Routine Gynecologic Care

Breast cancer screening, including mammograms and breast exams with a gynecologist, is an essential part of good healthcare for adults of all backgrounds. However, not everyone attends their regular screenings as recommended by their doctor.

Many factors influence whether someone can undergo regular screening, from financial opportunity to awareness of mammography services in their area.

When an individual cannot access the cancer screening they need, they face an increased risk of more severe types of cancer due to the failure to detect precancerous development early.

This can result in poorer long-term outcomes, greater financial costs, and other negative consequences. If you are facing barriers to breast cancer screening, there are options to help you get the testing you need.

The Problem: Healthcare Coverage

The Affordable Care Act mandated that mammography screening be included with no co-payment; however, not everyone has health insurance.

Data indicate that less than 50% of those who did not have health insurance had a screening mammogram done within the previous two years. This number was slightly higher for those with private health insurance at 80%, but many patients are still not being screened.

The Solution

Patients who lack healthcare coverage have multiple options. The ACA may provide one alternative: subsidies for low-income individuals could cover the cost of nominal health insurance, either in part or in full. Alternatively, some individuals or families may qualify for Medicaid, which typically covers one mammogram per year for those over the age of 40.

The Problem: Awareness

Even among those who have insurance, many do not get regular breast cancer screening because they are not aware of its importance or what role it can play in their health.

Some may assume that breast cancer will show symptoms and that they do not need to worry before then; others (especially men or those with small breasts) may believe that breast cancer is not really a risk for them.

Those who know about breast cancer and the options for screening for it may still lack awareness of local resources that can help.

The Solution

Increasing education for all patients is the first step toward greater awareness of the importance of screening. From quick notes from a primary care doctor to informational pamphlets available at pharmacies, many resources may be available to help people better understand the need for breast cancer screening.

The Problem: Access

Some patients may have the knowledge to understand why screening is important, and it may even be covered by their insurance—but without proper access to screening facilities, these elements do not matter. A person who cannot find public transportation to a clinic or does not have enough sick leave from work might not be able to access screening services, even if they want to.

The Solution

Patients having trouble getting to a screening center might benefit from contacting volunteer organizations in their community. Churches, cancer treatment volunteer groups, and others may be able to provide temporary transportation for those who do not have another option.

In some cases coordinating your mammogram appointment with your routine doctor visit can reduce time away from work and transportation costs. As another line of defense, patients can learn how to do breast self-exams at home.

The Problem: Cultural Differences

America is a melting pot, with an increasing number of residents identifying as belonging to more than one culture. When these other cultures are at odds with how the American medical system conducts screenings, patients may not receive the necessary services.

The most common challenge is language barriers. Patients may not receive helpful education or understand their doctor’s recommendations if they do not share a connection via language—and in some cases, patients struggle to make an appointment at all. In other instances, cultural or religious pressures could prevent patients from seeking medical care from certain providers or offices.

The Solution

Utilize state-provided translation services that are available at many doctors’ offices or research volunteer or non-profit organizations that can provide translation.

Choose medical offices with friendly staff who demonstrate a commitment to patient comfort, including making important information available in a way that makes sense for patients.

Offices with online portals can be beneficial, as they allow patients to review documents in their own time and with the assistance of translation services, knowledgeable family members, and more.

Get Your Breast Cancer Screening as Scheduled to Protect Your Health

Breast cancer screening is an essential service, but many patients do not receive it due to factors ranging from cultural differences to lack of access to being unaware.

Both patients and doctor’s offices can work together to bridge these gaps and make cancer screening accessible for everyone.

The team at Raleigh Gynecology and Wellness champions patient comfort, and we truly strive to get to know all of our patients so that we can communicate with them clearly and completely. Contact Raleigh Gynecology and Wellness to schedule your breast cancer screening.

Breast cancer is one of the leading causes of cancer death among women (second only to lung cancer). Most women assume that getting cancer comes down to random chance stemming from genetics and environment, but did you know that you can take active steps to reduce your risk of breast cancer? Your breast health is at least partially within your control.

