult. Or rather, I should say the detection of an anomalous lump.
I have read that getting a baseline mammogram in your 30s can be a useful tool to compare later mammograms to, especially if your chances of getting BC are higher than normal for some reason. But, in looking into that just now, it seems like there is some doubt about the usefulness of baseline mammograms unless you're at least 40-70, and possibly 50+.
And yeah, congratulations!
posted by cocoagirl at 11:08 PM on June 19, 2009
I have read that getting a baseline mammogram in your 30s can be a useful tool to compare later mammograms to, especially if your chances of getting BC are higher than normal for some reason. But, in looking into that just now, it seems like there is some doubt about the usefulness of baseline mammograms unless you're at least 40-70, and possibly 50+.
And yeah, congratulations!
posted by cocoagirl at 11:08 PM on June 19, 2009
It's not really that mammograms in your 30's are more risky -- it's that they're kind of fruitless.
The tissue in your breasts loses density with age. The reason that mammograms work after the age of 40 is that that's when the breast tissue has finally lost enough density for any lumps to even show up on a mammogram. Before age 35-40, the tissue is just too dense to give a good reading -- your breasts show up as a fairly solid mass, and you can't see a damn thing. Some places still try to give them to you anyway, if there are certain concerns; twice in my early 30's I found lumps myself, and my doctor referred me to get a sonogram, but the place she referred me to insisted on giving me a mammogram as well because they just automatically did that to anyone over the age of 30 who had a "family history." In both cases, they did the mammogram first, saw that they couldn't see a damn thing on it, and sent me in to get the sonogram. (I was fine both times -- they were cysts in both cases, and my doctor has noticed I'm just generally prone to cysts and so now we don't even bother to check any lump out unless it's been there for more than a couple months.)
It could be that the "risk" is more about how having any x-ray you don't really need is risky, because cumulative exposure to x-rays is generally risky, so why get something that you are already certain won't really work.
posted by EmpressCallipygos at 12:58 AM on June 20, 2009
The tissue in your breasts loses density with age. The reason that mammograms work after the age of 40 is that that's when the breast tissue has finally lost enough density for any lumps to even show up on a mammogram. Before age 35-40, the tissue is just too dense to give a good reading -- your breasts show up as a fairly solid mass, and you can't see a damn thing. Some places still try to give them to you anyway, if there are certain concerns; twice in my early 30's I found lumps myself, and my doctor referred me to get a sonogram, but the place she referred me to insisted on giving me a mammogram as well because they just automatically did that to anyone over the age of 30 who had a "family history." In both cases, they did the mammogram first, saw that they couldn't see a damn thing on it, and sent me in to get the sonogram. (I was fine both times -- they were cysts in both cases, and my doctor has noticed I'm just generally prone to cysts and so now we don't even bother to check any lump out unless it's been there for more than a couple months.)
It could be that the "risk" is more about how having any x-ray you don't really need is risky, because cumulative exposure to x-rays is generally risky, so why get something that you are already certain won't really work.
posted by EmpressCallipygos at 12:58 AM on June 20, 2009
If your girlfriend's doctor recommends a mammogram, why would you trust your expertise in oncology over his?
Many of your past question are to challenge or verify what doctors and dentists have told you. If you have a distrust of doctors and dentists, why bother going to them at all?
And, you say, "I intend to request the doctor to go for ultrasound examination only." What about your girlfriend's wishes? It's her health, after all. I'm really not sure that a doctor will do what you tell him to do, anyway, since you are not the patient.
posted by Houstonian at 5:20 AM on June 20, 2009 [4 favorites]
Many of your past question are to challenge or verify what doctors and dentists have told you. If you have a distrust of doctors and dentists, why bother going to them at all?
And, you say, "I intend to request the doctor to go for ultrasound examination only." What about your girlfriend's wishes? It's her health, after all. I'm really not sure that a doctor will do what you tell him to do, anyway, since you are not the patient.
posted by Houstonian at 5:20 AM on June 20, 2009 [4 favorites]
i would imagine that any risk a mammogram poses is far lower than undiagnosed or late-diagnosed breast disease.
to put it in another light, you both put your lives at far greater risk every time you get into a car than she would experience by getting yearly mammograms at an earlier age than recommended.
posted by thinkingwoman at 6:15 AM on June 20, 2009
to put it in another light, you both put your lives at far greater risk every time you get into a car than she would experience by getting yearly mammograms at an earlier age than recommended.
posted by thinkingwoman at 6:15 AM on June 20, 2009
A relative contracted breast cancer at 25. It happens. If breastfeeding will make detection more difficult this baby should go on formula. Breastfeeding has benefits for a baby. Growing up with a mother has even more benefits for a child. It's also time to make sure you are seeing top notch doctors.
posted by caddis at 6:58 AM on June 20, 2009
posted by caddis at 6:58 AM on June 20, 2009
When I went to get screened for the breast cancer gene mutation, they explained to me that if I had it, I would be eligible for MRI screening instead of mammograms. The downside is that the MRI is less accurate about detecting exactly where the cancer is, or even confirming that it's cancer, so you may get a whole breast removed and find that it was benign. They figure that it's worth it, for women who have an 80%+ life time risk of breast cancer. The upside is that it has (or had, at the time of this conversation), a 100% track record of detecting cancer before it metastasizes. Unlike mammograms, which are completely hit and miss. My grandmother survived breast cancer and my mother died of breast cancer. I don't have the genetic mutation (at least, not the known one), and I think I'll probably give mammograms a miss. Cancer makes your life miserable enough once you have it, I don't want to give my life over to it before I have to.
posted by Salamandrous at 7:10 AM on June 20, 2009
posted by Salamandrous at 7:10 AM on June 20, 2009
Am I right in seeing a trend of the guys in this thread have the "don't ask questions, just do the damn mammogram" answers and the women have the "weighing the pros and cons" answers?
posted by small_ruminant at 9:21 AM on June 20, 2009 [1 favorite]
posted by small_ruminant at 9:21 AM on June 20, 2009 [1 favorite]
Am I right in seeing a trend of the guys in this thread have the "don't ask questions, just do the damn mammogram" answers and the women have the "weighing the pros and cons" answers?
No, I don't think that's correct.
posted by Houstonian at 9:52 AM on June 20, 2009
No, I don't think that's correct.
posted by Houstonian at 9:52 AM on June 20, 2009
This thread is closed to new comments.
posted by 0xFCAF at 6:00 PM on June 19, 2009