Mass General's director of Breast Imaging addresses confusion over mammograms and provides advice on when women should get one.

Connie Lehman, MD, PhD, director of Breast Imaging at Massachusetts General Hospital, wants to clear up confusion about mammograms.

Mammograms are still important, says Dr. Lehman, who is leading Mass General’s efforts to encourage use of the screening technique that takes an image of the breast to detect cancer.

“Simply put, mammograms are the best way to detect breast cancer early and avoid the risk of late diagnosis,” she says. “When we find cancers early, women have increased options for less aggressive treatments and a better chance of being cured.”

Connie Lehman, MD, PhD
Connie Lehman, MD, PhD

Despite widespread advocacy, only about half of women in the United States engage in regular screening mammography. And every year, more than 40,000 women in the U.S. alone die from breast cancer.

Guidelines Differ By Age, Risk

With debate among nonprofit organizations, physicians’ groups and the U.S. government resulting in varying recommendations, Dr. Lehman worries that women might think mammograms are not useful.

Dr. Lehman, also a professor of radiology at the Harvard Medical School, emphasizes that all major medical groups agree women age 50 to 74 should have a mammogram at least every two years and early screening with mammograms, beginning at age 40, saves the most lives.

The groups differ in their recommendations for women age 40 to 50. Some give more weight to the consequence of false positive exams, where women are told they may have cancer and they do not. False positives can result in additional imaging, biopsies and surgery. Others give more weight to saving lives through early detection.

Catching Cancer Early

At Mass General, radiologists work closely with physicians and patients to help patients understand the benefits and limitations of mammograms.

One point that Dr. Lehman emphasizes is that early detection of breast cancer can save a woman’s life.

“We know that the most years of life lost to breast cancer occur in women diagnosed before age 50.”

“We know that the most years of life lost to breast cancer occur in women diagnosed before age 50,” says Dr. Lehman. “In the 40s, breast cancers grow faster, compared to those diagnosed when a woman is in her 70s. And at Mass General, our rate of false positive exams is significantly lower than national rates, so our balance of benefits and harms is better than that used to make national recommendations for centers across the country.”

When cancer is caught early, physicians and patients have more treatment options. They might avoid chemotherapy or have the option of breast-conserving surgery, instead of a mastectomy, Dr. Lehman explains.

Improving the Experience

Some women find mammograms uncomfortable. To help address this issue, Mass General will begin using an industry-first wireless remote control, recently approved by the FDA, that lets patients control their own breast compression during a mammogram under the careful supervision of a specialized technologist. Compression lasts a few seconds but one bad experience can keep patients from returning; Mass General wants to prevent that.

Mass General will be the first center in the U.S. to use this self-compression equipment, Dr. Lehman says.

Technologists work with each individual patient to provide the best experience possible. One example is using calming language. For example, to ask a patient to “relax into the machine” instead of “hold on and brace yourself.” They want to know if the patient feels pain, because adjustments can be made to ensure the exam, though uncomfortable, is never painful, Dr. Lehman explains.

Under the Affordable Care Act, a screening mammogram is free. No copay or deductible is required.

Expanding Mammogram Access

To improve access, Mass General has added early morning, evening and Saturday hours for mammograms at their centers in and outside of Boston. The hospital started a “Pink Card Program,” which allows women to take a card and walk-in for a same-day mammogram.

Mass General is also working on programs to deliver all information about mammograms to patients in their preferred language to avoid misunderstandings. And they are using text messaging reminders so patients don’t miss their scheduled exams.

Under the Affordable Care Act, a screening mammogram is free. No copay or deductible is required.

Assessing Risk

Dr. Lehman encourages women to know their personal risk of breast cancer. Women can explore online resources and talk with their physician to determine if they are at an elevated risk. If an elevated risk is suspected, some women will benefit from referral to specialists such as the Mass General Center for Cancer Risk Assessment.

Dr. Lehman says Mass General’s approach is to provide the best imaging and consultation to reduce the risk of advanced breast cancer in their patients. “We use the most advanced tomosynthesis mammography for every patient, every time; and every exam is acquired by a specialized technologist and then interpreted by a specialized breast imager. With this combination, Mass General’s cancer detection rate is high and our false positive rate is low,” Dr. Lehman says. “It does matter where you go.”

Tips from Mass General Radiology

  • Regular screening mammography is part of staying healthy. All women aged 50-74 should at the very minimum have a mammogram every two years. And women in their 40s are encouraged to consider annual screening at a high-quality center.
  • Women with a significant breast cancer family history may benefit from genetic testing that can identify genes responsible for inherited breast cancer risk. Finding such a gene can provide a more accurate risk assessment and a recommendation to start breast cancer screening at an earlier age. In addition, some women with inherited breast cancer risk can benefit from MRI screening at a high-quality center.
  • Physicians urge women to be aware of changes in their breast, and take notice if they or their partners feel something different in their breast and talk to their doctor.

To make a donation to support the work of Dr. Lehman and breast imaging at Mass General, please contact us.