Physical activity has been correlated with a reduction in breast cancer risk. In other words, people who are more active tend to have lower rates of breast cancer than those who are less active. The even better news is that you do not have to be an Olympic athlete dedicating your entire day to working out to see the benefits.

How Physical Activity Reduces Breast Cancer Risk

Reducing the risk of breast cancer through increased physical exercise occurs from a multifaceted set of biological mechanisms. The main ways that a person’s body can become more resistant to cancer through regular exercise are:

Weight

When a person is overweight or obese, they are doing more than just putting extra strain on their joints. Their fat cells can prompt the body to produce excess growth hormone—a chemical responsible for telling cells to divide more frequently. Because an individual’s breast tissue cells replace themselves more often, they are at an increased risk of cancer from an erroneous cell division.

Blood Estrogen

Similar to the issue with excessive growth hormone, fat tissue arising from lack of exercise produces estrogen, which leads to more free estrogen in the blood.

As a feminizing hormone, estrogen also contributes to breast cell proliferation, which can be a cancer driver by itself. However, more recent studies are also finding that estrogen changes how those cells repair their own DNA—and if they do so incorrectly, these faulty cells can become cancerous. More estrogen from more fat and less exercise increases this chance.

Immune Response

The body has many pathways that carry blood, nerve signals, and more. One system that people tend to forget about is the lymphatic system, which carries lymph.

Lymph houses white blood cells, antibodies, T cells, and other important immune defenders. When a person exercises, their exertion helps to facilitate the movement of lymph throughout the body, circulating more immune cells and boosting the immune system.

As a result, people who exercise more often expose potentially cancerous cells to more immune defenders. This can allow their immune system to more effectively attack and destroy pre-cancerous cells, potentially slowing or even stopping their growth in the early stages.

How Much Exercise Is Enough?

Everyone knows that they should get exercise, but it can be daunting to feel that you must dedicate hours each day to working out. In reality, breast cancer risk reduction can be achieved with just a few small changes to a person’s everyday routine. Make sure that you get at least 2.5 hours of moderate activity every week, and aim for at least an hour and a half of vigorous activity, too.

Exercise does not need to happen all at once! It is all right to spread it over the course of the week. This makes getting active more accessible for people with busy schedules and other responsibilities.

Tips to Improve Activity

You may already be getting moderate exercise without realizing it! When aiming for your 2.5 hours of moderate activity, try exercises such as:

• Walking at a brisk pace
• Mowing the lawn with a push mower
• Lifting weights
• Riding a bike to work or to run errands
• Gardening
• Washing the car
• Walking up and down stairs

Vigorous exercise takes a little more intentionality—usually necessitating a chunk of the day carved out for it. But even 20 minutes per day is enough! Vigorous exercises can include:

• Jogging
• Swimming laps
• Spinning
• Aerobics
• Martial arts
• Dancing
• Competitive sports

The best way to incorporate more exercise into your life is to find activities you enjoy. If you have a dog, consider using your morning walk as a brisk, moderately-paced activity, then during the evening walk, alternate between walking and short sprints. You will boost your heart rate into the vigorous zone, and your pet will have a great time!

Get Checked for Breast Cancer Regularly

Physical activity is one piece of the breast cancer prevention puzzle. Alongside at-home self-exams, eating healthy, and understanding your genetic history, stopping breast cancer requires being proactive. Be sure to get checked for breast cancer regularly by your gynecologist.

They can examine your breast tissue and teach you what is normal, how to do self-exams, and more. Contact Raleigh Gynecology & Wellness to schedule your breast exam if you are due!

Mammograms are an essential part of healthcare for women and individuals of any gender who are experiencing abnormalities in the breast tissue, have a family history of breast cancer, or have been born with the BRCA gene that increases the risk of breast cancer. However, getting the test results may leave patients with questions, as mammography reports are not always written in terms meant for non-medical professionals to understand.

Despite this, mammography reports all use the same layout and numerical system—so by having knowledge of BI-RADS, the Breast Imaging Reporting and Data System, patients can read their mammogram results and take a more active role in their own healthcare.

