While chest X -rays have a low success rate in detecting whether breast cancer has spread to your lungs, your doctor may still recommend one for several reasons. Chest X -rays are no longer recommended as part of staging, according to the guidelines of the National Comprehensive Cancer Network.
A 2015 study looking at chest X -rays done as part of staging found that this test did not improve the detection of occult metastases, but it did increase costs. In addition, chest X -rays in people with early-stage breast cancer have a high incidence of false positives, which can increase emotional distress. As an added concern, some studies have found that chest X -rays may increase breast cancer risk in young women who carry BRA gene mutations.
When symptoms occur, they often include a dry cough, shortness of breath, or recurrent respiratory infections. Roughly 6% of women have metastases (most commonly to the bones, liver, lungs, and brain) at the time of diagnosis.
If your doctor is concerned that you may have a tumor or metastases in your lungs, a better test is a chest computed tomography (CT) scan. Chest X -rays are limited in their ability to detect small areas of cancer (either metastases or a primary lung tumor). In fact, screening chest X -rays are not recommended for people who smoke because they fail to pick up cancer early enough to make any difference in survival.
If you do shop around in an attempt to save money, be sure to check with your doctor about the place you choose to make sure it's reputable and reliable. Have any written orders your doctor may have given you, and be prepared to answer questions about your medical history.
But unless you know why it's being done, your brain may try to fill in the answers, which can lead to a lot of anxiety and worry. Being your own advocate for your cancer care not only reduces anxiety but may even improve outcomes.
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Screening mammograms can also find microcalcification (tiny deposits of calcium) that sometimes indicate the presence of breast cancer. Mammograms can also be used to check for breast cancer after a lump or other sign or symptom of the disease has been found.
The technologist may magnify a suspicious area to produce a detailed picture that can help the doctor make an accurate diagnosis. Early detection of breast cancer with screening mammography means that treatment can be started earlier in the course of the disease, possibly before it has spread.
False-positive results occur when radiologists see an abnormality (that is, a potential “positive”) on a mammogram, but no cancer is actually present. False-positive mammogram results can lead to anxiety and other forms of psychological distress in affected women.
The additional testing required to rule out cancer can also be costly and time-consuming and can cause physical discomfort. Screening mammograms can find cancers and cases of ductal carcinoma in situ (DCI, a noninvasive tumor in which abnormal cells that may become cancerous build up in the lining of breast ducts) that need to be treated.
However, they can also find cases of DCI and small cancers that would never cause symptoms or threaten a woman’s life. False-negative results can lead to delays in treatment and a false sense of security for affected women.
Some breast cancers grow so quickly that they appear within months of a normal (negative) screening mammogram. Finding breast cancer early may not reduce a woman’s chance of dying from the disease.
Instead, women with such tumors live a longer period of time knowing that they likely have a potentially fatal disease. In addition, finding breast cancer early may not help prolong the life of a woman who is suffering from other, more life-threatening health conditions.
Many organizations and professional societies, including the United States Preventive Services Task Force (which is convened by the Agency for Healthcare Research and Quality, a federal agency), have developed guidelines for mammography screening. Although NCI does not issue guidelines for cancer screening, it conducts and facilitates basic, clinical, and translational research that informs standard clinical practice and medical decision-making that other organizations may use to develop guidelines.
In clinical trials, BSE alone was not found to help reduce the number of deaths from breast cancer. Women who do so should remember that breast changes can occur because of pregnancy, aging, or menopause ; during menstrual cycles; or when taking birth control pills or other hormones.
Whenever a woman notices any unusual changes in her breasts, she should contact her health care provider. The American College of Radiology (ACR) has established a uniform way for radiologists to describe mammogram findings.
Each BI-RADS category has a follow-up plan associated with it to help radiologists and other physicians appropriately manage a patient’s care. CategoryAssessmentFollow-up0Need additional imaging evaluationAdditional imaging needed before a category can be assigned1NegativeContinue regular screening mammograms2Benign (noncancerous) findingContinue regular screening mammograms3Probably benignReceive a 6-month follow-up mammogram4Suspicious abnormality May require biopsy 5Highly suggestive of malignancy (cancer)Requires biopsy6Known biopsy-proven malignancy (cancer)Biopsy confirms presence of cancer before treatment beginsBI-RADS also includes four categories of breast density that may be reported.
The breasts are almost entirely fatty There are scattered areas of dense glandular tissue and fibrous connective tissue (together known as fibroglandular density) The breasts are heterogeneously dense, which means they have more of these areas of fibroglandular density. In addition to making mammograms harder to read, dense breasts are a risk factor for breast cancer.
Insurance plans governed by the federal Affordable Care Act must cover screening mammography as a preventive benefit every 1–2 years for women age 40 and over without requiring co-payments, coinsurance, or deductibles. In addition, many states require that Medicaid and public employee health plans cover screening mammography.
Women should contact their mammography facility or health insurance company for confirmation of the cost and coverage. Women who need a diagnostic mammogram should check with their health insurance provider about coverage.
Some state and local health programs and employers provide mammograms free or at low cost. For example, the Centers for Disease Control and Prevention (CDC) coordinates the National Breast and Cervical Cancer Early Detection Program.
This program provides screening services, including clinical breast exams and mammograms, to low-income, uninsured women throughout the United States and in several U.S. territories. Under the law, all mammography facilities must: 1) be accredited by an FDA-approved accreditation body; 2) be certified by the FDA, or an agency of a state that has been approved by the FDA, as meeting the standards; 3) undergo an annual MESA inspection; and 4) prominently display the certificate issued by the agency.
Women can ask their doctors or staff at a local mammography facility about FDA certification before making an appointment. MESA regulations also require that mammography facilities give patients an easy-to-read report of their mammogram results.
Implants can hide some breast tissue, making it more difficult for the radiologist to detect an abnormality on the mammogram. It is important to let the mammography facility know about breast implants when scheduling a mammogram.
The technologist and radiologist must be experienced in performing mammography on women who have breast implants. Digital images can also be shared electronically, making virtual (remote) consultations between radiologists and breast surgeons easier.
Newer tomosynthesis strategies allow DEBT to be done alone, potentially reducing the radiation dose to a level closer to that of standard mammography. Although many women are offered DEBT, it has not yet been determined conclusively whether it is superior to 2-D mammography at identifying early cancers and avoiding false-positive results.
Selected Reference Mandelbrot JS, Cronin A, Bailey S, et al. If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions.