Dr. Olga Mengin, a radiologist and medical director of breast imaging at UCHealth Memorial Hospital, is passionate about mammography, a screening tool that can help detect cancer earlier, giving patients a higher chance of successful treatment and living longer.
Mengin is also passionate about letting patients know that they should not replace mammography with thermography, which uses infrared technology that provides a surface temperature of the skin.
While thermography is sometimes marketed as a screening tool for breast cancer, it is not, Mengin said.
“It is not FDA-approved as a screening tool for breast cancer,’’ Mengin said.
UCHealth Today sat down with Mengin, who completed a fellowship in breast radiology from Harvard Medical School, to talk about thermography and mammography, and the importance of having a mammogram annually.
What is thermography?
It is essentially an infrared image of the body, so it gives you the surface temperature of the skin. For breast tissue, not all cancers are just under the surface of the skin. In fact, many cancers are in the deeper tissue. Just under the surface, we have our subcutaneous fat, which is a layer of tissue where we typically do not see breast cancer. We need to get into the fibril glandular tissue to see a malignancy.
What does the U.S. Food and Drug Administration (FDA) say about thermography?
The FDA has approved thermography as an adjunct to mammography.
“In other words, it can be used because it does not cause any harm. However, it is not FDA-approved as a screening tool for breast cancer,’’ Mengin said.
“Thermography is not particularly helpful. In fact, it has no studies to support it as a way to identify breast cancer. It has been a problem for some patients because it has been presented by the companies that do it as a screening tool and it has been confusing for patients.’’
Why do patients consider thermography if it is not a screening tool for breast cancer?
Patients like the idea that it is a whole-body scan — that it seems holistic. However, the FDA has put out a warning because it is so misleading. The FDA actually has a warning against thermography because it has been presented as a screening tool when, in fact, it is not.
It does not have data to support its use for screening in any way. There are no studies to support it, so we do not recommend it.
What is the technology used in thermography also used for?
It is very similar to what is used in airports. The technology is used in airports to ensure a passenger doesn’t have a fever when they board an airplane. It’s the same technology. They can do an overall thermal scan of the body. So, it is identical.
Women consider thermography because they see it as holistic, and it doesn’t compress their tissue. Some women don’t like to have their tissue compressed because it can be sensitive, it can be painful, and some women are afraid of the radiation that a mammogram has.
How much radiation is in a mammogram?
Mammograms and X-rays are some of the lowest radiation studies that we do. In fact, it is so little that it is a lot less than the normal background radiation that you get over a year living anywhere.
In Colorado, we actually get more radiation because we are living at high altitude. There’s more radon exposure, so a mammogram is essentially a drop in the bucket. I like to tell patients it is all about risks and benefits. You have radiation exposure all throughout your life and you get very little radiation from a mammogram, but the benefit of a mammogram is enormous.
You get all this immense benefit from screening, of early detection, and having a cancer diagnosed when it is small, and you take this teeny-tiny risk of a minimal amount of radiation. And, in fact, these tiny amounts of radiation are negligible in terms of how they affect us, because we are continually exposed to them and the amount that you get from a mammogram is small.
The radiation, Mengin said, is so minimal that we encourage pregnant women to have mammograms and it used to be that there used to be no screening if a woman was pregnant, but they did all of the research and the amount of radiation that goes to the baby in the belly is negligible, there’s no impact.
What percentage of women will get breast cancer?
Breast cancer is the most commonly diagnosed cancer in women. One out of 8 women, or 13%, will be diagnosed with breast cancer during her lifetime.
Is there usually a family history for women who are diagnosed?
Many women ask us if family history is important in the diagnosis of breast cancer. In fact, most women who are diagnosed with breast cancer do not have a family history. The ratio is about three out of every four women diagnosed with breast cancer will have no family history. That is why we call breast cancer a spontaneous cancer. We would love to know what causes it, but in most cases, it is not genetic, and it is not because of family history.
When should women get a mammogram done?
The recommendation for most women is to start screening mammography at age 40 and to do it every year. If a patient has a known family history, or a known genetic risk factor, then we would want to potentially start screening before that. But in terms of our general population with no family history or no genetic risk factors, we would like to begin screening by age 40 and do it every year.
