a special program of the National Emergency Medicine Association (NEMA)
Transcripts: 531-1 to 531-3
Week: 531.1 Guest: Patty Wilcox, the Breast Center/ Women's Center for Health & Medicine Topic: Mammography/ Part One- Questions and results Host: Steve Girard
NEMA: There are all kinds of questions a woman asks when it's suggested she have a mammogram... or begin to have them regularly. Patty Wilcox of the Breast Center at the Women's Center for Health and Medicine at Mercy Hospital in Baltimore is with us today...Patty, you tell me there are three basic categories of questions....
WILCOX: In terms of mammography, and being ready for mammography...the first set of questions should be about the quality of the mammography. Particularly, women worry about, "is the place where I'm having my mammography safe?...is the level of radiation safe?...are the quality of the films good? Are the doctors good? Y'know, how do I know that I'm getting my mammograms done at a good place. That's a real worry, because basically, if that's not a criteria that's being met, there really isn't any point in having the test done. Luckily, in the United States, the FDA has taken over responsibility for doing quality assurance and certification of mammography units.... many years ago, it was true that you could have a mammogram machine, and you could mail the mammograms to another state and a doctor you never saw could read them, and they may or may not be good quality films, the doctor may or may not be a good radiologist or specialize in mammography, and the issues would happen that mammograms may or may not be accurate in terms of reports. When the FDA took over a few years ago, the responsibility for certifying all mammography centers, then, that kind of problem disappeared. Women are very able to feel safe that mammograms can be read well ...read by good quality people because the FDA has done a very good job of quality assurance.
NEMA: Does the government certification include the mammography center's personnel as well?
WILCOX: The certification includes several things, it includes that every so often, each center has to send samples of their work to the FDA or the FDA comes and reviews those samples. In terms of the X-ray, the quality of the X-ray...the FDA does spot inspections so they can look and see whether there are quality behaviors happening all the time...they send people in with films that are pre-diagnosed... to make sure the radiologist is doing a good job of picking up subtle things, if the radiologist gets too many things wrong, then the radiologist is requested, and required to maintain certification, to take a special update course. They even check the technicians, and make sure they position the patient correctly, so if its supposed to be a view from, say the side, that it truly involves the whole part of the side that needs to be on that film. So, they're really doing a very good job of checking quality.
NEMA: So, what's the best way to find a good place to have a mammogram done?
WILCOX: I think that referral can be a good way. I think another good way is to ask your provider...who provides your usual doctor's care. But a third way is to call the American Cancer Society...they have a toll free number - 1-800-ACS-2345...and they will have an updated, ongoing list of all the certified centers in your area.
NEMA: Our thanks to Patty Wilcox....Join us for Part Two. I'm Steve Girard.
Week: 531.2 Guest: Patty Wilcox, the Breast Center/ Women's Center for Health & Medicine Topic: Mammography/ Part Two- Sensitive questions Host: Steve Girard
NEMA: When a woman is urged to get a mammogram, or advised to do so on a regular basis, a lot of concerns rush in. Patty Wilcox of the Breast Center at the Women's Center for Health and Medicine at Mercy Hospital in Baltimore tells us the first category of questions that arises includes the quality of the exam, the people who administer it and the place where its done. The second group involves the personal questions...the areas of fear and embarrassment...
WILCOX: Well, I think that underlying many women's concerns are issues like, "does the mammogram hurt"?....How does it feel?...What can I expect? And I think that many women are uncomfortable about asking their doctors those questions, partly because many of their doctors are men, but the fact is that its sort of one of those things you have to do, and there are a lot of things that we have to do that we just put up with. So I think its important that if women have a question, they know to ask the technician, y'know, how long is this gonna take?...What kind of interruption is it gonna be? There are a lot of myths that people have... I've heard patients tell me, "Oh, I was told I couldn't have coffee for five days before my mammogram." There's no medical reason why you can't drink coffee. There is a medical reason for not using anti-perspirants, and not using powder: and that is that powders and anti-perspirants contain metals, and they could show up on the mammogram as an abnormality, which would be a false positive X-ray. In terms of comfort, wear a two piece outfit, so its easy to get dressed and undressed, don't use deodorant or talcum powder or other powders the day of the exam...Pain is usually not a big problem...but for women who have breast tenderness, have the mammogram scheduled at a point in time of your cycle when you're less tender. The other thing is: plan that everything is gonna take a half an hour to 45 minutes longer than you thought...if you get back to the office, if you're at work...or you get back to the house sooner than you expected, you don't have much of a problem, but if you're later, often you get really agitated, so the more you can be de-stressed, the more comfortable the tests will be.
