HEALTHCARE

Another reason to get a mammogram: Finding breast cancer before it forms a lump

Nicole Villalpando
Austin American-Statesman

Shirley Bohmann said she "never had an ear open for breast cancer stories." She had no family history. She hadn't felt a lump. She regularly had mammograms.

Then last November, after her usual mammogram, she was called back for an additional one. Then a biopsy. She had a feeling this was not good.

Bohmann, 79, was diagnosed with ductal carcinoma in situ, commonly known as DCIS, which is considered a zero stage breast cancer.

A later MRI showed that her breast tissue looked like Play-Doh with flecks of glitter in it where the cancer was. "It was just there doing its dividing," Bohmann said.

Shirley Bohmann took a family trip to Hawaii last summer before having breast cancer surgery and radiation. Her cancer was caught through a mammogram at stage zero, the lowest stage.

"It's considered sort of a noninvasive breast cancer," said Dr. Aimee Mackey, a surgical oncologist with Texas Breast Specialists, who practices at St. David's South Austin Medical Center. Some people even think of it as a precursor to a more serious breast cancer.

The dilemma with DCIS is some of these cancers will turn into a more advanced, invasive breast cancer. Some will not, but Mackey said there currently isn't good research into which ones will advance. Those clinical trials are being done to observe DCIS, but not treat it. Until that research is completed and doctors can rule out which ones are not threatening, Mackey said, they treat DCIS just like a breast cancer that has not spread.

Bohmann had a lumpectomy, followed by 21 days of radiation. The radiation wasn't that bad, she said, though she did get brain fog and fatigue. The hardest thing was driving into Austin every weekday from Sunrise Beach in Llano County, west of Austin.

She'll have follow-up physical breast exams and mammograms to make sure she remains cancer-free.

She is glad she had it taken care of. As Bohmann thinks of it, "It's growing at some rate. Once it jumps ship, then it goes wherever it wants to go."

"If I hadn't had that mammogram, it could be growing right now and I wouldn't know it," Bohmann said.

Zero-stage breast cancer usually has no symptoms, Mackey said. On a rare occasion, there might be an unusual nipple discharge. Most of the time, the only way doctors find this cancer before it progresses is through a mammogram.

Bohmann tells every woman she sees to get a mammogram. "Don't apologize to me," she'll say. "Just get it done."

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When to get your mammogram

For people at average risk, doctors suggest getting a mammogram every year beginning at age 40.

Around age 30, your doctor should do an assessment of your risk factors such as family history, the age you started your period, weight and height, hormone use, previous cancers, density of breast tissue, whether you've had children and at what age your first child was born. There's actually a calculator for this. Anyone who has a lifetime risk of 20% or greater should begin getting mammograms between ages 30 and 35.

Anyone with a family member who has been diagnosed with breast cancer should get a mammogram 10 years before the age that person was diagnosed, or by age 40, or by 30 to 35 depending on her risk factors, or by whichever age is lower, medical experts say.

At age 75, a conversation on when to stop begins. Mackey said she assesses a patient's other medical conditions. If something else is likely to kill the person before a breast cancer, she might not recommend an annual mammogram. She also might ask: If we find something, would you want to do something about it? For most 75-year-olds in good health, she recommends continuing until age 80 or 85.

The American Cancer Society's recommendations differ slightly. For ages 40-44, it gives women a choice to begin annual mammograms. It recommends annual mammograms for ages 45-54. For ages 55 and older, they could switch to mammograms every other year or continue annual mammograms. Screening should continue as long as a woman is estimated to have a life expectancy of 10 or more additional years. Again, it emphasizes personal risk factors.

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Mammograms are the only way to find ductal carcinoma in situ.

What to know about mammograms

Stacey Ambroselli, a screening technician at St. David's South Austin, said they are beginning to see women return to getting their mammograms regularly after many of them skipped a year or two because of COVID-19, "which is wonderful," she said.

When technicians such as Ambroselli are doing the mammogram, they need to get the whole breast as well as the muscle into the armpit, which is why they turn the machine to the side for a different view.

It should not hurt, and you should let the technician know if it does. "Every woman's different and every woman's pain tolerance is different," Ambroselli said.

Taking acetaminophen beforehand can help, if you are more sensitive, she said. She also reminds that you should not wear any lotion, cream or deodorant because it can affect the image quality.

It's common to get called back to do an additional mammogram, Ambroselli said. "Usually it just means we need additional pictures ... or we might have missed something or it wasn't clear," she said. "Most of the time, it turns out to be nothing," she said.

Mackey said for every 1,000 mammograms, about 100 women are called back for a second one, and only about five of those women will actually have cancer.

Sometimes at that call-back appointment, the radiologist will look at the new mammogram and then do an ultrasound right then to get a different look.

If the radiologist sees something of concern, a biopsy will be ordered.

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