Questions and Answers about Mammography Screening

1. Did you Know?

Over 500 women die of breast cancer in British Columbia every year.
There is no known way to prevent the disease, but if detected early, it can be treated successfully.
Womens' risk for breast cancer increases with age.

2. How can breast cancer be detected early?

International studies tested the use of a special x-ray, called a mammogram, to look for breast cancer. The studies were successful in finding breast cancer very early in its development. This early detection decreased the number of deaths by 30% in the groups studied, which included women aged 40-74. Finding the cancer when it is very small (before it can be felt) means that it often can be cured.

3. Who is eligible?

If you are 40 years of age or older and have no symptoms of breast cancer, you are eligible to participate in the Screening Program.

You will be ineligible if you have had breast cancer or have had breast implant surgery. Symptoms or problems such as a breast lump or bloody nipple discharge make you ineligible and you will be encouraged to see your family doctor so that he/she can arrange a diagnostic mammogram or other tests.

4. Why can't women with breast implants participate in the Screening Program?

The presence of breast implants makes the demonstration of the breast tissue a little more difficult. Therefore, it is recommended that women with breast implants be referred by their doctors to a diagnostic mammography office in order that additional and special x-rays can be done, if required.

5. What is the difference between a Screening Centre and a diagnostic mammography service?

St. Joseph's Hospital provides both a Screening Centre as well as diagnostic mammography services.
A Screening Centre provides screening mammography.
Screening mammography is a "check-up" for healthy women for breast cancer even though they do not have any symptoms of the disease. Results of the screening will identify those women who need further examination or investigation. Those women whose screening examinations indicate the need for further information (less than 10% of those screened) will be referred back to their general practitioners, who will refer them for a diagnostic mammogram.
Diagnostic mammography is for the evaluation of a patient with signs or symptoms of breast disease such as a lump, nipple discharge or an abnormal finding from a screening mammogram.

6. Why should I use a Screening Program centre?

The Screening Mammography Program of British Columbia is provincially coordinated to provide:
- quality control standards and monitoring
- follow-up on participants to ensure appropriate diagnostic exams are provided
- improved knowledge of breast disease in British Columbian women
This is a free diagnostic service provided by Ministry of Health funding and is the most cost effective and efficient way to provide screening mammography to large numbers of women.

7. What is involved?

Mammography uses safe, low dose x-rays to take two images of the breast (one view from above and one view from the side). A plastic shield is employed to compress the breasts during the x-ray.

8. Is compression necessary?

Yes, compression is necessary to create the best image and to allow the minimum amount of radiation. The average compression time is 1.5 seconds. The compression may cause some discomfort for some women, but this varies greatly. You can reduce the possibility of discomfort by:

Scheduling the mammogram to follow your menstrual period.
Limiting your caffeine intake 2-3 days prior to your appointment.

9. Is there a risk from Mammography?

No. Newer x-ray equipment and film processing methods allow very low levels of radiation. The average radiation dose for mammography has decreased 87 to 98% in the last 20 years. The American Cancer Society has stated that the risk from mammography is negligible. The radiation dose is equivalent to the amount of "natural radiation" exposure in travelling by airplane across the country.

10. Do I need my doctor's permission to have a screening mammogram?

No. You can have a screening mammogram on your own initiative. However, you must tell us the name of a physician to whom you want the results of your mammogram sent. In the event of an abnormality being detected, your family physician will ensure that appropriate follow-up examinations are carried out.

11. What should I do on the day of the mammography exam?

You should refrain from using deodorant, talcum powder, creams or lotions on your breasts or underarms. These products leave a residue that can obscure your mammogram. For convenience, wear a two piece outfit.

12. What are the major risk factors for breast cancer?

The two major risk factors for breast cancer are:
- female gender
- increasing age
The majority of breast cancers occur in women with no other risk factors. Some factors which may slightly increase your risk are:
- family history of breast cancer
- personal history of breast cancer

13. Do females with naturally lumpy breasts have an increased risk?

No.

14. Is it necessary for small breasted women to have mammography for early detection of breast cancer?

Yes, definitely.

