Tiffany Delp, of Muncy, didn’t fear her first-ever mammogram when she turned 40 last year. A nursing coordinator at the Emergency Department of Evangelical Community Hospital, Delp scheduled the screening because she tries to keep up with routine exams.
“Based on the American Cancer Society recommendations, women are recommended to start their screening mammograms from age 40 onward and continue until the age of 75 or if they have a life expectancy of 10 years or more,” said Dr. Mohammad Tahir, breast surgeon at UPMC Susquehanna Health, Breast Center, in Williamsport.
That first mammogram is supposed to provide a sort of baseline for doctors to compare to each year. In Delp’s case, it found an aggressive cancer.
“It was quite a shock,” she said. She met with Dr. John F. Turner, medical director of the Cancer Service Line at Evangelical Community Hospital and clinical co-manager of the Thyra M. Humphreys Center For Breast Health, and Dr. Victor Vogel, a breast cancer specialist at Geisinger. The doctors told her they would treat her cancer aggressively, starting with chemotherapy followed by a lumpectomy, radiation and immunotherapy.
“I’m married, and I have two kids,” Delp said. “I told (the doctors), let’s get this going.”
Resistance to mammograms
Mammograms can present a bit of a conundrum for women. No one wants to learn they have cancer. But if they do have it, they want to find it early, like Delp did.
“Yes, there’s fear, and it requires a certain amount of fear to convince yourself that you need to be screened,” Turner said. “But too much fear can cause you not to come in.”
Dr. Rosemary Leeming, breast surgeon and Geisinger Medical Center’s chief medical officer, said the compression of a mammogram, which many women dread, is not as bad as they might imagine.
“The compression is uncomfortable,” she said. “But it really is a test that takes only a few seconds. If you think of the big picture, who wouldn’t put up with a few seconds of discomfort for something that potentially can save your life?”
Not only that, mammography techniques have been improved over the years.
“Most women don’t have any discomfort at all,” Leeming said. “I would say the vast majority are surprised by that.”
3D mammography is available at the breast care centers of all three local hospitals. It takes just a few seconds more than traditional 2D mammography, Leeming said, because the machine actually moves around the breast as it takes pictures rather than staying in one spot.
“It may take five or 10 more seconds, which feels like an eternity when you’re in it, but it takes a much better picture, so it is absolutely worthwhile with the 3D mammograms,” she said, “particularly with women with denser tissue. That’s really where we see the benefit.”
Another benefit is reduced anxiety for patients.
“3D mammography reduces the chance that women will be called back after their mammogram for further imaging,” Tahir said. “So the 3D is actually quite good in assessing women with dense breasts as well as to reduce the number of women that will be called back for further imaging or recommended for biopsy.”
Mammograms use low-dose x-rays to take pictures of breast tissue, but some people find it counter-intuitive to subject themselves to even that small amount of radiation.
“There is some misinformation that mammograms may increase exposure to radiation and it might cause cancer,” Tahir said. “However, there is no such evidence. Mammogram has a pretty low dose of radiation. It’s safe, and there has been plenty of data on the safety of mammograms. It’s considered the gold standard for detecting breast cancer.”
The majority of breast cancers seen on a mammogram are early stage cancers, Turner said, making possible a better outcome with less impact on the patient.
He pointed to improvements in mammography, from the early days when doctors hung the x-rays on light boards and peered at them through magnifying lenses.
“Now we’ve blown through digital and we’re up to 3D tomography,” he said.
For the more than 50 percent of women with dense breast tissue, 3D mammography and automated whole breast ultrasound can better detect problems. On a traditional, 2D mammogram, abnormalities show up as white — Turner describes it as trying to see the stars through the clouds.
“When the background is already white, your concern is that you can miss something in there,” he said.
Automated whole breast ultrasound has helped Thyra M. Humphreys technologists detect cancers that, even in retrospect, could not be seen on a mammogram because of the density.
“So automated whole breast ultrasound is a 3D ultrasound which creates a recorded loop of images that the radiologist scrolls through in a three-dimensional fashion, from front to back, side to side and top to bottom,” Turner said. “I believe we are the only institution in the (Central Pennsylvania) area that utilizes automated breast ultrasound, at least until you get down to Harrisburg.”
At Geisinger, Leeming pointed out that hand-held ultrasound, which does not require compression, is sometimes requested as a screening tool instead of a mammogram, but that is not advisable.
“I don’t think that replaces compression,” she said. “We will sometimes use that in very young women, but the truth is, mammograms and ultrasounds can be complementary. and I would say a mammogram is worth any discomfort that you would experience. Really, mammograms are the mainstay.”
Know what’s going on
Delp felt relieved after Dr. Vogel assured her that her cancer was treatable.
“But then I made the mistake everyone does. I went on the internet and read things and got myself upset,” she said, shaking her head. “My husband said, “Just stop reading. You’re going to be fine.’”
Sometimes, when home alone, she got “super angry,” questioning why this had to happen to her. Sometimes she “screamed and yelled and cried.” Through it all, she was buoyed up by both the nurse navigators at the Thyra M. Humphreys Center, who answered her questions and guided her through the process, and the social workers at the Geisinger Cancer Center, who helped her handle the unexpected amount of paperwork that needed to be filed.
As challenging as the past year has been, she is grateful she did not put off that first mammogram. She knows how much more invasive and scary her treatment could have been if her cancer had not been detected so early.
“You should never be too busy for a mammogram,” she said. “Your life is way too important to not do it.”
As to people who fear mammograms, she repeated what Leeming said about the momentary discomfort being worthwhile. She emphasized that the technicians are caring and walk the patient through every step.
“There’s nothing to be afraid of,” she said. “I’d be more afraid not to know what’s going on.”
Cindy O. Herman lives in Snyder County. Email comments to her at CindyOHerman@gmail.com