Debunking Myths

Besides controversy, misunderstandings about mammograms abound. Some women with breast implants, for instance, think they don’t need to undergo screenings. That’s not true, says Ted Gansler, director of medical content for the American Cancer Society. Women with implants can and should undergo breast exams and mammograms.

Other myths, sometimes propagated via mass e-mails, suggest that using antiperspirant or wearing a bra will give you breast cancer. Both claims are false, although antiperspirant can interfere with a mammogram, so it should be avoided on the day of the test.

Another controversy surrounds self breast exams. Once thought to be a necessity, these are now viewed as optional by many providers. If you want to perform a monthly check, speak with your doctor to make sure you know how to do it. If not, Gansler says, “just be aware of breast changes and get checked when you have a concern.”

The best ways to promote breast health, according to experts, are to maintain a healthy weight, particularly after menopause, exercise regularly, and consume no more than one alcoholic drink a day.

After undergoing four images, two of each breast, I return to the waiting area. During my previous visit, when my breasts were lumpy, my mammogram was followed by an ultrasound, which uses sound waves to create a picture of breast tissue. An ultrasound can help determine whether lumps are fluid-filled (cysts) or solid masses. My ultrasound at Ourisman, unlike ones I’ve had elsewhere, was performed by two radiologists rather than a technician. They gave me my verdict on the spot: benign cysts. This time, because my breast exam was so clean, I’m expecting an early dismissal with no ultrasound.

I’m half right. Eluwa summons me again. She points to a white smudge on the computerized representation of my left breast and takes two more images. A short time later, radiologist Scott Kuo explains that the smudge was an area of density; he needed to view it from additional perspectives and compare it with earlier results to make sure it was nothing new. It wasn’t, he tells me. No need for an ultrasound.

“See you next year,” he says.

The Future: Decisions

I breathe a sigh of relief that the appointment is over and the outcome is good. Yet I have decisions to make.

There’s the MRI order, which for the moment I stuff into my purse. The thought of lying inside a noisy tube with my breasts suspended into cones doesn’t thrill me. Nor does the fact that the test generates more false positives than do mammograms. This isn’t to say I’m not persuadable. Both Warren and Stukus say they’re available to discuss this matter further, and I’ll likely take them up on their offers.

There’s also the question of whether to take a drug that’s been approved to lower the chance of breast cancer in women with an increased risk. One drug is tamoxifen, which is also given to women who have had cancer; my sister took it for five years to reduce her risk of recurrence. It appears to have been a good move for her, but I doubt I’ll take it. I worry about possible side effects—blood clots, stroke, uterine cancer, cataracts—even though the Breast Cancer Prevention Trial, a study funded by the NCI, found a reduction in invasive breast cancer in high-risk women who took tamoxifen for five years.

Warren said I could wait until winter to have the MRI, which gives me a chance to discuss it with my gynecologist, too. Usually, my gynecologist and my breast-care providers agree, but not always. The Ourisman team, for instance, has placed a higher priority on getting me off of the birth-control pill.

What’s clear is that all of my practitioners have my best interest in mind. It’s also clear that while the science has advanced a lot since my mother’s diagnosis, and even my sister’s, it’s not yet exact.

“We have no guarantee tamoxifen will prevent you from developing breast cancer,” Warren says. “What we can say is that it reduces your risk. The reason we don’t insist on it is that we’re not the ones who are going to be experiencing the side effects, and they’re not trivial, although thankfully they’re rare. We try to give you the best information we can so you can make an informed decision.”

I like my doctor’s approach. It tells me he understands the challenging decisions facing women at an elevated risk for breast cancer. It also tells me he’s open to hearing me express hesitancy over a recommended procedure. I tend to side with experts such as breast surgeon Susan Love, who has cautioned against overscreening and overtreatment. For me, the stress associated with unnecessary procedures seems as significant a health concern as any.

In the end, each person has to be comfortable with her decisions and confident that she has a skilled and supportive team behind her. On this last point, I feel very good.

This article first appeared in the October 2010 issue of The Washingtonian.