Mammography, self-exams, prioritizing your health
Partnership with Samaritan Health Services is changing the image of breast cancer screenings
Women have long heard the message that an annual mammogram is the best way to detect cancer and hopefully stop it in its tracks. And for good reason. Mammograms can often detect breast cancer up to two years before symptoms appear and reduce breast cancer mortality by about 40%.
But did you know that breast cancer sometimes emerges in between screenings? Called interval breast cancers, they often are diagnosed at a later stage, are more aggressive and larger in size, and result in poorer survival than screen-detected breast cancer.
Why does this happen? What should women do? Is there anything doctors and hospitals can do?
Timing, dense breast tissue and fast-growing tumors are among the potential causes of these cancers. And the solution is another longstanding message familiar to many women over 40: Examine your breasts in-between mammograms.
The importance of self-exams
“Mammograms don't work alone, and a breast self-exam cannot detect asymptomatic cancers. Mammography screening is definitely needed, but it's that pairing of a mammogram and continued breast self-exams,” says Associate Professor Veronica Irvin. “An unintended consequence of screening is the idea that you're safe for the year or two following a screening and feel that you don't need to keep checking your breasts.”
In a collaborative study with Samaritan Health Services, Veronica and her team, including undergraduates and graduate students in the College of Health, recorded 20 in-depth interviews with women who were between the ages 40-69, had all their health services completed within the Samaritan system, and experienced interval breast cancer. In these interviews, the women were asked to describe their symptoms and reactions to their diagnosis and identify ideas for educating other women.
“An unintended consequence of screening is the idea that you're safe for the year or two following a screening and feel that you don't need to keep checking your breasts.”
~ Veronica Irvin
What researchers found was that symptoms were all first discovered by the woman, 75% of whom noticed a lump or cyst during a self-breast exam or when dressing.
“Women in these interviews told us they don’t think breast self-exams are being promoted like they were in the past. They remembered hearing about self-exams regularly and now don’t hear about it or are told there’s no value in doing a breast self-exam,” Veronica says. “Better technology could be one reason, but a woman also has to know her own body, recognize when there's something unusual, and seek help. No technology will remove that piece.”
After noticing a suspicious symptom, most women in her study reached out to their gynecologist or primary care provider; however, others waited out of worry they would be seen as overreacting, often based on previous experiences. They also were surprised that screening tools could not see all cancer, were unaware that interval breast cancers could occur, and in some cases disappointed that they waited to reach out for care.
There were many reasons why women hesitated. Some had contacted their doctor with previous symptoms and felt dismissed, so they questioned reaching out again. Many were so focused on their family’s health and schedule they just never got around to making an appointment.
“When we presented our work, we heard that reaching out to their doctor isn’t a waste of time and that they shouldn’t feel embarrassed about calling attention to a symptom, even if it turns out to be nothing. Women should feel empowered to contact their provider, get in and get themselves checked right away because breast cancer is so much easier to treat the sooner it's detected. Clinicians and health care organization can do better at helping women feel respected and valued so they don’t hesitate in calling attention to a concern,” she says.
“The bottom line is to schedule your mammogram, perform self-checks, prioritize your health, and resist putting yourself last. Be an advocate for yourself, listen to your body, and don’t be afraid to take up space. Make the phone call and show up for yourself.”
As part of the study, Veronica and her team are working on educational materials for women that will be published later this year.
The Cleveland Clinic provides instructions and information on breast self-exams.
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