Here is what patients need to know.

What Is Included in a Mammogram Report?

Your doctor may have recommended a mammogram to check on a specific issue, or it may simply have been time for a routine mammogram to detect early changes associated with breast cancer. Regardless of the reason, the test itself will typically evaluate the same criteria:

• The composition of the breast (how much fat vs fibrous tissue))
• The position and size of any identified masses (relative to the location of the nipple)
• The location of any calcium deposits inside the breast tissue
• The level of asymmetry between the two breasts
• General features of the breast (nipple size, skin thickness)

Once this information is collected, the report will be synthesized using the BI-RADS scale. This numerical system ranks potential abnormalities and other areas of concern, providing a value that dictates what steps should be taken next.

Interpreting the BI-RADS Scale

The BI-RADS scale is a six-point system; it begins at zero and ends at six, and all results from the mammogram will be sorted into these categories. Patients can look at their BI-RADS score to understand the mammogram’s findings.

Category 0

A mammogram classed as zero on the BI-RADS scale is incomplete or part of a series. Occasionally, mammography can produce unclear results (such as if the patient moves during the exam) or the radiologist may detect a new breast mass or other changes that need further assessment.

The medical team may want to take additional images to obtain different views or to compare them to prior results. In these cases, the mammogram cannot stand alone as a diagnostic tool, so it receives a score of zero. The patient should return to the office for additional imaging.

Category 1

Patients whose mammogram results have been assigned a BI-RADS value of one have a negative test. In other words, the doctors could not find any abnormalities or areas of concern. This is good news, but continue to get mammograms regularly to identify issues while they are still minor.

Category 2

If breast tissue is categorized as BI-RADS two, the result is negative, but doctors may have described elements of the breast that were non-cancerous. For instance, if an individual has a harmless cyst in one breast, their BI-RADS result would be a two; this is normal and is no cause for concern.

Category 3

Sometimes, a doctor may find abnormal tissue, but there is only a slight chance it is cancerous. This is a typical category three case. Patients in category three should return in six months for another mammogram to see if the area has changed.

Category 4a, 4b, 4c

Patients assigned a BI-RADS four have mammogram results that are suspicious of cancer. The subcategories (a, b, and c) indicate how likely the tissue is to be cancerous (2-10%, 10-50%, and 50-95%, respectively). A breast biopsy is recommended to sample the tissue and determine next steps.

Category 5

A BI-RADS score of five indicates that the imaged tissue is at least 95% likely to be cancerous. The doctor will do a biopsy to identify the cancer cells (if present) and begin creating a treatment strategy.

Category 6

Some patients are aware that they have breast cancer and continue to receive mammograms, either to check on the efficacy of treatment or to see whether the cells are growing in new locations.

The BI-RADS category six exists to describe these patients and is only used in cases of existing breast cancer diagnoses.

Maintain Breast Health Through Regular Gynecological Care

Getting regular mammograms is one of the most important decisions patients can make when investing in good long-term health. Breast cancer is often highly treatable if it is caught in its earliest stages, and mammograms provide useful imaging to identify problematic tissue in its infancy.

The professional team at Raleigh Gynecology & Wellness is always eager to educate our patients on the importance of mammograms and how to interpret their results. Contact Raleigh Gynecology & Wellness to schedule your mammogram!

Breast cancer is one of the leading causes of female mortality, though it can affect anyone with breast tissue. One of the most essential elements of preventing breast cancer development is catching potentially cancerous growth early when it is at its most treatable. Mammography is one option for doing so, though many women also choose to do self-exams.

While both are pivotal in health care, mammography and breast self-exams serve different functions. If you have not been doing self-exams, the best time to start is now! And if you are overdue for a mammogram, take some time out of your day to schedule one today.

Do You Need a Mammogram If You Do Self-Exams?

Many people mistakenly believe that self-exams are simply a replacement for getting a mammogram. However, patients should be sure to take the time to do both.

