Is a Mammogram Enough?

Digital mammograms. Ultrasounds. MRIs. To stay healthy and protected, here is what you need to know about the new breast-cancer screening options.
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Start with a Mammogram

Once you hit 40 -- sooner, if you're at high risk -- doctors recommend that you get a mammogram every year. There's no question that the test saves lives. In fact, when the number of women over 40 having mammograms doubled between 1987 and 2000, the jump was linked to an estimated 5,000 fewer breast-cancer deaths per year.

But while the should-you-or-shouldn't-you question is no longer debatable, other new considerations may now complicate your decision. Do you opt for a traditional film mammogram, the most widely available, least costly type? Or should you make sure you get the newer digital mammogram? Should you request an MRI or ultrasound for even-more-detailed images? Use our guide to decide what makes sense for you.

Start with a Mammogram

No matter what else you do, get an annual mammogram. The first one you have -- as soon after age 40 as possible -- becomes your baseline. (Since you'll probably switch doctors over the years, get a copy of the report and image for your home medical files.) As most women who have had one know, mammograms can be uncomfortable; even the digital kind requires compressing your breast between two plates while it's x-rayed, albeit for a very short time. (Younger women whose breasts swell before menstruation can minimize pain by scheduling the test shortly after their period.)

Conventional mammograms store the images on film, where they cannot be altered or manipulated. Digital tests, on the other hand, create an electronic image that can be enhanced by computer for an even closer look at possible problems. The catch? Three out of five breast-imaging centers still don't offer digital mammograms, and they cost more (a low average of $134, compared with a low average of $83 for film, says the American College of Radiology). According to Etta Pisano, MD, director of the Biomedical Research Imaging Center at the University of North Carolina School of Medicine at Chapel Hill, the digital picture is more accurate at detecting breast cancer if you fit into one of these three categories: You're under age 50, you have not gone through menopause, or you have dense breasts that make it harder to find cancer using x-rays. If that's not your situation, a film mammogram will detect cancer just as well as a digital one, says Dr. Pisano, who was lead investigator of a study of more than 49,000 women that compared the two types. For maximum accuracy, use an imaging center that performs a lot of mammograms -- or sends them out via computer to be read by mammography experts.

Continued on page 2:  Do You Need Further Screening?


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