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Straight Talk on Mammograms

Monday, June 3, 2013
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Debra Somers Copit, M.D., Director of the Gershon-Cohen Breast Clinic, Einstein Healthcare Network

Einstein has the newest form of breast imaging: digital breast tomosynthesis. What is it?

“I am really excited about digital breast tomosynthesis because it allows us to see breast tissue in a more detailed way,” explains Dr. Debra Copit, director of Einstein’s Gershon-Cohen Breast Clinic. “DBT is still mammogram, but it uses low radiation doses and takes multiple pictures at different angles to get an almost three-dimensional picture of the breast. It allows us to look through overlapping layers of breast tissue and find abnormalities more easily. Einstein has been involved with the research behind DBT for over four years and our radiologists have extensive experience interpreting these images. Einstein is one of only two medical centers in the city to have this, and I’m thrilled to have it for our patients.”

Who should get a mammogram? At what age and how often?

“These are both simple and complex questions,” Copit says. “I go by what the American College of Radiology and the American College of Surgeons recommend. That is: Start at age 40 and get a mammogram every year. There is Level 1 evidence — the highest grade in medicine that includes randomized, controlled trials — to support that. The research showed a 30 to 40 percent reduction in mortality when women were screened versus those who were not screened in multiple studies. Period. End of story.”

But other medical organizations disagree with that recommendation. “That stems from a report by the U.S. Preventive Services Task Force which said that mammograms should start at age 50 and be done every other year until age 74,” Copit says. “That task force was riddled with problems. It did not include anyone who specializes in breast cancer or mammography. Many professional medical organizations refuted the task force’s recommendation, but the cat was already out of the bag and a lot of confusion was caused.

 “I see what happens when we find cancer in its advanced stage,” Copit adds, “and we know that it could be very different if it was found early with a mammogram.”

The guidelines differ for women with a family history of breast cancer and those who have the BRCA genetic mutations.

“Women who have the BRCA mutations need a breast MRI and a mammogram, one every six months, so they get screened twice a year,” Copit says. “Go to a facility where the radiologist and surgeon specialize in breast cancer. The doctors really have to know what to look for.”

The same twice-yearly screening is recommended for those who have not been genetically tested but have relatives who tested positive for the mutation. “And I very strongly suggest getting screened not just for the BRCA mutations but for other genetics that indicate cancers,” Copit says. “Having all of the facts empowers patients to make decisions about their health.”

Why are mammographys so uncomfortable?

“We have to compress the breast so that we can see through what can be dense layers of tissue,” Copit explains. She offers tips on making the experience less painful. “Don’t go around the time of your menstrual cycle when your breasts are most tender. If you have had pain in previous mammograms, take a Motrin or Advil before your appointment. Bring a friend or family member for emotional support. And most importantly, be your own advocate. If it is too tight, say so. There is a difference between pressure and pain. The technologists should work with you to make it as comfortable as possible.”

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