A self-exam provides the first line of defense, allowing patients to notice potential changes to their breast tissue between doctor’s appointments.

However, mammography can visualize areas of the breast that patients cannot feel, providing a more thorough view of the breast tissue.

Thus, mammography and self-exams are not two separate strategies; they work best when used together to create the most complete picture of breast health.

What You Can Identify

Both self-exams and mammograms can help to identify potentially cancerous growth in the breast tissue, but each offers individual advantages.

With a self-exam

A breast self-exam is useful because it is simple, time-efficient, and repeatable as often as the patient desires. Many people choose to perform a quick self-exam when taking a shower or before going to sleep while lying in bed.

Self-exams allow individuals to become familiar with the typical state of their breast tissue, equipping them with the knowledge and experience to quickly identify when something has changed.

With a mammogram

A mammogram is a more intensive process that requires an office visit to visualize the breast tissue with a special machine. It can provide a picture of the entire breast, including areas that are difficult to access or too deep for manual exams to reach.

Thus, a mammogram creates a thorough image that can identify potentially cancerous growths that are too small or too remote to be felt immediately. This type of imaging can also find other problems, such as cysts that may be causing discomfort.

How to Perform a Self-Exam the Right Way

Performing a breast self-exam is simple! Starting from the nipple, gently use the pads of your fingers to push into the tissue in a straight line up toward the collarbone.

Imagine the breast as a clock and start with 12. Then, once you have completed one line, move on to 1, and then 2, and so forth until you have thoroughly examined the breast tissue in all directions.

Throughout this process, it can be helpful to repeat a line at varying pressures; start with a light touch, then do the same motion again with a heavier press. This helps to palpate surface-level and deeper tissue, allowing you to identify more potential areas of concern if they are hidden far below the skin.

Preparing for a Mammogram

Breast self-exams are a useful way to keep track of breast health at home. Still, patients should also schedule mammograms regularly—especially if they have a family history of breast cancer, a genetic predisposition, or are over the age of 40.

Getting ready for a mammogram does not require in-depth preparation; there are only a few things to keep in mind.

• Compile a list of all the medications you are taking and the results of any previous mammograms to bring with you.
• The technician will ask you to remove your top, so wear clothing that is simple and easy to take off.
• Do not wear lotion, deodorant, or any other substance applied to the skin of the torso and underarm areas, as this can appear in mammogram imaging and interfere with results.
• Try to schedule the appointment for a time when the breasts will not be tender; the two weeks after a menstrual cycle are often ideal.

Get Regular Mammograms to Preserve Your Health

Both mammograms and breast self-exams have important roles to play in a person’s overall health in the long term, and doing one does not mean that you can skip the other. If you are overdue for a mammogram, or if you have noticed something that you want to check up on, be sure to schedule as soon as possible.

Contact Raleigh Gynecology & Wellness to set up your mammogram appointment and invest in good breast health alongside your regular at-home self-exams.

Mammograms are pivotal in early breast cancer detection, which significantly improves treatment success rates. But confusion often surrounds screening guidelines concerning when to start mammograms, how frequently to get them, and what technologies serve you best.

Read on for expert recommendations so you can monitor your breast health at optimal intervals.

What Is a Mammogram?

A mammogram is a low-energy X-ray scan that allows radiologists to examine breast tissue for abnormalities that could indicate cancer. Specialized mammography machines take images from two angles of each breast, which technicians carefully compress to even out layers during imaging.

Standard 2D mammography produces two-dimensional pictures. On the other hand, 3D breast tomosynthesis, also called 3D mammography, uses multiple X-rays at various angles to reconstruct detailed, layered images showing fine gradations of tissue density. This improves early tumor detection and reduces false positive recall rates of patients for further testing.

When to Start Getting Mammograms

Most major medical organizations, including the American Cancer Society (ACS), now advise starting yearly mammogram screening at age 40 for women at average risk of breast cancer.

Previously, guidance suggested waiting until age 50. However, statistical data on modern cancer trends show that beginning annual monitoring in a patient’s 40s finds more early-stage tumors and saves more lives.

