Both mammograms and breast exam must be of high quality to be any use at all. A mammogram must be performed on specialized equipment and interpreted by an experienced radiologist. The Canadian and American Associations of Radiologists have put in place a program to accredit mammogram centers, but many centers have not been approved yet. There is no nationwide co-ordination to monitor mammogram quality, equipment, interpretation, management and follow-up in either country.
Likewise, doctors have not been trained adequately in the art of skilful breast exam. Breast exams may be haphazard or sloppily performed. Thus, most experts still recommend that all women 50 or over get a screening mammogram every two years, as well as an annual physical exam of the breasts.
Dr. Anthony Miller, director of the NBSS study, testifying before a status of women committee on breast cancer said, "I think our study demonstrated that [physical examination of the breasts] is rarely performed well by physicians... [They] just do not take the time, they do not know what they are looking for... I personally believe... that we need to set up a professional education program in this country (C.M.A. Journal, Jan/93)."
Not All Mammograms Are Created Equal
When you go for a mammogram, the procedure may be stressful and may likely hurt. After you strip to the waist, your breast will be flattened between two plates positioned above and below the breast while X-ray pictures are taken of each breast separately. If possible, schedule your mammogram during or soon after your period when the breasts are the least tender.
Screening for breast cancer with mammography is of no value unless the mammogram is done correctly and interpreted by an experienced radiologist.
Dr. Cornelia Baines, Department of Preventative Medicine and Biostatistics, University of Toronto and Deputy Director of the National Breast Screening Study, said recently that screening for breast cancer is only effective if certain criteria are met.
These criteria are:
The safest bet for a reliable mammogram is a center that specializes in mammograms and does at least 20 to 30 mammograms a day. Dr. Howard Seiden (Toronto Star, Dec.17/92) suggests that you pay extra to have your mammogram interpreted by a second radiologist. He maintains that approximately 15 percent of cancers missed by the first doctor will be picked up by the second.
The U.S. Preventative Services Task Force found that the quality of a mammograph varied greatly from place to place. Of the 11,000 mammography units in the U.S., only 3,500 have been accredited by the American College of Radiology. In Canada, as in the U.S., there are no nationwide standards being enforced. In the U.S. women can call the National Cancer Institute at 1-800-4-CANCER or the state chapter of the American Cancer Society to find out where to get quality mammograms.
Mammography Can Be Used For Two Purposes
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