15. Will mammography detect 100% of breast cancer?

No. About 10% of cancers are not detectable on x-rays. That is why regular breast self examination and an annual exam by your doctor are recommended as part of a complete breast health program. The Canadian Cancer Society provides Breast Self Examination instruction. Call your local office for more information.

16. If my screening mammogram indicates I need further examination, does that mean I have cancer?

No. Out of every 1,000 women screened, approximately 100 will be notified that further examination is required. Out of those 100, only 4 will prove to have a cancer, many of these cancers will be detected early enough that the woman has a 90-100% chance of complete cure.

17. Is a Breast Screening Program expensive to the healthcare system?

Screening studies are provided at a lower cost to the healthcare system than diagnostic studies for symptom-free women.

Scientific studies have shown that if 100% of eligible women are screened, the total cost will be approximately 70% of treating all women whose cancers are not detected early.

The cost of breast screening compares reasonably with the following healthcare practices (cost estimates are averages provided by the Ministry of Health):

breast screening $10,000/cancer detection
cervical screening (pap smear) $17,000/cancer detection
kidney transplant surgery $38,000/patient
renal dialysis (in hospital) $40,000/year/patient
open heart surgery $17,000/patient
heart transplant surgery $100,000/patient
terminal care (daily hospital cost $1,500) $12,000/week

18. Why are there different age and frequency of examination recommendations?

While there is general agreement, individual medical organizations have issued statements that vary in detail. This is very confusing for the public and many physicians. In June, 1989, eleven of the world's largest healthcare and medical research organizations reached consensus on mammography screening guidelines. The Screening Mammography Program of British Columbia based their criteria on the following guidelines:

Clinical examination of the breasts and mammography are the best detection methods.
Examinations are complimentary and both are necessary to achieve maximum detection rates.
It is recommended that the screening process begin by age 40 and consist of annual clinical examination with screening mammography performed at 1 to 2 year intervals.
Beginning at age 50, both clinical examination and mammography should be performed on an annual basis.
The recommendations apply to women without signs or symptoms of breast cancer; the frequency and type of examination will vary for the individual with symptoms and should be determined by the responsible physician.

Should further research demonstrate a benefit from revising the guidelines for routine screening, the SMPBC guidelines will be reassessed.

19. Can I come to the Program if I am under 40?

If special circumstances indicate screening before 40 years of age, your family physician may consult with a Program radiologist to gain your admittance to the Program.

20. Is there a charge for the Program?

No. The Screening Mammography Program of British Columbia is an early detection Program funded by the Ministry of Health.

To book a mammogram, call the Screening Centre toll free long distance 1-800-663-9203 Other inquiries may be directed to:
St. Joseph's General Hospital 250-339-1420	Canadian Cancer Society Comox Valley Unit 250-338-5454

AFTER YOUR SCREENING MAMMOGRAPHY

What happens after my screening mammogram appointment?

Following your visit, a radiologist will review your mammogram. Approximately two weeks after your visit, both you and your family doctor will receive a letter from the Screening Mammography Program of BC (SMPBC) with the results of your mammogram.

If my screening mammogram results are normal, what should I do?

About 93% of women have normal results.
You should return to the Screening Program in one to two years.
Because some cancer lumps cannot be seen on a mammogram, make sure your doctor examines your breasts annually and practice breast self-examination regularly.

If my mammogram results are abnormal, what should I do?

You should call your doctor for an appointment. The Screening Centre will provide your doctor with information on the tests recommended for you.

Getting an abnormal report is worrying, but does not mean you have breast cancer. All it means is that further tests are needed. There are many reasons why the mammogram could be abnormal. Most abnormalities are not breast cancer.

What if my follow-up tests do find cancer?

Your doctor will continue to coordinate your care and will give you advice on the types of treatment available.

No one wants to find out they have breast cancer, but detecting it in its early stages gives you a much better chance for cure.

Who should I call if I have questions or comments?

If you have any questions or concerns about your visit to the Screening Centre, please call the SMPBC Program Administrator at (604) 660-3641 or your local Screening Centre.

For more information about breast health or breast cancer, call 1-888-939-3333.