NEMA: One of the main concerns, I would imagine, is, "When should I get a mammogram"?
WILCOX: The guidelines for mammography are somewhat in flux, its always being looked at and revisions are being considered, but at the moment, the guidelines are :
Every woman over the age of fifty should have a clinical breast exam and a mammogram every year.
For women between the ages of 40 & 49, the current recommendations are....women should have a mammogram every one to two years. There is some evidence that says every year is better than every two years. But that has not been adapted into a guideline yet.
Women under forty do not routinely need mammograms, unless they have a family history of breast cancer, and in that case, we recommend that mammography begins ten years before the earliest breast cancer in the family. We recommend that all women have an annual, clinical breast examination, and that all women practice breast self examination once a month.
NEMA: There is one more category of important questions women ask about mammography: "What happens if..."? More from Patty Wilcox' 25 years experience in the area, on our next program. Join us for Part Three. I'm Steve Girard.
Week: 531.3 Guest: Patty Wilcox, the Breast Center/ Women's Center for Health & Medicine Topic: Mammography/ Part Three- What If....? Host: Steve Girard
NEMA: We've talked recently with Patty Wilcox, a nurse practitioner at the Breast Center at Baltimore's Mercy Hospital with 25 years experience helping women accept and utilize the mammogram as a tool for early detection of breast cancer. She's told us that the first category of concern is the quality of the x-ray, the doctor and the facility. The second category has to do with the personal fear and embarrassment a woman may feel about the procedure. And the third category has to do with, "What if something shows up on my mammogram...."?
WILCOX: The best outcome of having a mammogram is having someone say, "Its fine, its normal, there's nothing to worry about, come back next year". That's not perfect, mammograms are 85 to 90 percent accurate, 10 to 15 percent of the time, they are not accurate...but when you add clinical breast examination, physical exam, to the mammogram, you get as close to 100 percent as you can get. So, number one, to reassure yourself that your mammogram is normal, also get a physical examination of the breast...number two, if the mammogram report says that everything is fine, then that means that you can just wait until the next recommended date for your mammogram. Many times however, the radiologist will literally want a different angle, a deeper pressure, or will want another kind of film. And that doesn't mean that there's a cancer or anything serious going on, it just means that there was something technically that didn't go exactly right. Probably, that is one of the most fearful things a woman can hear is, "We need to have you come back for more films"..its a very frightening time. So, I think that its important to realize that being called back does not mean disaster...it does not mean breast cancer.
NEMA: Patty, what do women ask you about dealing with a positive mammogram?
WILCOX: If the worst should happen, and the radiologist would say, "We need to have you see a surgeon". We still don't usually make a diagnosis of breast cancer until there's tissue. So, if the question of needing a biopsy comes up, then a woman should try to take a few minutes, take a deep breath, find out what her choices are, and she can certainly make a decision about what sounds the most reasonable to her at that time, or...she can say, "I need a day or two to think this over". It is never an emergency to have a breast biopsy. If its a very early cancer, than its a very early cancer...and the diagnosis is very positive and two or three days is not going to make any difference...or two or three weeks isn't gonna make any difference. If its a very late breast cancer, we can't change that either...and again, two or three weeks is not going to make a major difference. So, women have time to think about what they're gonna do and make a decision about what kind of doctor they want to see, what kind of biopsy they want to have. If it is a cancer, what kind of treatment for that cancer do they want to have.
NEMA: Patty Wilcox of the Breast Center at Mercy Hospital in Baltimore says its important that women don't feel alone or rushed in their decisions concerning breast health. For more information, head to the library, or call the American Cancer Society at 1800-ACS-2345...or the National Cancer Institute at 1800-4- CANCER. I'm Steve Girard.