Katie Couric was in the news recently. Does that help raise awareness for screening?
Whenever we have a celebrity who brings a personal story that people can associate with, it is wonderful because it brings an awareness and I think it also helps people become more comfortable with the process. It makes it easier for people to talk about it. And that is a good thing, things are less taboo, there’s less of a stigma, when people can talk about them.
When you have someone who brings a personal story for what they went through, and making it relatable, that’s a wonderful thing. I am extremely grateful for her to share her extremely personal story, this extremely traumatic event that she went through, and sharing it with everyone because we all benefit from it. … I’m sure there are women out there getting screening mammograms because of her story.
Why is it more difficult to detect a tumor in women who have dense breast tissue?
Breast density has always been discussed in our mammograms because it affects our ability to read a mammogram. And the reason for that is, if your tissue is not dense, we can see gaps through that breast tissue. … We can see a very small cancer within that breast tissue because there’s lots of gaps in between it. Whereas, if tissue is dense, a small breast cancer can hide in dense tissue. Dense tissue has a masking effect; you don’t have enough gaps in the tissue to be able to see a small mass forming. When we see dense breast tissue, we want to do something extra. One of the extra things that we do are 3D mammograms. Those make an enormous difference in our ability to diagnose cancer. That 3D mammogram is beneficial for all women, not just women with dense breast tissue. All women are recommended to have 3D mammograms, or what is recognized as Tomosynthesis.
Is breast cancer the No. 1 killer among women?
Even though breast cancer is the most commonly diagnosed cancer in women, it is not the No. 1 killer. The No. 1 killer is lung cancer in terms of cancer mortality. And the reason for that is breast cancer, especially when caught early, is treatable. The whole reason we are doing screening is to catch cancer early. We want to catch cancer when it is treatable, when it requires smaller surgeries, less radiation, less chemotherapy and the treatment is much more manageable. We want to give women as many years of life as we can. We actually talk about the success of a screening modality in terms of how many years life do we save? So that is what we’re looking to do, we want to give many years of life and quality of life. And that is why we screen for breast cancer.
What do you recommend for women who have breast implants?
We recommend 3D mammography.
What is the Colorado Breast Density Notification law?
There are now 38 states that have created a dense breast notification law of some sort. Colorado’s law is unique in that is says we have to provide notification to any woman about her dense breast tissue. If a woman has dense breast tissue, we will need to send her a letter with notification that she has dense breast tissue and what that means in layman’s terms. Some states have a more expansive law; some states actually require insurance coverage for additional screening. Colorado does not have that.
Is there a big cost difference between 3D mammography and regular mammography?
We do encourage people to get a 3-D mammogram because the cost of it is very similar to a regular mammogram. And most insurance companies, with very few exceptions, cover the 3D mammogram because it is the superior mammogram.
White women are diagnosed at higher rates, and Black women are more likely to have bad outcomes. Why is that?
Health care disparity has been a topic of discussion in recent years because so many studies have been done on just part of our population. Recent studies have shown that Black women in particular, have lower rates of breast cancer than white women. And the likelihood that Black women will die from breast cancer is higher.
There are a number of reasons why that is the case. One of them is that we feel we are not doing as good of a job as we can at screening these women. Diagnosis is happening later. Another reason is that Black women are more likely to have what is called triple negative breast cancer. This is a more aggressive type of breast cancer so because of these reasons, though a Black woman has a lower likelihood of having breast cancer, she is more likely to die from it.
When should a Black woman be evaluated for the risk of breast cancer?
The new recommendations are for all Black women to have a formal risk assessment by the time they are 30. There are other groups that this is recommended for, including women who have Ashkenazi Jewish ancestry. They are also recommended to have a risk assessment earlier because of genetic risk factors.
With these populations, we recommend a risk assessment, which means: Let’s talk about your family history, let’s talk about your risk factors, and let’s talk about when you should start screening. The recommendation for them is to also start screening by age 40 unless they have these risk factors.