The ACS does leave the choice open for women 40-44 years old to start screening anytime during that decade. Waiting gives you a few more years before accumulating radiation exposure. However, beginning mammograms immediately at 40 provides maximum protection against aggressive cancers.

Essentially, it’s a choice between accumulating a small degree of radiation exposure and potentially discovering you have a serious disease when it’s progressed to a serious degree.

Ideally, you should talk to your gynecologist about whether to start at 40 or closer to 45 based on your risk factors.

How Often to Get Screened

For women 45 years and older, authoritative groups such as the ACS and American College of Radiology recommend continuing yearly mammogram screening.

Evidence clearly shows that finding cancers at the earliest stages reduces mortality rates compared to cases where larger tumors that have already spread to lymph nodes are detected, which is why staying vigilant and getting screened annually is essential.

At age 55, guidelines say healthy women without risk factors for breast cancer can optionally switch to biennial screenings every two years instead of annually.

While most breast cancer patients are 50 years or older, when it does occur in younger patients, it tends to be more aggressive, indicating that tumors may grow more slowly in older patients.

So, longer intervals may still catch cancers in time for favorable treatment while cutting radiation exposure and false positive recalls.

High-Risk Groups Need Earlier and More Frequent Monitoring

Women with elevated breast cancer risk due to genetic mutations, strong family history, or previous chest radiation should start yearly mammograms as early as age 30.

They might need supplementary annual breast MRI scanning as well. Talk to your physician about whether you meet high-risk criteria warranting earlier and more intensive surveillance.

Knowing When to Stop Mammogram Screenings

At a certain point, screening is no longer advised for elderly women or those with serious health conditions. When life expectancy falls below 10 years due to age or illness, the benefits of finding slower-growing cancers no longer outweigh the potential downsides of over-testing or overtreatment. Discuss with your doctor an appropriate age for you to stop mammogram screenings.

Spotlight on Breast Density

Breast density is a risk factor that plays an increasingly prominent role in customized screening protocols. Breasts contain varying proportions of fibroglandular tissue versus fatty tissue, with dense breasts having a higher amount of the former versus the latter.

Why does density matter? Dense breasts demonstrate higher cancer risk while also making tumors more challenging to spot on mammograms.

Cancerous cells often start multiplying within gland tissue. Substantial densities hide small lesions that would stand out clearly against largely fatty backgrounds.

Radiologists grade breast density into four categories when reading mammograms. Those with heterogeneously or extremely dense classifications may qualify for supplemental ultrasound or breast MRI screening.

However, density can change over time, so each new mammogram report should be checked. Discuss options with your gynecologist if your last mammogram showed dense breasts.

What About Breast Self-Awareness?

What about breast self-exams? Performing regular structured self-checks following precise palpation patterns lacks solid proof for boosting early cancer detection.

Tumors often grow too deep or subtly to feel. And there’s no apparent connection between an improvement in mortality rates when self-exams are done in addition to mammogram screening.

However, it’s smart to stay generally self-aware by noticing skin changes or new lumps between mammograms. If you feel anything unusual as you go about normal activities, report it promptly without waiting for your next scheduled mammogram.

A Look at Mammogram Limitations and Downsides

While extremely useful for early detection, mammograms cannot prevent tumors from initially forming. They also cannot diagnose all breast diseases.

Mammograms occasionally miss fast-growing cancers or those that spread using pathways that aren’t easily seen, such as lymphatics. And overdiagnosis represents a downside risk when testing finds non-threatening oddities that may never have impacted your health.

Partner With Raleigh Gynecology & Wellness for Evidence-Based Breast Wellness Care

Remaining up to date on mammography based on the latest medical guidance is among the most meaningful health investments you can make. Raleigh Gynecology & Wellness provides compassionate counseling on the appropriate timelines for your individual risk profile.

Contact us today at (919) 636-6670 or online to discuss keeping your breasts safe, whether through 2D or advanced 3D mammography personalized to your needs.