OhioHealth's mobile mammogram and bone density screening unit. Photo Greg Wehr/Courtesy OhioHealth.
Each year in the United States, more than 200,000 women are diagnosed with breast cancer. While this is a staggering glimpse at our mortality, there is hope in the fact that the disease frequently is discovered—in its very early stages, in many cases.
Dr. Jerry Mitchell of the Mark H. Zangmeister Center says most early diagnoses can be linked to the mammogram. “The small masses are almost always found in a mammogram,” he says. “They have to be larger than a centimeter to feel them.” He says even some slightly larger masses can be missed in the palpation exam, but the mammogram detects many irregularities the sense of touch might miss.
Virtually everyone has been touched by cancer in one way or another and rarely is it an uplifting experience. But some women let the fear of cancer keep them from protecting their health as well as they could. Maybe they’ve heard that mammograms can be uncomfortable or seen conflicting information in research studies about when to get them. Or they dislike any visit to the doctor that means the clothes will have to come off. These women push the thought to the back of their minds, thinking they’ll get around to it eventually. The question becomes whether “eventually” will be early enough.
Other women have such busy lives that their health takes a backseat. The kids have a fever and they’re in the pediatrician’s office by 9 am. But somehow 15 minutes spent on a mammogram every 24 months seems just too inconvenient. These women may spend time caring for their families, friends, careers and even their outward appearance, while neglecting a simple screening test that could save them from the battle of their lives.
Mobilizing a solution
Dr. Kristen Fults-Ganey, a radiologist and breast specialist with OhioHealth, says putting the opportunity right in front of women’s eyes may be the key to saving lives.
“Although some women avoid mammograms due to anxiety or concerns about discomfort, I feel the majority of women would participate in screening if the exam was available close to where they live or work,” she says. While mammography equipment is available at doctors’ offices, radiology facilities and hospitals around Columbus, OhioHealth takes the convenience one step further by mounting equipment on wheels and taking it on the road. The company unveiled its new and improved mobile mammography unit in January.
Kay Holland, regional manager of clinical operations for OhioHealth Neighborhood Care, says the unit travels by appointment to corporations and other organizations that request it, within Franklin County and beyond. “We are scheduling the mobile unit five days per week, and the hours are dependent upon the organization’s needs,” she says.
Two mammographers are on board the unit each time it goes into the community. The mammography staff rotates between the mobile unit and Riverside’s Breast Health Center. “This will allow for them to stay connected with the radiologist, perform diagnostic and biopsy procedures as well,” Holland says.
The unit was redesigned and outfitted with state-of-the-art technology for both mammography and bone-density testing. The testing process is quick, and so are the results. Mammograms take 15 minutes, and bone density scanning takes 30 minutes.
“This unit has the latest digital imaging equipment that produces high-quality images and images can be viewed immediately,” Holland says. “These images also can be sent to the radiologist via the network for improved interpretation time.” Results are generally available the next business day, she says.
Cost may be another hurdle, but thanks to grants from the Susan G. Komen Breast Cancer Foundation, OhioHealth now offers free mammograms to women in financial difficulty. The Komen foundation and Limited Brands also contributed $200,000 each toward the redesign and refitting of the mobile unit. OhioHealth paid the remainder of the cost, but the final figures aren’t available yet, Holland says.
Do benefits outweigh the risks?
While mammograms can detect benign changes to the breast tissue, such as fibrocystic disease, their primary purpose is to detect breast cancer. And they’re pretty good at doing their jobs.
“Mammograms do save lives,” Fults-Ganey says.
Thomas Sweeney, an oncologist with Columbus Oncology & Hematology Associates, says that while the technology isn’t perfect and does result in occasional false positives, overall the science benefits women. “The data right now supports the need for screening mammograms,” he says. “They are probably not as good as we would like them to be, but we hope to get to the point that we will find all cases very early when they will be imminently curable.”
Experts in the field of breast health have an ongoing tug-of-war, debating at what age women should begin getting mammograms. Sweeney says most experts recommend starting to get a mammogram every other year at age 40.
In 2009, some experts recommended raising the age to 50, since the evidence for reduced mortality from 40 to 49 was inconclusive. Some say that’s true, but it all depends on what studies you read.
Mitchell of the Zangmeister Center says researchers recently combined nine studies into a meta-analysis, and their figures showed a 34 percent reduction in deaths from breast cancer in the group that underwent screening. He admits that some other studies don’t show as great a decrease, and that some of the positive results could be due to improved treatment or other factors.
Sweeney says some of the debate comes from the assertion that, in many cases, screening too early is pointless at best and harmful at worst. He says it’s known as the screening paradox.
“When you look at screening, you think, how can it be bad?” he says. “But if you’re not doing what you’re setting out to do, then all you’re doing is churning people through the medical system.”
That could result in increases in false positives and unnecessary biopsies, Sweeney says. “That doesn’t bring great risk, but it is annoying and very frightening,” he says. So many factors come into play; it is difficult to draw solid conclusions about the efficacy of mammogram screening from one case to another. Sweeney says people who undergo screening tend to be diagnosed earlier, which gives doctors a better shot at eliminating the cancer before it becomes too invasive.
“Anecdotally, people who are diagnosed earlier tend to do better,” he says. “Whether this ultimately improves survival rates is difficult to say. I get the feeling it is probably true, but this is where the controversy comes in.”
Dr. Jeanna Knoble, also of the Zangmeister Center, says the ideal starting age can be debated endlessly and it still will depend on the individual patient’s background.
“I think we see a skewed population, because many of the women we see have breast cancer that was found on a mammogram,” she says. A false positive is not uncommon, but it’s not the norm, either, and a few false positives don’t outweigh the benefits of discovering thousands of other actual cases.
“Mammography can save lives and it is important,” she says. “Hopefully, women will see that the anxiety of a potential false positive is far outweighed by the benefits.” She says about 10 percent of questionable mammograms turn out to be false positives.
It couldn’t happen to me
Ruth Lander may well owe her life to a mammogram she didn’t think she needed. “There was no known cancer in my family, so I really thought there was no way I would get it,” she says. “Since I am the practice administrator of a respected oncology group, I personally thought I should set an example for employees and others by getting the mammogram, even if it would never detect any cancer.”
Lander, who has worked in the Columbus Oncology & Hematology Associates practice for 23 years, went above and beyond the typical recommendation and had a mammogram every year. In February 2006, at the age of 57, her goal of being a good example for others really paid off. In two decades worth of mammograms, radiologists had found benign cysts, but nothing hazardous to her health. But after her exam in 2006, the screener expressed concern Lander hadn’t seen before. Technicians took a few additional pictures and scheduled a biopsy.
Lander had the procedure on Valentine’s Day and received her results the next day. Her chemotherapy treatment began about a month later, on St. Patrick’s Day.
She says she considers herself fortunate to have been diagnosed so early. “Only a cancer cell or two had spread into the lymph nodes because it was caught early,” she says.
This year marks her fifth anniversary of having beaten the disease. Lander inspired her sisters to take the same cautious path she did, and she encourages all women to play it safe and be screened.
“Get the mammogram,” she says. “I was so fortunate to have been detected early. Just think if I had let it slide six months, a year or more. The disease certainly would have spread and the outcome would not have been so good.”
She says the mammogram equipment has improved over the years, as has the patients’ comfort during the exam. That’s a plus, but the best part is being around to tell the story.
“I appreciate every day of living,” she says.
Kristin Campbell is a freelance writer.