Black women are also slightly more likely that white women to have breast cancer in their 40s. So they are having cancer earlier and a more aggressive form of breast cancer, so it is especially important for women to start screening by age 40 and doing it every year.
What’s the role of genetic testing?
Genetic testing plays a role in risk assessment, but it is not the full picture. We don’t know everything there is to know about genetics, so we have this short list of genes that we know are associated with higher lifetime risks of breast cancer, but they don’t cover the spectrum. We might have a woman who tested negative for all the known strains of genes that cause breast cancer, but when we look at her family history, she has a lot of known relatives, either on the maternal side or the paternal side, who have breast cancer. Then we are talking about a family history in terms of risk for breast cancer even though all of her genetics were negative. Both play a role.
About 5% to 10% of women who have been diagnosed with breast cancer will have some kind of genetic factor.
What if a woman is scared to get a mammogram?
It is extremely common for women to be hesitant, and many studies have been done on it. Stress about a mammogram is extremely common, and we just have to look at it as the big picture. Is it stressful to go into a medical clinic? Yes, we all know that. None of us like to go into that because we don’t know what we might learn. We are worried that it might hurt. So, I recommend to women, just try to relax as much as you can. We have wonderful mammogram techs here, they are as gentle as they can be, but they also want to get great images. They will do as much as they can, and as much as you can tolerate, but it is extremely important to compress the breast because we get better images.
What can patients expect after a mammogram?
There’s the stress of, ‘what’s next? I got through my mammogram, what if I get called back?’ We try to tell everyone that one in 10 women are going to get called back because not all women’s breasts look the same. Sometimes, we have a unique pattern, and we can’t see something as much as we would like.
One out of 10 women are going to get called back for the mammogram. Once we get extra images and possibly an ultrasound, the majority of those women are done. Just a small percentage of those women are going to even need a biopsy. But even that, the biopsies are mostly benign. So, even a small number of women who need a biopsy will actually be diagnosed with breast cancer.
The whole point of diagnosing that breast cancer is to catch it early. Early means treatable. I like to tell people that in the grand scheme of your life, it’s like going over a speed bump. It’s not fun to go over a speed bump, you don’t want to slow down, you don’t want to jolt everyone. But, in the long run, when you look back at that speed bump, that’s what it is – a speed bump. You want people to go on with their life, live a long and healthy life, enjoy their children, their grandchildren, their great-grandchildren, and when you think of it that way, one little mammogram is absolutely worth it.
What if breast cancer is diagnosed?
The big C – the word cancer – makes people feel like they’re on a cliff, but they are not because we have a whole wonderful oncology team that helps them realize that there are actually bridges across that cliff to the other side. Cancer is a scary word but it is treatable when it is caught early.
Breast cancer is one of the few cancers that we screen for. Most cancers, we don’t screen for because there is no effective screening tool. With breast cancer, we have one. An early diagnosis can be made and it makes an enormous difference.
So not only can we screen for breast cancer, but we can change outcomes with an early diagnosis. That’s phenomenal. There’s not that many cancers that we can do that with – we can change things by screening and that’s why we do it.
How important is it to do routine self-breast exams?
It is so important. Think about it, you are coming in for a mammogram once a year, and nothing is perfect, and a mammogram is not perfect either, especially when you have dense breast tissue. You will find superficial things but if you are used to doing your breast exam, you will also be used to all of your own little lumps and bumps. I can’t tell you how many women who have had come in who feel their own cancer. It is an extremely important thing to do, and we recommend that women do this once a month.
If it is a woman who is menstruating, the best time to do it is at the end of the menstrual cycle. That’s when the breast tissue is what I like to call the calmest. It’s the least hormonally active, so your breast tissue is going to be the most uniform, and you are most likely to feel something worrisome – if it is there, rather than be obscured by all of this hormonally active glandular tissue. I recommend doing that breast exam right after the end of your period, you can even do it on the last day if that is easier, or the first day after it stops.
Post-menopausal women can pick a day: It can be the first of the month, the 15th of the month and just do it every month like clockwork. Cancer can develop in a breast in between that annual mammogram cycle, or if you have dense breast tissue, it might be so small at the time of screening that it will become just large enough for you to feel it sometime during the year.