Annual mammograms starting at the age of 40 may do more harm than good for many women, say some health advisors. They recommend that women delay the age at which they conduct their mammogram screening to 50 to avoid the side effects that mammograms may create

By Ola El Soueni

laboratory with mammography machine

Heba El Kassas has an MD in Radiodiagnosis and is currently doing a Fellowship at The Royal College of Radiologists. She graduated from Kasr Al-Ainy medical school in 2004, and started working at the National Cancer Institute, Radiodiagnosis department, specifically in the Breast Imaging section, at Cairo University. El Kassas obtained her Masters Degree in March 2011, followed by an MD degree in Radiodiagnosis and Interventional Radiology.

She performs mammograms and ultrasounds specifically for patients who are at high risk of breast cancer. In addition, she deals with symptomatic patients, such as those presenting with a lump, as well as those who are already diagnosed with breast cancer and are following up either after surgery or after their course of chemotherapy. El Kasssas is also a consultant at Baheya Breast Screening Hospital.

Community Times held an interview with Dr. Heba El Kassas to discuss the early mammogram controversy.

What inspired you to become a doctor and specifically in this field?

Actually, my inspiration to become a doctor came from my dad. As a child, I always saw him suffering from eye problems and that’s when I decided I should be a doctor to treat him! I ended up having a great passion for women’s well care too, and I decided to specialize in women’s imaging. Through my experience in Kasr El-Ainy, and dealing with women from different backgrounds, especially those who struggle financially, I came to realize how these women are helpless, selfless, lead very simple lives, and would willingly sacrifice their own well being for their families.

With the latest controversial debates on mammograms–where advice is given to postpone scanning as long as one can– What do you recommend?

I strongly believe in the importance of screening, and that each and every woman should have a mammogram done after the age of 40– with exception of those who have a first-degree family member diagnosed with breast cancer at an early age. In their case, they should start their screening mammograms 10 years earlier than the age of their relative, who was diagnosed with cancer.

I am not for the new recommendations about delaying the mammogram after the age of 50. In Egypt, a very big proportion of breast cancer does manifest before. Unfortunately, I see many patients in their mid thirties with breast cancer. By delaying the screening mammogram, it’s very likely that cancer advances to a delayed stage. Detecting cancer at a T1 stage is the whole point of screening for early detection because it has a 100% cure rate.

What are the specific scans with which women can detect breast cancer?

The most important scan remains to be the full field mammogram that is the most accurate in the majority of cases to detect cancer in a symptomatic patient. If we want to know its exact extent and presence of other lesions, then we might need to proceed to further studies like MRI or contrast enhanced mammograms. For other cases, we might need to perform a contrast-enhance mammography; this is like using a dye to enhance any suspicious lesions.

What’s the difference between an ultrasound and a mammogram?

They actually compliment each other. A mammogram usually shows a density, which is like a white patch on the film and from its shape and margin, we can tell if it’s benign or malignant. On the other hand, an ultrasound gives more info about this density,

whether it’s a cyst (a small collection of water) or a solid lesion. It is recommended that ultrasounds be used for younger women, as their dense breasts will hinder the mammographic sensitivity. Also, mammograms are better at detecting micro-calcifictations, which raise the doubt about the presence of a suspicious lesion.

A standard digital mammogram, left, compared to a 3-D tomosynthesis mammogram, right.
A standard digital mammogram, left, compared to a 3-D tomosynthesis mammogram, right.

How can women carry out breast self-examinations (BSE) at home?

The breast self-examination (BSE) process has 3-4 steps. The first step is to look at yourself in the mirror with both arms resting by your thighs and check for any difference in size or skin changes like dimpling (orange skin). Then raise your arms above your head and check for any fluid coming out from the nipples or any protruding lumps. After that, you lie down and examine your breasts using your hands; use the right hand to examine the left breast and vice versa. Do circular motions using your finger pads, and remember there is nothing too small or insignificant, if you have any doubts, you must have it checked.

Women should start carrying out their BSE at the age of 20. BSEs should be performed once a month after your menstrual period, when breasts aren’t tender or swollen. If you’re not always regular, do it on the same day every month.

Is it true that women who nurse their children are at a lower risk of developing breast cancer?

Yes. Many studies have established this correlation. It is mainly based on the fact that most women have fewer menstrual cycles when they’re breastfeeding, which means lower estrogen levels, which are a contributing factor for breast cancer development. In addition, many women tend to eat more nutritious food and healthier lifestyle choices (avoiding alcohol and not smoking), while they’re breastfeeding.

What are the most common treatments for breast cancer?

Each case will be tailored differently. Sometimes we need to do a radical mastectomy, which is the removal of the entire breast or sometimes the cancer is so localized that we can give chemotherapy before surgery then perform a conservative operation, where only a part of the breast is removed. What are the recommendations that every woman should follow to preserve her well-being? The list of things that should be done can go on forever; however, I believe that indulging in self-love is one of the most important acts. In other words don’t stress yourself out! Adopting a healthy lifestyle by eating nutritious food and working out is crucially important. It has been established now that there is a strong correlation between the consumption of sugar and growth of cancer cells.