“Mammograms save lives, period, end of story. But it takes decades to appreciate just how many,” announced ABC News Medical Unit correspondent Courtney Hutchison, reporting June 28, 2011 on a 29 year long mammogram study in Sweden. “The researchers found that seven years of mammograms made for 30 percent fewer breast cancer deaths years down the road, when compared with women who didn’t receive mammograms.” According to Dr. Laurie Margolies, chief of breast imaging at Mount Sinai Medical Center in New York, the longer follow-up period is essential, because a number of breast cancers are very slow growing, and they take many years to become lethal.

Therefore, the shorter term studies that have been done previously, can only account for breast cancer deaths due to the more aggressive, fast growing cancers. This study is a wake up call for those who have claimed that mammograms don’t have enough benefit to warrant starting them at age forty, or having yearly exams. “Overall, breast cancer experts believe this study out of Sweden supports the message they’ve been sending all along: Regular mammograms save lives. Period,” concludes Hutchinson.

Mammograms aren’t a prevention tool, however, they’re a detection tool. When it comes to breast cancer, of course, both are extremely important. Dr. Colin Kopes-Kerr has recently written in these pages of the essential nature of diet, exercise, relaxation, not smoking, and holding to a healthy weight. According to Kopes-Kerr, this “Healthy Lifestyle” plan has been proven in repeated studies by top researchers to reduce the rate of “all cancers by 36 to 64 percent.”

So, if women combine a healthy lifestyle (prevention) with yearly mammograms after the age of 40, beginning earlier if they have certain risk factors (early detection), they should be able to reduce their risk of breast cancer by a very significant amount.

Breast cancer detection has taken a leap forward with the advent of digital mammography. “Digital is the state of the art modality for early detection of breast cancer used in mammography screening,” according to Michie Russ, mammographer and x-ray technician for the past fifteen years, who works in the imaging department at Eastern Plumas Health Care.

Russ has spent most of her time as a mammographer utilizing film equipment. She describes the film cassettes that had to be loaded and unloaded. Then, the film had to be processed, including the developer, fixer, and wash. After that, film cassettes had to be cleaned. A small spot of dust could cause what she called an “artifact,” which meant further images would be required. Still, it was a fairly quick process considering all that was involved—2 -3 minutes per image as opposed to the approximately 5 seconds per image with digital. Though that may not seem like a lot of time saved, “the extra time not spent focusing on the mechanics of film,” said Russ, allows her to “spend that time with the patient, answering her questions,” helping her to understand and feel comfortable with the process.

In film mammography, the mammographer chooses a focus point at the most important part of the breast, which Russ terms “the optimal density.” This can cause the portion of the breast nearest the chest wall to be underexposed and nearest the nipple to be over exposed, she said. In digital imaging, the digital plate is made of a computer grid, and each small square of that grid receives proper exposure for that particular portion of the breast. This is particularly important, she explained, at the front skin line, which often appears “burned out” in a film image.

A clear image of this skin line is essential in the diagnosis of Paget’s Disease of the breast, a very aggressive, very deadly form of breast cancer. Its characteristic surface swelling of the skin is often misdiagnosed as Mastitis, said Russ, which is an inflammation of the breast. Early diagnosis is especially important in Paget’s Disease because it is so fast growing and so lethal. In addition, it tends to occur more in younger women.

Digital mammography is especially good at penetrating dense breast tissue and breasts with implants. Also, the image quality is much higher—“it’s crisp, clean, beautiful,” said Russ—so, problems can be diagnosed more quickly and precisely. And, it’s better able to distinguish between different types of breast tissue—from fibrous to glandular to fatty tissue.

The detail allowed by digital makes it easier to assess calcifications, as well. Many of these are benign, but small cluster calcifications can indicate the earliest stages of the breast cancer Ductal Carcinoma In Situ. This is one of the most common cancers and it’s non-invasive—confined to the milk duct of the breast. It doesn’t form a lump that can be felt, however; 80% of cases are found by mammograms. Because it’s discovered before it has spread, the prognosis for this form of cancer is excellent. “That’s when we want to catch [it] before it has invaded anything. That’s when it really saves lives.” Russ cautioned women that “just because the doctor says it’s calcification doesn’t mean it’s cancer,” however.

She added that EPHC works with radiologists at North Star Imaging in Reno, who read the image and determine if further images need to be taken. Digital images can be transferred almost immediately, meaning results can be relayed to patients much more quickly, as well.

A further advantage of digital mammography is that it reduces the already small amount of radiation emitted in film mammography by another 30 – 50 percent. It also affords a higher level of comfort. Newly trained digital mammographer, EPHC’s Nicole Sheldon, emphasized that patients need to understand it’s still just as vital to compress the breast to get a quality image. But, she added that the breast doesn’t need to be compressed for as long. As soon as the button is pressed and the image taken, the compression paddle automatically lifts away from the patient. The whole process takes about 20 seconds, said Sheldon.

In addition, said Russ, the new paddle design slopes with the breast, which “allows for overall compression with less pinching at the chest wall.” EPHC is also experimenting with new “mammo pads,” which cushion the breast and make the whole experience more comfortable. “We don’t want anyone to turn away because they had a bad experience in the past,” she said.

Plumas County hospitals routinely offer low cost mammography specials during October, Breast Cancer Awareness Month. Eastern Plumas Health Care is celebrating the arrival of its new digital mammography system with a special during the month of July, as well. And, under the Affordable Care Act, Medicare patients can now have very low or no cost mammograms as part of their Welcome to Medicare and yearly prevention exams.* Now, there’s no excuse for women not to get their potentially lifesaving breast screenings.

*Your health care provider will help you determine when you qualify for your Medicare mammogram during your Welcome or annual exam.