Lunch with Pippa Hudson: A candid talk about breast imaging
Yes, going for a mammogram isn’t an experience that women relish and there are many reasons for women not to go for annual breast imaging. Do the reasons for going for an annual mammogram really outweigh these?
SCP radiologist Dr Salomine Theron recently joined well-known CapeTalk presenter Pippa Hudson to have a candid discussion about breast cancer screening and the medical imaging that it involves. She also shared some lesser known details about what a symptomatic patient may expect after the initial mammogram.
These are some interesting insights from the interview:
Women may avoid a mammogram because they dread hearing that they have cancer. It should not keep them from going for their mammogram.
In response to Pippa highlighting how treatable breast cancer is in 2023, Dr Theron said, “Yes, I absolutely agree and I think early detection is the most important thing. The earlier you detect cancer, the more treatment options you have. It might sometimes be less invasive treatment. Sometimes you might not need chemotherapy or radiotherapy, so I really would urge people not to ignore any breast symptoms and rather have an early diagnosis with more options for treatment.”
A lump in the breast does not necessarily mean you have cancer
“The other reassuring stat that we should remind our listeners of is the fact that just because there’s a lump, doesn’t necessarily mean it’s cancer,” Pippa said.
Dr Theron confirmed this by explaining that after the initial mammogram, further investigation is often needed before doctors can come to their conclusion. One option may be tomography to obtain more images of the same breast. Another option is ultrasound and it is often determined that the lump is merely a cyst of water blister.
“A cyst cannot develop into cancer so we can then reassure the patient and tell them this is not something to worry about. We could also find a very good-natured lump that turns out to be fibroadenoma. They’re very well circumscribed and they’re common in young women. In a case like that we would want to confirm that these lesions aren’t growing – sometimes a very aggressive cancer can also look good natured but then they grow.
“So if we find something that looks like fibroadenoma we’ll suggest ultrasound follow-up in six months and again at 12 months and again at 24 months. If we’ve shown that the lesion has been stable for a 24 month-period, it’s really reassuring for a benign etiology. If, at any time during this 24-month period, the lesion increases 30% in size, we will do a biopsy to prove that it is a good-natured lesion or if it is a rare tumour.”
Doctors don’t rush to treatment based on the results of just one mammogram
“From what you have just said there are layers upon layers of checking and double checking before you engage in any discussions about treatment. I’m raising this because one of the criticism about regular mammogram screenings is that it might lead to over treatment; to women being diagnosed and treated when it wasn’t necessary,” Pippa said. “I’ve seen a lot of doctors pushing back against that argument to say, ‘No we don’t just rush to treatment based on the findings of just one mammogram. What you’ve just described is a process of several additional layers that would kick in if you find something on a mammogram that puts up a red flag.”
Dr Theron confirmed that if radiologists see something on a mammogram that looks malignant, and the ultrasound also confirms a spiculated lesion that has malignant characteristics, they will suggest a biopsy.
“If the lesion is visible on ultrasound it will be an ultrasound-guided biopsy. If it’s only visible on a mammogram, we do a stereotactic-guided biopsy. By doing that, we will be able to get tissue diagnosis so you’ll know if it’s cancer or not before any treatment is advised.”
In some circumstances, a clear mammogram may well be followed by additional breast imaging
“If there are no findings on a mammogram but there’s a high risk for breast cancer or the clinician is worried about something, one can do tomography to help you better evaluate the breast,” Dr Theron added. “One can also, as a problem-solving tool, opt for breast MR. Breast MR is not for everyone – it’s expensive, it’s time consuming, it’s 45 minutes in the MR tunnel and you get an intravenous injection with gadolinium. But it can be a very valuable tool to solve problems. It can also be used for screening in very, very high risk individuals.
Dr Theron further discussed the South African screening guidelines for women, breast cancer in men and SCP Radiology’s partnership with the breast cancer charity ILoveBoobies.
Listen to the full interview here.