An acquaintance of Mary Murray, M.D. was diligent in receiving yearly mammograms, which always came back negative for breast cancer. Yet during one self-examination, the woman discovered a lump about the size of a half-dollar. By that time, it had progressed to the lymph nodes. Ultimately, a mastectomy was necessary.
It’s just one scenario, but it’s the perfect example of why Murray stresses the three facets to detecting breast cancer: annual mammograms beginning at age 40, self-exams once a month and an annual clinical exam beginning at age 25.
“Mammograms can be falsely negative about 15 percent of the time. That means there is actually something in there even though the mammogram says there isn’t,” says Murray, the breast surgical oncologist for Akron General Medical Center. “That’s why the clinical exam is so important on top of that. We like to catch all (breast cancer) as early as we can.”
Smart Business spoke to Murray about what women can do to ensure early detection of breast cancer.
How important is it to maintain regular mammograms?
The general recommendation is to start getting them at the age of 40 and every year after that. In the past, they’ve said every one to two years, but I firmly believe every year women should have one every year. If you skip one year, you could miss a tumor from the year before. By the time we see a tumor on the mammogram, it’s approximately 1 centimeter in size, which is about the size of an eraser on the tip of a pencil. The year before, it was half that. It doubles every year, so if someone skips a year, it’s going to be two to three times the size the next year. By the time a woman feels a mass on a self-breast examination, it’s usually the size of a nickel to a quarter. You can see it’s real important because a screening mammogram is the earliest way to detect a lesion before it even becomes palpable.
What are the survival rates for discovering breast cancer in a mammogram as opposed to a self examination?
If you catch it early, when it’s still very small and it hasn’t spread to lymph nodes and blood vessels, it’s called Stage One, which has a 95 percent to 99 percent survival rate. At that point, it may be about completely curable.
People who find them during a self-exam; usually, they’re the size of a half-dollar. Those people tend to have a poor prognosis. By that time, it has gotten to such a large size that it has been able to invade blood vessels. When it has access to the blood vessels, it can land in any other part of the body. As far as a prognosis at that point, at the latest stages you’re looking at a survival rate of 50 percent or less. When it becomes that advanced it’s almost impossible to cure.
How can women with dense breasts ensure they are doing all they can to detect breast cancer?
When we’re looking at mammograms, the things that are abnormal show up white, but the dense breast tissue also shows up white. Fat tissue shows up as gray, so it’s easy to see those abnormalities. But with the denser breasts, you can’t tell by feel or touch.
A study out of Toronto, recently published in the New England Journal of Medicine, studied more than 1,100 women in Toronto over a 25-year period. They found women with denser breasts have five times the risk of women that have a more fatty breast. Of all the women diagnosed with breast cancer, about one in six have dense breasts.
When people have dense breasts, it’s almost impossible to read on a mammo-gram and it can mask cancers. It’s like looking for a polar bear in a snow storm. These women are often diagnosed later. If someone comes into my office with dense breasts, I will use a Gail Model risk score.
How does that help detect breast cancer?
It helps classify a woman’s risk for breast cancer. It helps stratify women as far as the risk, then from that model you can recommend chemo prevention to help stop the tumors from growing or even forming. That can reduce a woman’s risk of breast cancer up to 50 percent.
If a woman has a higher Gail Model risk score and she has dense breasts and I can’t read the mammogram, I’ll order an MRI. That’s something that is not clear-cut in the literature, but the American College of Radiologists have put out guidelines that suggest women with higher risk scores should have an MRI. Not everyone follows that, but I think it’s a good idea that these women get them. It’s the most sensitive test you can have in picking up breast cancers. Most of the time, if you have breast cancer, an MRI will pick it up.
MARY MURRAY, M.D. is the breast surgical oncologist for Akron General Medical Center. Reach her at (330) 670-9700.